We determined the effect of varying ventilator tidal volume (VT) and inspiratory flow (V) on the inspiratory muscle work (WI) during assist-mode mechanical ventilation (AMV) in four healthy subjects. In another four subjects, under constant chemoreceptor input, we determined the responses of neuromuscular output as assessed by the mouth occlusion pressure (P0.1) to alteration in WI. During AMV,...

because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiratio...

STUDY OBJECTIVES To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system. SETTING Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system. DESIGN Preintervention and postintervention observational study. PATIENTS Patients admitted to the four participating h...

Patient-ventilator synchrony is a complex issue affected by ventilator performance, patient characteristics, and the patient-ventilator interface. The history of patient-ventilator interaction includes avoidance of pharmacalogic paralysis, the development of spontaneous breathing systems, microprocessor technology to maximize interaction, and closed-loop control. While most clinicians agree tha...

toll like receptors (tlrs) recognize pathogens and generate an immediate defense response by inducing the production of pro-inflammatory cytokines, which rapidly destroy or limit the pathogens. in their bridging role, tlr downstream signals link innate and adaptive immunity, particularly by mediating dc maturation and activation of pathogen specific t lymphocytes. these pathways lead to the act...

introduction:ventilator- associated pneumonia(vap),as defined by the centers for disease control and prevention (cdc),is a pneumonia that occurs in a patient receiving mechanical ventilation that develops 48 hours or more after initiation of ventilation.re-intubation which occur within 72 hours of planned extubation may effect vap incidence.the aim of this study was to determine vap incidence i...

BACKGROUND Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV). METHODS A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator co...

BACKGROUND Ventilator-associated pneumonia is a clear risk factor for acute lung injury which has been poorly described in trauma patients. This prospective study was undertaken to estimate the incidence of such ventilator-associated pneumonia leading to acute lung injury, the risk factors, and the associated morbidity and mortality in a group of multiple trauma patients. METHODS Trauma patie...

OBJECTIVES The Centers for Disease Control and Prevention shifted the focus of surveillance paradigm for adult patients receiving mechanical ventilation, moving from the current standard of ventilator-associated pneumonia to broader complications. The surveillance definitions were designed to enable objective measures and efficient processes, so as to facilitate quality improvement initiatives ...

Background: Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV). Methods: A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator co...