uu.seUppsala universitets publikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Maintenance of Airway Pressure During Filter Exchange Due to Auto-Triggering
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Sjuksköterskeutbildningar.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
Visa övriga samt affilieringar
2014 (Engelska)Ingår i: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 59, nr 8, s. 1210-1217Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Daily routine ventilator-filter exchange interrupts the integrity of the ventilator circuit. We hypothesized that this might reduce positive airway pressure in mechanically ventilated ICU patients, inducing alveolar collapse and causing impaired oxygenation and compliance of the respiratory system. METHODS: We studied 40 consecutive ICU subjects (P-aO2/F-IO2 ratio <= 300 mm Hg), mechanically ventilated with pressure-regulated volume control or pressure support and PEEP >= 5 cm H2O. Before the filter exchange, (baseline) tidal volume, breathing frequency,end-inspiratory plateau pressure, and PEEP were recorded. Compliance of the respiratory system was calculated; F-IO2, blood pressure, and pulse rate were registered; and P-aO2, P-aCO2, pH, and base excess were measured. Measurements were repeated 15 and 60 min after the filter exchange. In addition, a bench test was performed with a precision test lung with similar compliance and resistance as in the clinical study. RESULTS: The exchange of the filter took 3.5 +/- 1.2 s (mean +/- SD). There was no significant change in P-aO2 (89 +/- 16 mm Hg at baseline vs 86 +/- 16 mm Hg at 15 min and 88 +/- 18 mm Hg at 60 min, P = .24) or in compliance of the respiratory system (41 +/- 11 mL/cm H2O at baseline vs 40 +/- 12 mL/cm H2O at 15 min and 40 +/- 12 mL/cm H2O at 60 min, P = .32). The bench study showed that auto-triggering by the ventilator when disconnecting from the expiratory circuit kept the tracheal pressure above PEEP for at least 3 s with pressure controlled ventilation. CONCLUSIONS: This study showed that a short disconnection of the expiratory ventilator circuit from the ventilator during filter exchange was not associated with any significant deterioration in lung function 15 and 60 min later. This result may be explained by auto-triggering of the ventilator with high inspiratory flows during the filter exchange, maintaining airway pressure. (ISRCTN.org registration ISRCTN76631800.)

Ort, förlag, år, upplaga, sidor
2014. Vol. 59, nr 8, s. 1210-1217
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-216400DOI: 10.4187/respcare.02892ISI: 000349199900007PubMedID: 24282318OAI: oai:DiVA.org:uu-216400DiVA, id: diva2:689649
Tillgänglig från: 2014-01-21 Skapad: 2014-01-21 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
Ingår i avhandling
1. Patient safety in the Intensive Care Unit: With special reference to Airway management and Nursing procedures
Öppna denna publikation i ny flik eller fönster >>Patient safety in the Intensive Care Unit: With special reference to Airway management and Nursing procedures
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that this technique could be implemented in airway algorithms for the intubation of hypoxemic patients. In study II, we investigated short-term disconnection of the expiratory circuit from the ventilator during filter exchange in critically ill patients. We demonstrated that when using pressure modes in the ventilator, there was no indication of any significant deterioration in the patient's lung function. A bench test suggests that this result is explained by auto-triggering with high inspiratory flows during the filter exchange, maintaining the airway pressure. Study III was a clinical observational study of critically ill patients in which adverse events were studied in connection with routine nursing procedures. We found that adverse events were common, not well documented, and potentially harmful, indicating that it is important to weigh the risks and benefits of routine nursing when caring for unstable, critically ill patients. In study IV, we conducted a retrospective database study in patients with pelvis fractures treated in the intensive care unit. We found that the incidence of respiratory failure was high, that the procedure involved in surgical stabilization affected the respiratory status in patients with lung contusion, and that the mortality was low and probably not influenced by the respiratory condition. In conclusion, the results obtained in the present thesis have increase our knowledge in important areas in the most severely ill patients and have underlined the need for improvements in the field of patient safety.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2016. s. 72
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1187
Nyckelord
intensive care unit, patient safety, nursing procedures, airway managment
Nationell ämneskategori
Anestesi och intensivvård
Forskningsämne
Anestesiologi och intensivvård
Identifikatorer
urn:nbn:se:uu:diva-275170 (URN)978-91-554-9493-3 (ISBN)
Disputation
2016-04-22, Enghoffsalen, Ingång 50, Akademiska sjukhuset, Sjukhusvägen, Uppsala, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2016-04-01 Skapad: 2016-01-31 Senast uppdaterad: 2016-04-04

Open Access i DiVA

Fulltext saknas i DiVA

Övriga länkar

Förlagets fulltextPubMed

Personposter BETA

Engström, JoakimReinius, HenrikFröjd, CamillaHedenstierna, GöranLarsson, Anders

Sök vidare i DiVA

Av författaren/redaktören
Engström, JoakimReinius, HenrikFröjd, CamillaHedenstierna, GöranLarsson, Anders
Av organisationen
Anestesiologi och intensivvårdSjuksköterskeutbildningarKlinisk fysiologi
I samma tidskrift
Respiratory care
Medicin och hälsovetenskap

Sök vidare utanför DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetricpoäng

doi
pubmed
urn-nbn
Totalt: 823 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf