Individualized positive end-expiratory pressure reduces driving pressure in obese patients during laparoscopic surgery under pneumoperitoneum: a randomized clinical trial.

Introduction: During pneumoperitoneum (PNP), airway driving pressure (ΔP) increases due to the stiffness of the chest wall and cephalic shift of the diaphragm, which favors atelectasis. In addition, depending on the mechanical power (MP) formulas, they may lead to different interpretations.

Methods: Patients >18 years of age with body mass index >35 kg/m were included in a single-center randomized controlled trial during their admission for bariatric surgery by abdominal laparoscopy.

Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients.

Background: The profile of changes in airway driving pressure (dP) induced by positive-end expiratory pressure (PEEP) might aid for individualized protective ventilation. Our aim was to describe the dP versus PEEP curves behavior in ARDS from COVID-19 patients.

Methods: Patients admitted in three hospitals were ventilated with fraction of inspired oxygen (FiO) and PEEP initially adjusted by oxygenation-based table.

Empirical evidence for safety of mechanical ventilation during simulated cardiopulmonary resuscitation on a physical model.

Background: Cardiac arrest is a critical event requiring adequate and timely response in order to increase a patient's chance of survival. In patients mechanically ventilated with advanced airways, cardiopulmonary resuscitation (CPR) maneuver may be simplified by keeping the ventilator on. This work assessed the response of an intensive care mechanical ventilator to CPR using a patient manikin ventilated in three conventional modes.

Variable Ventilation Associated With Recruitment Maneuver Minimizes Tissue Damage and Pulmonary Inflammation in Anesthetized Lung-Healthy Rats.

Background: Recruitment maneuver and positive end-expiratory pressure (PEEP) can be used to counteract intraoperative anesthesia-induced atelectasis. Variable ventilation can stabilize lung mechanics by avoiding the monotonic tidal volume and protect lung parenchyma as tidal recruitment is encompassed within the tidal volume variability.

Methods: Forty-nine (7 per group) male Wistar rats were anesthetized, paralyzed, and mechanically ventilated.

Generalized estimation of the ventilatory distribution from the multiple-breath washout: a bench evaluation study.

Background: The multiple-breath washout (MBW) is able to provide information about the distribution of ventilation-to-volume (v/V) ratios in the lungs. However, the classical, all-parallel model may return skewed results due to the mixing effect of a common dead space. The aim of this work is to examine whether a novel mathematical model and algorithm is able to estimate v/V of a physical model, and to compare its results with those of the classical model.

Generalized estimation of the ventilatory distribution from the multiple-breath nitrogen washout.

Background: This work presents a generalized technique to estimate pulmonary ventilation-to-volume (v/V) distributions using the multiple-breath nitrogen washout, in which both tidal volume (V T ) and the end-expiratory lung volume (EELV) are allowed to vary during the maneuver. In addition, the volume of the series dead space (v d ), unlike the classical model, is considered a common series unit connected to a set of parallel alveolar units.

Methods: The numerical solution for simulated data, either error-free or with the N2 measurement contaminated with the addition of Gaussian random noise of 3 or 5 % standard deviation was tested under several conditions in a computational model constituted by 50 alveolar units with unimodal and bimodal distributions of v/V.