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Effective ventilation during cardiopulmonary resuscitation (CPR) is essential to reduce morbidity and mortality rates in cardiac arrest. Hyperventilation during CPR reduces the efficiency of compressions and coronary perfusion.
Problem
How could ventilation in CPR be optimized? The objective of this study was to evaluate non-invasive ventilator support using different devices.
Methods
The study compares the regularity and intensity of non-invasive ventilation during simulated, conventional CPR and ventilatory support using three distinct ventilation devices: a standard manual resuscitator, with and without airway pressure manometer, and an automatic transport ventilator. Student’s t-test was used to evaluate statistical differences between groups. P values <.05 were regarded as significant.
Results
Peak inspiratory pressure during ventilatory support and CPR was significantly increased in the group with manual resuscitator without manometer when compared with the manual resuscitator with manometer support (MS) group or automatic ventilator (AV) group.
Conclusion
The study recommends for ventilatory support the use of a manual resuscitator equipped with MS or AVs, due to the risk of reduction in coronary perfusion pressure and iatrogenic thoracic injury during hyperventilation found using manual resuscitator without manometer.
LacerdaRS, de LimaFCA, BastosLP, VincoAF, SchneiderFBA, CoelhoYL, FernandesHGC, BacalhauJMR, BermudesIMS, da SilvaCF, da SilvaLP, PezatoR. Benefits of Manometer in Non-Invasive Ventilatory Support. Prehosp Disaster Med. 2017;32(6):615–620.
Acute heart failure (AHF) may arise from systolic or diastolic dysfunction, rhythm disorder or preload and afterload mismatch from various aetiologies. The strongest sign is presence of a S3 or gallop rhythm on auscultation. Other clinical signs depend on the aetiology of AHF and its correlation with the history helps guide further investigation and treatment. The investigation is performed by electrocardiogram, and imaging techniques such as chest X-ray, computed tomography (CT), and echocardiography. For optimal management of AHF, full blood count, clotting, urea and electrolytes, blood glucose, cardiac enzymes, inflammatory markers and arterial blood gas analysis are recommended. The other investigations for AHF include coronary angiography, endomyocardial biopsy, and CT angiogram. The invasive monitoring of AHF is performed by arterial line, central venous lines, pulmonary artery flotation catheter and echocardiography. The management of AHF includes ventilatory support, the use of inotropes and renal replacement therapy.
This chapter focuses on assessing the need for ventilatory support in seriously ill patients in acute wards, emergency departments and critical care units. The need for ventilatory support is probably the commonest reason for patients requiring admission to critical care units, and the provision of mechanical ventilation has major resource implications. Patients requiring ventilatory support fall into two broad categories. First, there are those with established or impending respiratory failure. Second, there are those who need support for reasons not directly related to the respiratory system. The chapter summarizes the aims of ventilatory support, and concentrates on those aspects of the clinical assessment which identify actual or impending respiratory muscle fatigue or weakness and which assess the adequacy of ventilation and gas exchange. In general, when assessing the need for ventilatory support, clinical symptoms and signs are more useful than arterial blood gases or other physiological measurements.
One of the extreme solutions for the management of ventilatory failure is to replace the lungs altogether, either by transplantation or by the use of machines. Once the transplant has been completed, the means used to support the new lungs are little different from those used for any other patient. In the context of severe respiratory failure, other solutions are therefore necessary to provide ventilatory support, either as a bridge to recovery or transplantation, or as long-term support in an increasingly elderly Western population. These solutions are based on various mechanical means that take over some of the lung functions. This chapter reviews some of the key clinical questions concerning the ventilation of the lung transplant recipient and mechanical support of the failing lung. Starting at the time of transplantation, pharmacological immunosuppression has to be continuously adjusted to balance the risks of infection or rejection.