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  1. Article ; Online: Quantifying ventilation by X-ray velocimetry in healthy adults.

    Siddharthan, Trishul / Grealis, Kyle / Kirkness, Jason P / Ötvös, Tamás / Stefanovski, Darko / Tombleson, Alex / Dalzell, Molly / Gonzalez, Ernesto / Nakrani, Kinjal Bhatt / Wenger, David / Lester, Michael G / Richmond, Bradley W / Fouras, Andreas / Punjabi, Naresh M

    Respiratory research

    2023  Volume 24, Issue 1, Page(s) 215

    Abstract: Rationale: X-ray velocimetry (XV) has been utilized in preclinical models to assess lung motion and regional ventilation, though no studies have compared XV-derived physiologic parameters to measures derived through conventional means.: Objectives: ... ...

    Abstract Rationale: X-ray velocimetry (XV) has been utilized in preclinical models to assess lung motion and regional ventilation, though no studies have compared XV-derived physiologic parameters to measures derived through conventional means.
    Objectives: To assess agreement between XV-analysis of fluoroscopic lung images and pitot tube flowmeter measures of ventilation.
    Methods: XV- and pitot tube-derived ventilatory parameters were compared during tidal breathing and with bilevel-assisted breathing. Levels of agreement were assessed using the Bland-Altman analysis. Mixed models were used to characterize the association between XV- and pitot tube-derived values and optimize XV-derived values for higher ventilatory volumes.
    Measurements and main results: Twenty-four healthy volunteers were assessed during tidal breathing and 11 were reassessed with increased minute ventilation with bilevel-assisted breathing. No clinically significant differences were observed between the two methods for respiratory rate (average Δ: 0.58; 95% limits of agreement: -1.55, 2.71) or duty cycle (average Δ: 0.02; 95% limits of agreement: 0.01, 0.03). Tidal volumes and flow rates measured using XV were lower than those measured using the pitot tube flowmeter, particularly at the higher volume ranges with bilevel-assisted breathing. Under these conditions, a mixed-model based adjustment was applied to the XV-derived values of tidal volume and flow rate to obtain closer agreement with the pitot tube-derived values.
    Conclusion: Radiographically obtained measures of ventilation with XV demonstrate a high degree of correlation with parameters of ventilation. If the accuracy of XV were also confirmed for assessing the regional distribution of ventilation, it would provide information that goes beyond the scope of conventional pulmonary function tests or static radiographic assessments.
    MeSH term(s) Adult ; Humans ; X-Rays ; Respiration ; Radiography ; Tidal Volume ; Lung/diagnostic imaging
    Language English
    Publishing date 2023-08-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041675-1
    ISSN 1465-993X ; 1465-993X
    ISSN (online) 1465-993X
    ISSN 1465-993X
    DOI 10.1186/s12931-023-02517-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Manual ventilation to prevent hypoxaemia during endotracheal intubation of critically ill adults: protocol and statistical analysis plan for a multicentre randomised trial.

    Casey, Jonathan D / Janz, David R / Russell, Derek W / Vonderhaar, Derek J / Joffe, Aaron M / Dischert, Kevin M / Brown, Ryan M / Lester, Michael G / Zouk, Aline N / Gulati, Swati / Stigler, William S / Rice, Todd W / Semler, Matthew W

    BMJ open

    2018  Volume 8, Issue 8, Page(s) e022139

    Abstract: Introduction: Hypoxaemia is the most common complication during endotracheal intubation of critically ill adults, and it increases the risk of cardiac arrest and death. Manual ventilation between induction and intubation has been hypothesised to ... ...

    Abstract Introduction: Hypoxaemia is the most common complication during endotracheal intubation of critically ill adults, and it increases the risk of cardiac arrest and death. Manual ventilation between induction and intubation has been hypothesised to decrease the incidence of hypoxaemia, but efficacy and safety data are lacking.
    Methods and analysis: The Preventing Hypoxemia with Manual Ventilation during Endotracheal Intubation trial is a prospective, multicentre, non-blinded randomised clinical trial being conducted in seven intensive care units in the USA. A total of 400 critically ill adults undergoing endotracheal intubation will be randomised 1:1 to receive prophylactic manual ventilation between induction and endotracheal intubation using a bag-valve-mask device or no prophylactic ventilation. The primary outcome is the lowest arterial oxygen saturation between induction and 2 min after successful endotracheal intubation, which will be analysed as an unadjusted, intention-to-treat comparison of patients randomised to prophylactic ventilation versus patients randomised to no prophylactic ventilation. The secondary outcome is the incidence of severe hypoxaemia, defined as any arterial oxygen saturation of less than 80% between induction and 2 min after endotracheal intubation. Enrolment began on 2 February 2017 and is expected to be complete in May 2018.
    Ethics and dissemination: The trial was approved by the institutional review boards or designees of all participating centres. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.
    Trial registration number: NCT03026322; Pre-results.
    MeSH term(s) Adult ; Clinical Protocols ; Critical Illness/therapy ; Female ; Humans ; Hypoxia/prevention & control ; Intubation, Intratracheal/adverse effects ; Intubation, Intratracheal/methods ; Male ; Respiration, Artificial/methods ; Treatment Outcome
    Language English
    Publishing date 2018-08-10
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2018-022139
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults.

    Casey, Jonathan D / Janz, David R / Russell, Derek W / Vonderhaar, Derek J / Joffe, Aaron M / Dischert, Kevin M / Brown, Ryan M / Zouk, Aline N / Gulati, Swati / Heideman, Brent E / Lester, Michael G / Toporek, Alexandra H / Bentov, Itay / Self, Wesley H / Rice, Todd W / Semler, Matthew W

    The New England journal of medicine

    2019  Volume 380, Issue 9, Page(s) 811–821

    Abstract: Background: Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during ... ...

    Abstract Background: Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial.
    Methods: In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%.
    Results: Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P = 0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73).
    Conclusions: Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.).
    MeSH term(s) Adult ; Aged ; Critical Illness/therapy ; Female ; Humans ; Hypoxia/etiology ; Hypoxia/prevention & control ; Intensive Care Units ; Intubation, Intratracheal/adverse effects ; Intubation, Intratracheal/methods ; Laryngeal Masks ; Male ; Middle Aged ; Oxygen/blood ; Respiration, Artificial/instrumentation
    Chemical Substances Oxygen (S88TT14065)
    Language English
    Publishing date 2019-02-18
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa1812405
    Database MEDical Literature Analysis and Retrieval System OnLINE

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