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- Suarez-Sipmann, Fernando, et al.
(author)
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Nuevos modos de ventilación: NAVA : [New modes of ventilation: NAVA]
- 2008
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In: Medicina Intensiva. - 0210-5691 .- 1578-6749. ; 32:8, s. 398-403
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Journal article (peer-reviewed)abstract
- Neurally adjusted ventilatory assist (NAVA) is a new mode of assisted mechanical ventilation that uses the signal obtained from diaphragmatic electrical activity (Edi) to control the mechanical ventilator. Edi directly represents the central respiratory drive and reflects the length and intensity of the patient's neural effort. During NAVA, mechanical inspiratory assist starts when the respiratory center initiates the breath and is therefore independent of any pneumatic component. During inspiration, the pressure delivered is proportional to the Edi and the inspiratory pressure assist ceases when the neural activation of the diaphragm starts to decline after reaching the inspiratory maximum value. NAVA is a new conceptual approach to mechanical ventilation that can significantly improve patient-ventilator interaction and optimize the level of effective respiratory muscle unloading during assisted mechanical ventilation.
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| 2. |
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| 3. |
- Suarez-Sipmann, Fernando
(author)
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New modes of assisted mechanical ventilation
- 2014
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In: Medicina Intensiva. - : Elsevier BV. - 0210-5691 .- 1578-6749. ; 38:4, s. 249-260
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Journal article (peer-reviewed)abstract
- Recent major advances in mechanical ventilation have resulted in new exciting modes of assisted ventilation. Compared to traditional ventilation modes such as assisted-controlled ventilation or pressure support ventilation, these new modes offer a number of physiological advantages derived from the improved patient control over the ventilator. By implementing advanced closed-loop control systems and using information on lung mechanics, respiratory muscle function and respiratory drive, these modes are specifically designed to improve patient-ventilator synchrony and reduce the work of breathing. Depending on their specific operational characteristics, these modes can assist spontaneous breathing efforts synchronically in time and magnitude, adapt to changing patient demands, implement automated weaning protocols, and introduce a more physiological variability in the breathing pattern. Clinicians have now the possibility to individualize and optimize ventilatory assistance during the complex transition from fully controlled to spontaneous assisted ventilation. The growing evidence of the physiological and clinical benefits of these new modes is favoring their progressive introduction into clinical practice. Future clinical trials should improve our understanding of these modes and help determine whether the claimed benefits result in better outcomes. (C) 2013 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.
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| 4. |
- Suárez Sipmann, Fernando
(author)
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Utilidad de las maniobras de reclutamiento (PRO) : [Utility of recruitment maneuvers (pro)]
- 2009
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In: Medicina Intensiva. - 0210-5691 .- 1578-6749. ; 33:3, s. 134-138
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Journal article (peer-reviewed)abstract
- In recent years lung recruitment maneuvers (RM) have awakened an increasing interest due to their potential beneficial effects in lung protection so that they have been progressively introduced into clinical practice. Many clinical and experimental studies have described the physiological benefits obtained after lung re-expansion although these benefits are not uniform, partly because of the wide heterogeneity of the RMs applied and lack of criteria defining their goal. Therefore, to date it has been difficult to establish the role of recruitment in the ventilatory management of ARDS patients. However, the information obtained from recent studies has improved our understanding regarding the mechanisms governing lung recruitment, interpretation of its response and its side effects and this has strongly contributed to its improved practical application. Lung recruitment must be applied in a protocolized and individualized way, establishing the pressure necessary to obtain the reasonably possible maximum lung re-expansion in each patient. Post RM PEEP adjustment is an essential aspect which, if ignored, renders RM useless and possibly without indication. Taking these essential aspects into account we are getting closer to, as the author believes, finally demonstrating the benefit of RM in lung protection and ARDS patients' outcome.
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| 5. |
- Tomicic, V., et al.
(author)
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Fundamentos de la ventilación mecánica en el síndrome de distrés respiratorio agudo [The basics on mechanical ventilation support in acute respiratory distress syndrome]
- 2010
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In: Medicina Intensiva. - : Elsevier BV. - 0210-5691 .- 1578-6749. ; 34:6, s. 418-427
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Research review (peer-reviewed)abstract
- Acute Respiratory Distress Syndrome (ARDS) is understood as an inflammation-induced disruption of the alveolar endothelial-epithelial barrier that results in increased permeability and surfactant dysfunction followed by alveolar flooding and collapse. ARDS management relies on mechanical ventilation. The current challenge is to determine the optimal ventilatory strategies that minimize ventilator-induced lung injury (VILI) while providing a reasonable gas exchange. The data support that a tidal volume between 6-8 ml/kg of predicted body weight providing a plateau pressure <30 cmH(2)O should be used. High positive end expiratory pressure (PEEP) has not reduced mortality, nevertheless secondary endpoints are improved. The rationale used for high PEEP argues that it prevents cyclic opening and closing of airspaces, probably the major culprit of development of VILI. Chest computed tomography has contributed to our understanding of anatomic-functional distribution patterns in ARDS. Electric impedance tomography is a technique that is radiation-free, but still under development, that allows dynamic monitoring of ventilation distribution at bedside.
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| 6. |
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