Artificial respiration: Difference between revisions
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In [[medicine]] and [[respiratory therapy]],, '''artificial respiration''' is "Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the [[lung]]s. Artificial respiration or ventilation is used in individuals who have stopped breathing or have respiratory insufficiency to increase their intake of [[oxygen]] (O<sub>2</sub>) and excretion of [[carbon dioxide]] (CO<sub>2</sub>)."<ref>{{MeSH}}</ref> | In [[medicine]] and [[respiratory therapy]],, '''artificial respiration''' is "Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the [[lung]]s. Artificial respiration or ventilation is used in individuals who have stopped breathing or have respiratory insufficiency to increase their intake of [[oxygen]] (O<sub>2</sub>) and excretion of [[carbon dioxide]] (CO<sub>2</sub>)."<ref>{{MeSH}}</ref> | ||
== | ==Airway access and protection== | ||
The methods differ by the means used to protect or provide access to the airway, and the way in which air is provided. | The methods differ by the means used to protect or provide access to the airway, and the way in which air is provided. | ||
===Manual methods=== | ===Manual methods=== | ||
Mouth-to-mouth or mouth-to-nose respiration can be performed with no equipment. A slight variant uses a thin mask to protect the rescuer, to be distinguished from positive ventilation masks. | |||
===Mask methods=== | ===Mask methods=== | ||
===Extraglottic methods=== | ===Extraglottic methods=== | ||
* i-gel<ref name="pmid18557971">{{cite journal |author=Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM |title=I-gel insertion by novices in manikins and patients |journal=Anaesthesia |volume= |issue= |pages= |year=2008 |month=June |pmid=18557971 |doi=10.1111/j.1365-2044.2008.05542.x |url= |issn=}}</ref> | * i-gel<ref name="pmid18557971">{{cite journal |author=Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM |title=I-gel insertion by novices in manikins and patients |journal=Anaesthesia |volume= |issue= |pages= |year=2008 |month=June |pmid=18557971 |doi=10.1111/j.1365-2044.2008.05542.x |url= |issn=}}</ref> | ||
===Using intratracheal intubation=== | ===Using intratracheal intubation=== | ||
[[Intratracheal intubation]] involves the insertion of a tube into the trachea to maintain an airway and to prevent obstruction. | [[Intratracheal intubation]] involves the insertion of a tube into the trachea to maintain an airway and to | ||
* PEEP. A [[randomized controlled trial]] has compared titrating PEEP with esophageal pressure and recommendations by the [http://www.ardsnet.org/ Acute Respiratory Distress Syndrome Network] (ARDSNet).<ref name="pmid19001507">{{cite journal |author=Talmor D, Sarge T, Malhotra A, ''et al'' |title=Mechanical ventilation guided by esophageal pressure in acute lung injury |journal=N. Engl. J. Med. |volume=359 |issue=20 |pages=2095–104 |year=2008 |month=November |pmid=19001507 |doi=10.1056/NEJMoa0708638 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19001507&promo=ONFLNS19 |issn=}}</ref> | prevent obstruction. | ||
===Surgical airway=== | |||
*[[Cricothryotomy]] | |||
*[[Tracheostomy]] | |||
==Types of air delivery== | |||
* [[Positive end expiratory pressure]] (PEEP). A [[randomized controlled trial]] has compared titrating PEEP with esophageal pressure and recommendations by the [http://www.ardsnet.org/ Acute Respiratory Distress Syndrome Network] (ARDSNet).<ref name="pmid19001507">{{cite journal |author=Talmor D, Sarge T, Malhotra A, ''et al'' |title=Mechanical ventilation guided by esophageal pressure in acute lung injury |journal=N. Engl. J. Med. |volume=359 |issue=20 |pages=2095–104 |year=2008 |month=November |pmid=19001507 |doi=10.1056/NEJMoa0708638 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19001507&promo=ONFLNS19 |issn=}}</ref> | |||
===Noninvasive=== | ===Noninvasive=== | ||
According to the U.S. [[National Library of Medicine]], the terms for the types of nonvinvasive ventilation, also called noninvasive positive pressure ventilation (NPPV) are: | According to the U.S. [[National Library of Medicine]], the terms for the types of nonvinvasive ventilation, also called noninvasive positive pressure ventilation (NPPV) are: | ||
*[[Continuous positive airway pressure]] (CPAP). | *[[Continuous positive airway pressure]] (CPAP). | ||
** Bilevel positive airway pressure (bilevel PAP). | ** [[Bilevel positive airway pressure]] (bilevel PAP). | ||
*[[Intermittent positive-pressure breathing]] (IPPB or NIPPB or called pressure support). | *[[Intermittent positive-pressure breathing]] (IPPB or NIPPB or called pressure support). | ||
| Line 27: | Line 30: | ||
* Some authors interchange [[Intermittent positive-pressure breathing|IPPB]] and IPPV with bilevel PAP as done in a recent [[randomized controlled trial]].<ref name="pmid18614781">{{cite journal |author=Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J |title=Noninvasive ventilation in acute cardiogenic pulmonary edema |journal=N. Engl. J. Med. |volume=359 |issue=2 |pages=142–51 |year=2008 |month=July |pmid=18614781 |doi=10.1056/NEJMoa0707992 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18614781&promo=ONFLNS19 |issn=}}</ref> | * Some authors interchange [[Intermittent positive-pressure breathing|IPPB]] and IPPV with bilevel PAP as done in a recent [[randomized controlled trial]].<ref name="pmid18614781">{{cite journal |author=Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J |title=Noninvasive ventilation in acute cardiogenic pulmonary edema |journal=N. Engl. J. Med. |volume=359 |issue=2 |pages=142–51 |year=2008 |month=July |pmid=18614781 |doi=10.1056/NEJMoa0707992 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18614781&promo=ONFLNS19 |issn=}}</ref> | ||
* Some authors interchange bilevel PAP with BiPAP. The latter is a specific brand of a bilevel PAP ventilator. | * Some authors interchange bilevel PAP with BiPAP. The latter is a specific brand of a bilevel PAP ventilator. | ||
==Supportive measures== | |||
==== | ==Humidification== | ||
=====Chronic obstructive pulmonary disease | ==Sedation== | ||
Although intratracheal intubation frequently involved sedating patients, continuous sedation may prolong intubation.<ref name="pmid20116842">{{cite journal| author=Strøm T, Martinussen T, Toft P| title=A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. | journal=Lancet | year= 2010 | volume= 375 | issue= 9713 | pages= 475-480 | pmid=20116842 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20116842 | doi=10.1016/S0140-6736(09)62072-9 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
==Effectiveness== | |||
Immediate information, especially in emergency situations, comes from [[pulse oximetry]] and [[capnography]]. | |||
===Chronic obstructive pulmonary disease=== | |||
All types of noninvasive ventilation studied through 2003 may help [[respiratory insufficiency]] due to [[chronic obstructive pulmonary disease]] according to [[systematic review]]s<ref name="pmid15266518">{{cite journal| author=Ram FS, Picot J, Lightowler J, Wedzicha JA| title=Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. | journal=Cochrane Database Syst Rev | year= 2004 | volume= | issue= 3 | pages= CD004104 | pmid=15266518 | All types of noninvasive ventilation studied through 2003 may help [[respiratory insufficiency]] due to [[chronic obstructive pulmonary disease]] according to [[systematic review]]s<ref name="pmid15266518">{{cite journal| author=Ram FS, Picot J, Lightowler J, Wedzicha JA| title=Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. | journal=Cochrane Database Syst Rev | year= 2004 | volume= | issue= 3 | pages= CD004104 | pmid=15266518 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=15266518 | doi=10.1002/14651858.CD004104.pub3 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=15688496 Review in: Evid Based Nurs. 2005 Jan;8(1):22] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid15222912">{{cite journal |author=Hess DR |title=The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature |journal=Respir Care |volume=49 |issue=7 |pages=810–29 |year=2004 |month=July |pmid=15222912 |doi= |url=http://www.rcjournal.com/contents/07.04/07.04.0810.pdf |issn=}}</ref> of [[randomized controlled trial]]s<ref name="pmid10859037">{{cite journal| author=Plant PK, Owen JL, Elliott MW| title=Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. | journal=Lancet | year= 2000 | volume= 355 | issue= 9219 | pages= 1931-5 | pmid=10859037 | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=15266518 | doi=10.1002/14651858.CD004104.pub3 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=15688496 Review in: Evid Based Nurs. 2005 Jan;8(1):22] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid15222912">{{cite journal |author=Hess DR |title=The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature |journal=Respir Care |volume=49 |issue=7 |pages=810–29 |year=2004 |month=July |pmid=15222912 |doi= |url=http://www.rcjournal.com/contents/07.04/07.04.0810.pdf |issn=}}</ref> of [[randomized controlled trial]]s<ref name="pmid10859037">{{cite journal| author=Plant PK, Owen JL, Elliott MW| title=Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. | journal=Lancet | year= 2000 | volume= 355 | issue= 9219 | pages= 1931-5 | pmid=10859037 | ||
| Line 45: | Line 53: | ||
* Inspiratory pressure was increased by 5 cm H<sub>2</sub>0 as needed up to 20 H<sub>2</sub>0 as tolerated. | * Inspiratory pressure was increased by 5 cm H<sub>2</sub>0 as needed up to 20 H<sub>2</sub>0 as tolerated. | ||
===Heart failure=== | |||
Noninvasive ventilation may help treat [[respiratory insufficiency]] due to [[heart failure]], but the optimal mode of noninvasive ventilation is not clear. A [[systematic review]] found that CPAP may be better than bilevel PAP.<ref name="pmid9792593">{{cite journal |author=Pang D, Keenan SP, Cook DJ, Sibbald WJ |title=The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: a systematic review |journal=Chest |volume=114 |issue=4 |pages=1185–92 |year=1998 |month=October |pmid=9792593 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=9792593 |issn=}}</ref> However, in a more recent [[randomized controlled trial]] of [[respiratory insufficiency]] due to [[heart failure]], neither CPAP or bilevel PAP reduced mortality as compared to standard oxygen therapy; however, both of the noninvasive methods provided similar symptomatic and metabolic improvement.<ref name="pmid18614781">{{cite journal |author=Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J |title=Noninvasive ventilation in acute cardiogenic pulmonary edema |journal=N. Engl. J. Med. |volume=359 |issue=2 |pages=142–51 |year=2008 |month=July |pmid=18614781 |doi=10.1056/NEJMoa0707992 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18614781&promo=ONFLNS19 |issn=}}</ref> In this trial CPAP was started at 5 cm of water and<sup> </sup>increased as needed to 15 cm of water. Bilevel PAP was started<sup> </sup>at an inspiratory positive airway pressure of 8 cm of water<sup> </sup>and an expiratory positive airway pressure of 4 cm of water<sup> </sup>and was increased as needed to an inspiratory pressure of 20 cm<sup> </sup>of water and expiratory pressure of 10 cm of water.<ref name="pmid18614781"/> | Noninvasive ventilation may help treat [[respiratory insufficiency]] due to [[heart failure]], but the optimal mode of noninvasive ventilation is not clear. A [[systematic review]] found that CPAP may be better than bilevel PAP.<ref name="pmid9792593">{{cite journal |author=Pang D, Keenan SP, Cook DJ, Sibbald WJ |title=The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: a systematic review |journal=Chest |volume=114 |issue=4 |pages=1185–92 |year=1998 |month=October |pmid=9792593 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=9792593 |issn=}}</ref> However, in a more recent [[randomized controlled trial]] of [[respiratory insufficiency]] due to [[heart failure]], neither CPAP or bilevel PAP reduced mortality as compared to standard oxygen therapy; however, both of the noninvasive methods provided similar symptomatic and metabolic improvement.<ref name="pmid18614781">{{cite journal |author=Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J |title=Noninvasive ventilation in acute cardiogenic pulmonary edema |journal=N. Engl. J. Med. |volume=359 |issue=2 |pages=142–51 |year=2008 |month=July |pmid=18614781 |doi=10.1056/NEJMoa0707992 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18614781&promo=ONFLNS19 |issn=}}</ref> In this trial CPAP was started at 5 cm of water and<sup> </sup>increased as needed to 15 cm of water. Bilevel PAP was started<sup> </sup>at an inspiratory positive airway pressure of 8 cm of water<sup> </sup>and an expiratory positive airway pressure of 4 cm of water<sup> </sup>and was increased as needed to an inspiratory pressure of 20 cm<sup> </sup>of water and expiratory pressure of 10 cm of water.<ref name="pmid18614781"/> | ||
==Weaning from ventilation== | |||
==References== | ==References== | ||
{{reflist|2}} | |||
==External links== | ==External links== | ||
* [http://www.ardsnet.org/ NHLBI ARDS Clinical Network] | * [http://www.ardsnet.org/ NHLBI ARDS Clinical Network] | ||
Revision as of 11:52, 18 February 2010
In medicine and respiratory therapy,, artificial respiration is "Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have respiratory insufficiency to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2)."[1]
Airway access and protection
The methods differ by the means used to protect or provide access to the airway, and the way in which air is provided.
Manual methods
Mouth-to-mouth or mouth-to-nose respiration can be performed with no equipment. A slight variant uses a thin mask to protect the rescuer, to be distinguished from positive ventilation masks.
Mask methods
Extraglottic methods
- i-gel[2]
Using intratracheal intubation
Intratracheal intubation involves the insertion of a tube into the trachea to maintain an airway and to prevent obstruction.
Surgical airway
Types of air delivery
- Positive end expiratory pressure (PEEP). A randomized controlled trial has compared titrating PEEP with esophageal pressure and recommendations by the Acute Respiratory Distress Syndrome Network (ARDSNet).[3]
Noninvasive
According to the U.S. National Library of Medicine, the terms for the types of nonvinvasive ventilation, also called noninvasive positive pressure ventilation (NPPV) are:
- Continuous positive airway pressure (CPAP).
- Bilevel positive airway pressure (bilevel PAP).
- Intermittent positive-pressure breathing (IPPB or NIPPB or called pressure support).
Inconsistent terminology of noninvasive modes
The terminology for noninvasive respiratory support is inconsistently used in the medical literature.
- Some authors interchange IPPB with IPPV. B indicates the patient is spontaneously breathing while V indicates ventilation via intratracheal intubation.
- Some authors interchange IPPB and IPPV with bilevel PAP as done in a recent randomized controlled trial.[4]
- Some authors interchange bilevel PAP with BiPAP. The latter is a specific brand of a bilevel PAP ventilator.
Supportive measures
Humidification
Sedation
Although intratracheal intubation frequently involved sedating patients, continuous sedation may prolong intubation.[5]
Effectiveness
Immediate information, especially in emergency situations, comes from pulse oximetry and capnography.
Chronic obstructive pulmonary disease
All types of noninvasive ventilation studied through 2003 may help respiratory insufficiency due to chronic obstructive pulmonary disease according to systematic reviews[6][7] of randomized controlled trials[8][9], especially if the exacerbations are severe[10]. In one trial[8]:
- Patients were included if PaCO2 was greater than 45 mm Hg.
- Bilevel PAP was started at:
- Inspiratory pressure 10 cm H20
- Expiratory pressure 4 cm H20
- Encouraged for up to:
- Day 1: As much as tolerated
- Day 2: 16 hours
- Day 3: 12 hours
- Inspiratory pressure was increased by 5 cm H20 as needed up to 20 H20 as tolerated.
Heart failure
Noninvasive ventilation may help treat respiratory insufficiency due to heart failure, but the optimal mode of noninvasive ventilation is not clear. A systematic review found that CPAP may be better than bilevel PAP.[11] However, in a more recent randomized controlled trial of respiratory insufficiency due to heart failure, neither CPAP or bilevel PAP reduced mortality as compared to standard oxygen therapy; however, both of the noninvasive methods provided similar symptomatic and metabolic improvement.[4] In this trial CPAP was started at 5 cm of water and increased as needed to 15 cm of water. Bilevel PAP was started at an inspiratory positive airway pressure of 8 cm of water and an expiratory positive airway pressure of 4 cm of water and was increased as needed to an inspiratory pressure of 20 cm of water and expiratory pressure of 10 cm of water.[4]
Weaning from ventilation
References
- ↑ Anonymous (2024), Artificial respiration (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM (June 2008). "I-gel insertion by novices in manikins and patients". Anaesthesia. DOI:10.1111/j.1365-2044.2008.05542.x. PMID 18557971. Research Blogging.
- ↑ Talmor D, Sarge T, Malhotra A, et al (November 2008). "Mechanical ventilation guided by esophageal pressure in acute lung injury". N. Engl. J. Med. 359 (20): 2095–104. DOI:10.1056/NEJMoa0708638. PMID 19001507. Research Blogging.
- ↑ 4.0 4.1 4.2 Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J (July 2008). "Noninvasive ventilation in acute cardiogenic pulmonary edema". N. Engl. J. Med. 359 (2): 142–51. DOI:10.1056/NEJMoa0707992. PMID 18614781. Research Blogging.
- ↑ Strøm T, Martinussen T, Toft P (2010). "A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial.". Lancet 375 (9713): 475-480. DOI:10.1016/S0140-6736(09)62072-9. PMID 20116842. Research Blogging.
- ↑ Ram FS, Picot J, Lightowler J, Wedzicha JA (2004). "Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease.". Cochrane Database Syst Rev (3): CD004104. DOI:10.1002/14651858.CD004104.pub3. PMID 15266518. Research Blogging. Review in: Evid Based Nurs. 2005 Jan;8(1):22
- ↑ Hess DR (July 2004). "The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature". Respir Care 49 (7): 810–29. PMID 15222912. [e]
- ↑ 8.0 8.1 Plant PK, Owen JL, Elliott MW (2000). "Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.". Lancet 355 (9219): 1931-5. PMID 10859037.
- ↑ Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A et al. (1995). "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.". N Engl J Med 333 (13): 817-22. PMID 7651472.
- ↑ Keenan SP, Sinuff T, Cook DJ, Hill NS (June 2003). "Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature". Ann. Intern. Med. 138 (11): 861–70. PMID 12779296. [e]
- ↑ Pang D, Keenan SP, Cook DJ, Sibbald WJ (October 1998). "The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: a systematic review". Chest 114 (4): 1185–92. PMID 9792593. [e]