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We evaluated extubation criteria in 48 postoperative general surgical and trauma patients receiving ventilatory support with intermittent mandatory ventilation (IMV) and continuous positive airway pressure (CPAP). Extubation criteria based on conventional respiratory mechanics demonstrated at 48% false-negative prediction of outcome, while those based on(More)
OBJECTIVE To evaluate the relationships between directly measured work of breathing (WOB) and variables of the breathing pattern commonly used at the bedside to infer WOB for intubated, spontaneously breathing patients treated with pressure support ventilation (PSV). DESIGN In vivo measurements of the WOB were obtained on a consecutive series of adults.(More)
Thirty-three trauma patients presenting with hypoxemia and normo- or hypocarbia were treated with continuous positive airway pressure (CPAP) via a snug-fitting face mask. All patients had demonstrated continued hypoxemia despite supplemental oxygen administration before institution of CPAP therapy as the primary mode of ventilatory support. Therapeutic(More)
Eight patients presenting with severe unilateral pulmonary injury responded poorly to conventional mechanical ventilation. Synchronous independent lung ventilation (SILV) was employed to provide support of ventilation and oxygenation without creating the ventilation/perfusion (V/Q) mismatch observed during conventional ventilation. All patients demonstrated(More)
Twenty-seven surgical patients who developed post-extubation hypoxemia unresponsive to routine respiration therapy (incentive spirometry and chest physical therapy) received continuous positive airway pressure (CPAP) delivered through a mask at an inspired oxygen fraction (FIO2) of 0.45. All patients responded with an increased PaO2 and achieved a PaO2/FIO2(More)
OBJECTIVE To test the hypothesis that, if apparent ventilatory insufficiency observed during a weaning or preextubation trial is due to a significant contribution of imposed work of the endotracheal tube and breathing apparatus (WOBImp), and the patient's actual physiologic work of breathing (WOBPhys) is not excessive, it should be possible to extubate(More)
The role of high-frequency jet ventilation (HFJV)/continuous positive airway pressure (CPAP) and HFJV/intermittent mandatory ventilation (IMV) in the treatment of surgical patients with the adult respiratory distress syndrome were evaluated. To compare the efficacy of HFJV to IMV at a constant FiO2 and positive end-expiratory pressure, patients in surgical(More)
OBJECTIVE The objective of this study was to describe the development of a cost-effective ventilatory strategy using a portable microprocessor-controlled respiratory monitor (Bicore CP-100; Allied Healthcare Products, Riverside, CA.) SUMMARY BACKGROUND DATA Until recently, clinicians have had to accept the uncertainties of clinical judgment, which(More)
OBJECTIVES There is increased awareness of imposed work of breathing contributing to apparent ventilatory dependency. This study evaluates the impact of tachypnea as an indicator of ventilatory failure during a room air-5 cm H2O continuous positive airway pressure, spontaneous breathing, preextubation trial when associated with increased imposed work of(More)
Mask CPAP is a safe and effective method of alleviating hypoxemia and reducing the work of breathing in selected patients with mild-to-moderate respiratory failure (PaO2/FIO2 less than 300). When mask-CPAP therapy is applied continuously, it is also effective in the treatment of atelectasis. Other applications of mask CPAP, such as those involving the(More)