Marc Wysocki

Background: Recent findings suggest that using alveolar PCO2 (PACO2 ) estimated by volumetric capnography in the Bohr equation instead of PaCO2 (Enghoff modification) could be appropriate for the calculation of physiological dead space to tidal volume ratio (VD/VT Bohr and VD/VT Enghoff, respectively). We aimed to describe the relationship between...

Objectives: The aim of our pilot study was to develop a model to better predict Paco2 in mechanically ventilated children using noninvasive parameters including volumetric capnography. Design: Prospective clinical pilot study. Setting: Level III PICU. Patients: Sixty-five mechanically ventilated children. Interventions: None. Materials an...

Background: Closed-loop modes automatically adjust ventilation settings, delivering an individualized ventilation over short periods of time. The objective of this randomized controlled trial was to compare safety, efficacy and workload for the healthcare team between Intellivent-ASV and conventional modes over a 48 hours period. Methods: ICU pa...

This chapter describes the basics and the clinical experience with two explicit computerised protocols (ECP) implemented in commercialised ventilators: Smartcare/PS® by Draeger Medical (Germany) and IntelliVent® by Hamilton Medical (Switzerland). These two ECPs manage ventilation, without the need of caregivers’ intervention but under their supervi...

Mechanical ventilation is a sophisticated technique with a very narrow therapeutic range. It is highly efficient and able to keep alive the most severe patients, but with considerable side effects and unwanted complications if not properly and timely used. Computerized protocols, closed-loop systems, and decision support, all terms which will be de...

We wish to report here a practical approach to an ARDS patient as devised by a group of intensivists with different expertise. The referral scenario is an intensive care unit of a Community Hospital with limited technology, where a young doctor, alone, must deal with this complicate syndrome during the night. The knowledge of pulse oximetry at room...

Intellivent is a new full closed-loop controlled ventilation that automatically adjusts both ventilation and oxygenation parameters. The authors compared gas exchange and breathing pattern variability of Intellivent and pressure support ventilation (PSV). In a prospective, randomized, single-blind design crossover study, 14 patients were ventilated...

Mechanical ventilation is a sophisticated technique with very narrow therapeutic ranges i.e. highly efficient and able to keep alive the most severe patients, but with considerable side effects and unwanted complications if not properly and timely used. Computerized protocols, closed loop systems, decision support, all terms which need to be define...

Purpose: Discrepancies between the demand and availability of clinicians to care for mechanically ventilated patients can be anticipated due to an aging population and to increasing severity of illness. The use of closed-loop ventilation provides a potential solution. The aim of the study was to evaluate the safety of a fully automated ventilator....

Purpose: Our aim was to compare adaptive support ventilation with and without closed loop control by end tidal CO2 (ASVCO2, ASV) with pressure (PC) and volume control ventilation (VC) during simulated clinical scenarios [normal lungs (N), COPD, ARDS, brain injury (BI)]. Methods: A lung model was used to simulate representative compliance (mL/cmH...

The present study is a pilot prospective safety evaluation of a new closed loop computerised protocol on ventilation and oxygenation in stable, spontaneously breathing children weighing more than 7 kg, during the weaning phase of mechanical ventilation. Mechanically ventilated children ready to start the weaning process were ventilated for five per...

IntelliVent-ASV(®) is a development of adaptive support ventilation (ASV) that automatically adjusts ventilation and oxygenation parameters. This study assessed the safety and efficacy of IntelliVent-ASV(®) in sedated intensive care unit (ICU) patients with acute respiratory failure. This prospective randomized crossover comparative study was condu...

IntelliVent-ASV® is a closed-loop ventilation mode that automatically adjusts ventilation and oxygenation settings in passive and active breathing patients. The minute volume is adjusted according to end-tidal CO2 (ETCO2) information in passive breathing patients (and respiratory rate in active breathing patients), and oxygenation is adjusted accor...

Background: Inappropriate selection of tidal volume and rate on mechanical ventilators in patients with reduced lung volume may cause lung damage. In spite of this rather recent insight, the optimal breath pattern and the relative importance of elevating end-expiratory lung volume (EELV) are still debated. A recent hypothesis is that lung injury is...

Mechanical ventilation can be perceived as a treatment with a very narrow therapeutic window, i.e., highly efficient but with considerable side effects if not used properly and in a timely manner. Protocols and guidelines have been designed to make mechanical ventilation safer and protective for the lung. However, variable effects and low complianc...

In the July 2011 issue of Respiratory Care we read with great consideration the paper from Marchese et al,[1][1] reporting the performance of 6 intensive-care ventilators currently available on the market. The present letter has no intention to contest the data reported in that paper;[1][1] instead

To measure the dynamics of recruitment and the hemodynamic status during a sustained inflation recruitment maneuver (RM) in order to determine the optimal duration of RM in acute respiratory distress syndrome (ARDS) patients. This prospective study was conducted in a 12-bed intensive care unit (ICU) in a general hospital. A 40 cmH(2)O sustained inf...

Objective To compare pressure–volume (P–V) curves obtained with the Galileo ventilator with those obtained with the CPAP method in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Design Prospective, observational study. Setting General critical care center. Patients and participants Patients with ALI/ARDS an...

To compare the short-term effects of adaptive support ventilation (ASV), an advanced closed-loop mode, with conventional volume or pressure-control ventilation in patients passively ventilated for acute respiratory failure. Prospective crossover interventional multicenter trial. Six European academic intensive care units. Eighty-eight patients in t...

Device to autimatically determine the PEEP of a patient.

Method to assess haemodynamic stability during mechanical ventilation

Adaptive support ventilation (ASV) allows the clinician to set a maximum plateau pressure (PP) and automatically adjusts tidal volume to keep PP below the set maximum. ASV was compared to a fixed tidal volume of 6 ml/kg. ASV determined the respiratory rate and tidal volume based on its algorithms. Maximum airway pressure limit was 28 cm H2O in ASV....

Inappropriate selection of tidal volume and rate on mechanical ventilators in patients with reduced lung volume may cause lung damage. In spite of this rather recent insight, the optimal breath pattern and the relative importance of elevating end-expiratory lung volume (EELV) are still debated. A recent hypothesis is that lung injury is caused by e...

Dual-control modes of ventilation adapt the pressure delivery to keep a volume target in response to changes in respiratory mechanics, but they may respond poorly to changes in ventilatory demand. Adaptive support ventilation (ASV), a complex minute volume-targeted pressure-regulated ventilation, was compared to adaptive pressure ventilation (APV),...

Mechanical ventilation is a lifesaving supportive therapy for patients with acute respiratory failure. However, prolonged mechanical ventilation results in the complete absence of neural activation and mechanical activity of the diaphragm and has been shown to induce ventilator-induced diaphragmatic dysfunction (VIDD) [1]. Few studies have shown th...

To compare pressure-volume (P-V) curves obtained with the Galileo ventilator with those obtained with the CPAP method in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Prospective, observational study. General critical care center. Patients with ALI/ARDS and receiving mechanical ventilation. Pressure-volume cur...

A closed-loop control method to achieve the best possible oxygen saturation with least impact on hemodynamics.

A graphical user interface with iconographic respresentation of ventilated lung and its distortion in disease.

A closed-loop controller to maintain an optimal ventilation for patients on mechanical ventilation.

To assess the hysteresis of the pressure-volume curve (PV curve) as to estimate, easily and at the bedside, the recruitability of the lung in ARDS patients. Prospective study. Twelve medico-surgical ICU beds of a general hospital. Twenty-six patients within the first 24 h from meeting ARDS criteria. A Quasi-static inflation and deflation PV curve f...

In a cohort of mechanically ventilated patients to compare the automatic tidal volume (VT)-respiratory rate (RR) combination generated by adaptive support ventilation (ASV) for various lung conditions. Prospective observational cohort study in the 11-bed medicosurgical ICU of a general hospital. 243 patients receiving 1327 days of invasive ventilat...

In humans, lung ventilation exhibits breath-to-breath variability and dynamics that are nonlinear, complex, sensitive to initial conditions, unpredictable in the long-term, and chaotic. Hypercapnia, as produced by the inhalation of a CO(2)-enriched gas mixture, stimulates ventilation. Hypocapnia, as produced by mechanical hyperventilation, depresse...

The rational for using closed loop ventilation is becoming strong and stronger. Studies are now available supporting the hypothesis that patient outcome is improved by using closed loop ventilation. In the highly sophisticated ICU world driven by the triumvirate of cost-efficiency, quality, and safety, closed loop ventilation will become definitely...

Improving safety and quality has become a major concern in medicine, especially in high-technology and complex environments such as intensive care units. Numerous publications report improved patient safety through the use of intuitive graphic representations in anaesthesiology and intensive care. A novel, intelligent graphical user interface (GUI)...

To compare descriptors of the breath-to-breath respiratory variability during a 60-min spontaneous breathing trial in patients successfully and unsuccessfully separated from the ventilator and the endotracheal tube and to assess the usefulness of these predictors in discriminating these two categories of patients. Prospective observational study. F...

The mammalian ventilatory behavior exhibits nonlinear dynamics as reflected by certain nonlinearity or complexity indicators (e.g. correlation dimension, approximate entropy, Lyapunov exponents...) but this is not sufficient to determine its possible chaotic nature. To address this, we applied the noise titration technique, previously shown to disc...

Ventilation is a continuous periodic activity with successive inspiratory and expiratory phases. Such activity is not monotonous and the breath-to-breath variability is not likely to be purely random. Breath to breath variability of breathing components may be a way to assess the complexity of the respiratory central pattern generator. Preliminary...

The present study provides further insights into the chaotic nature of the ventilatory behaviour in spontaneously breathing heal thy humans by applying the noise titration method t o ventilatory flow signals gathered in this s e t t i n g . In five subjects with normal breathing pattern and end-tidal CO2, the noise titration method gave a positive...

Proportional-assist ventilation (PAV) is able to unload respiratory muscles in proportion to the subject's inspiratory effort. However, leak-related alterations in the flow signal, effort-induced modifications in respiratory mechanics, or approximate adjustment of PAV could jeopardize such a theory. The aim of this study was to compare noninvasive...

To compare short-term administration of noninvasive proportional assist ventilation (NIV-PAV) and pressure support ventilation (NIV-PSV). Prospective, crossover, randomized study. Medicosurgical intensive care unit in a nonteaching hospital. Twelve chronic obstructive pulmonary disease patients admitted for hypercapnic acute respiratory failure. NI...

A continuous infusion of vancomycin (CIV) may provide an alternative mode of infusion in severe hospital-acquired methicillin-resistant staphylococcal (MRS) infections. A multicenter, prospective, randomized study was designed to compare CIV (targeted plateau drug serum concentrations of 20 to 25 mg/liter) and intermittent infusions of vancomycin (...

In acute hypoxaemic respiratory failure (HRF), oxygenation, reduction in the work of breathing and in dyspnoea may be achieved by delivering noninvasive mechanical ventilation (NIMV). Several uncontrolled and 13 randomized controlled studies (RCS) were reviewed. Uncontrolled studies confirmed the feasibility and the possibility to improve arterial...

A prospective survey was performed over a period of 3 wk among 42 intensive care units to assess the incidence of use and effectiveness of noninvasive mechanical ventilation (NIV) in clinical practice. All patients requiring ventilatory support for acute respiratory failure (ARF), either with endotracheal intubation (ETI) or NIV, were included. Ven...

A prospective survey was performed over a period of 3 wk among 42 intensive care units to assess the incidence of use and effectiveness of noninvasive mechanical ventilation (NIV) in clinical practice. All patients requiring ventilatory support for acute respiratory failure (ARF), either with endotracheal intubation (ETI) or NIV, were included. Ven...

Treatment of acute respiratory failure (ARF) generally requires mechanical ventilation via endotracheal intubation. This technique, however, involves numerous side effects. Noninvasive ventilation (NIV) reduces the need for endotracheal intubation and the related morbidity in patients with acute exacerbation of chronic obstructive pulmonary disease...

To evaluate the effects of high-dose almitrine infusion on gas exchange and right ventricular function in patients with severe hypoxemia related to acute respiratory distress syndrome (ARDS). Prospective study. Medicosurgical intensive care department (ten beds). Nine patients with ARDS and severe hypoxemia (PaO2/FIO2 ratio, <150 torr [20 kPa]). Hi...

Treatment of acute respiratory failure (ARF) generally requires mechanical ventilation via endotracheal intubation. This technique, however, involves numerous side effects. Noninvasive ventilation (NIV) reduces the need for endotracheal intubation and the related morbidity in patients with acute exacerbation of chronic obstructive pulmonary disease...

Non invasive mechanical ventilation represents all the techniques of mechanical ventilation not using endotracheal connection to the respirator. Non invasive mechanical ventilation is essentially represented nowadays by facial (generally used for acute respiratory failure) and nasal ventilation (widely used for long term mechanical ventilation at h...

Non invasive mechanical ventilation represents all the techniques of mechanical ventilation not using endotracheal connection to the respirator: Non invasive mechanical ventilation is essentially represented nowadays by facial (generally used for acute respiratory failure) and nasal ventilation (widely used for long term mechanical ventilation at h...

To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. A prospective, multi-institutional, initial cohort study including 28-day follow-up. Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF). All the patient...

Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up. Settings: Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care So...

To assess the effectiveness of a scoring system (omega) for medical activity. In 100 consecutive patients (phase A), the omega scores were calculated by the physician in charge and controlled by an independent physician. In 100 additional patients, the omega scores were controlled again while using corrective measures (phase B). Phase A: at least o...

The aim of this study was to evaluate the contribution of clinical, angiographic and haemodynamic findings in predicting the cardiorespiratory efficacy of thrombolytic therapy in acute massive pulmonary embolism. Haemodynamic measurements and pulmonary angiography were performed before (H0) and 12 h after (H12) initiating thrombolytic therapy in 23...

In ventilated patients with acute lung injury (ALI) we investigated whether respiratory changes in arterial pulse pressure (DeltaPP) could be related to the effects of PEEP and fluid loading (FL) on cardiac index (CI). Measurements were performed before and after application of a PEEP (10 cm H2O) in 14 patients. When the PEEP-induced decrease in CI...

Non-invasive mechanical ventilation (NIV) for the treatment of patients suffering from acute respiratory failure and requiring ventilatory support has been investigated extensively during the past decade [1, 2]. Three prospective randomized studies on patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) [3–5] demonstrate...

La vancomycine reste l'antibiotique de choix dans le traitement des infections sévères à staphylocoques résistant à la méticilline. Les arguments en faveur de la perfusion continue de vancomycine viennent d'une part de l'expérience clinique acquise avec la vancomycine administrée de manière discontinue et de connaissances pharmacocinétiques récente...

Right ventricle (RV) preload assessment remains controversial because the complexity of RV geometry is an obstacle to wall stress modeling. We developed a method to evaluate end-diastolic RV elastic energy (EL), a variable that integrates all the stretching effects of venous return and that can be easily estimated at the bedside from the area under...

In order to reduce the endotracheal intubation - associated morbidity Non Invasive Pressure Support Ventilation (NIPSV) can be used successfully for patients with various etiology of Acute Respiratory Failure (ARF). We used NIPSV in 25 patients with formerly healthy lungs (without chronic respiratory insufficiency) who had ARF. Successful cases (n...

In patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation may be used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. We conducted a prospective, randomized study comparing noninvasive pressure-support ventilation delivered through a face mask with...

Peak and trough serum concentrations are routinely measured to monitor vancomycin therapy. Optimal therapy depends upon maintaining a concentration above that necessary for antibacterial activity and is therefore determined by the trough concentration. I determined the post dose increases in serum drug concentrations in routine clinical practice in...

The benefit of noninvasive pressure support ventilation (NIPSV) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease (COPD). Patients were randomly as...

To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange. Prospective self-controlled study. 3 medico-surgical intensive care units. 17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88 +/- 30 mmHg, venous admixture: 47 +/- 7%) and elevated mean pulmonary artery pressure (MPAP: 30 +/-...

To further delineate indications for noninvasive pressure support ventilation (NIPSV), we proposed this noninvasive technique as an alternative to endotracheal intubation in 17 consecutive patients with acute respiratory failure from various causes. Eight patients (47 percent) were successfully ventilated with NIPSV, while in 9 (53 percent), NIPSV...

To help clarify the oxygen uptake/transport (VO2/TO2) relationship and because the oxygen extraction ratio (OER) and TO2 share no common variable such as cardiac index, we examined the changes in OER when TO2 was decreased in 12 patients with sepsis in whom a PEEP trial was performed. From zero end-expiratory pressure (ZEEP) to PEEP (12 +/- 3 cm H2...

Nosocomial infections affect about 5 p. 100 of surgical patients, and postoperative infections of the operative wounds or sites account for the major part of these infections. A knowledge of the potential organisms causing such infections and which vary according to the site and type of the surgical procedure is the most important guide to prophyla...

Non cardiogenic pulmonary oedema occurs rarely in patients with diabetic ketoacidosis, except in conjunction with an infection. A case is reported of non cardiogenic pulmonary oedema in a patient with severe diabetic ketoacidosis, which resolved within 72 h with oxygen supply only. There were no objective facts which could explain its pathogenesis,...

Non cardiogenic pulmonary oedema occurs rarely in patients with diabetic ketoacidosis, except in conjunction with an infection. A case is reported of non cardiogenic pulmonary oedema in a patient with severe diabetic ketoacidosis, which resolved within 72 h with oxygen supply only. There were no objective facts which could explain its pathogenesis,...