K G Hickling's research while affiliated with Gold Coast University Hospital and other places
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Publications (30)
There has been increasing recognition that mechanical ventilation can cause acute parenchymal lung injury (ventilator-induced lung injury, or VILI) in addition to the more widely recognized forms of barotrauma. Furthermore, in patients with acute lung injury, this type of injury may cause considerable morbidity and mortality. Subsequently, the goal...
New evidence requires a reinterpretation of the inflation pressure-volume curve and suggests that neither the lower nor the upper inflection point provides reliable information to determine safe ventilator settings in the acute respiratory distress syndrome. Recruitment probably continues throughout the inflation pressure-volume curve, and studies...
A mathematical model of the acute respiratory distress syndrome (ARDS) lung, incorporating simulated gravitational superimposed pressure and alveolar opening and closing pressures, was used to study the mean tidal pressure-volume (PV) slope ("effective compliance") during incremental and decremental positive end-expiratory pressure (PEEP) trials wi...
To compare the degrees of ventilator-induced lung injury caused by two ventilation protocols.
Randomized trial.
University animal laboratory.
Sixteen New Zealand white rabbits.
After five sequential saline lung lavages, eight pairs of anesthetized rabbits were allocated randomly to receive either of two ventilation protocols for 4 hrs during neurom...
A mathematical model of the ARDS lung, with simulated gravitational superimposed pressure, evaluated the effect of varying alveolar threshold opening pressures (TOP), PEEP and peak inspiratory pressure (PIP) on the static pressure-volume (PV) curve. The lower inflection point (Pflex) was affected by SP and TOP, and did not accurately indicate PEEP...
A mathematical model of the ARDS lung, with simulated gravitational superimposed pressure, evaluated the effect of varying alveolar threshold opening pressures (TOP), PEEP and peak inspiratory pressure (PIP) on the static pressure–volume (PV) curve. The lower inflection point (Pflex) was affected by SP and TOP, and did not accurately indicate PEEP...
The optimal ventilation strategy in patients with acute lung injury is currently a subject of much
debate. A recent American College of Chest Physicians Consensus Conference (1) suggested
that some of the primary clinical objectives of mechanical ventilation are to: a). reverse
hypoxemia; b). reverse respiratory acidosis; c). to relieve respiratory...
The main evidence supporting pressure limited ventilation in the adult respiratory distress syndrome (ARDS), has come from animal studies demonstrating that mechanical ventilation (MV) can cause a form of acute parenchymal lung injury histologically similar to ARDS, resulting in progressive respiratory failure and sometimes death. In some animal mo...
To determine whether pressure-limited intermittent mandatory ventilation with permissive hypercapnia and positive end-expiratory pressure (PEEP) titrated to arterial oxygen tension (PaO2) prevents or reduces acute lung injury, compared to conventional ventilation, in saline-lavaged rabbits.
Prospective randomised trial.
University animal laboratory...
Low volume ventilation with permissive hypercapnia is becoming widely used in the treatment of acute respiratory distress
syndrome. A mathematical model was developed to examine the effects of hypoventilation on pulmonary gas exchange in lungs
with a range of shunt fractions. Hypoventilation did not worsen gas exchange, provided the inspired oxygen...
Many experimental studies have shown that mechanical ventilation with high tidal volumes (V1) or with a low end-expiratory volume allowing repeated end-expiratory collapse, can result in acute parenchymal lung injury and probably an inflammatory response. Low volume ventilation with permissive hypercapnia has been used in an attempt to avoid such i...
To evaluate the outcome in patients with severe adult respiratory distress syndrome (ARDS) managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes (4 to 7 mL/kg), spontaneous breathing using synchronized intermittent mandatory ventilation from the start of ventilation, and permissive hypercapnia without the use of...
Objectives: To evaluate the outcome in patients with severe adult respiratory distress syndrome (ARDS) managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes (4 to 7 mL/kg), spontaneous breathing using synchronized intermittent mandatory ventilation from the start of ventilation, and permissive hypercapnia withou...
There have been at least 29 clinical trials comparing once-daily administration of aminoglycosides with conventional administration 2 to 4 times daily. In general, efficacy has not been shown to be different between regimens, although one trial showed an advantage for once-daily administration compared with administration 3 times daily. A small num...
Many animal studies have demonstrated that mechanical ventilation with high peak inspiratory pressures (PIP) can result in a form of acute lung injury closely resembling ARDS, ie characterised by hyaline membranes, granulocyte infiltration, increased pulmonary and systemic vascular permeability, and eventually proliferation of fibroblasts and type...
To determine the relationships among serum aminoglycoside clearance, renal aminoglycoside clearance, measured creatinine clearance, and estimated creatinine clearance derived from a standard formula in critically ill patients.
A ten-bed general ICU in a university hospital.
Eighteen critically ill patients who were being treated with gentamicin or...
Many animal studies have shown that high peak inspiratory pressures (PIP) during mechanical ventilation can induce acute lung injury with hyaline membranes. Since 1984 we have limited PIP in patients with ARDS by reducing tidal volume, allowing spontaneous breathing with SIMV and disregarding hypercapnia. Since 1987 50 patients with severe ARDS wit...
Animal studies have demonstrated that mechanical ventilation with high peak inspiratory pressure (PIP) results in acute lung injury characterised by hyaline membranes, granulocyte infiltration and increased pulmonary and systemic vascular permeability. This can result in progressive respiratory failure and death. In surfactant deficient lungs this...
A prospective randomised trial was conducted in critically ill patients to evaluate a computer aided pharmacokinetic method of aminoglycoside dose prediction based on 3 measured plasma concentrations following the loading dose. The ability of this method to achieve therapeutic plasma aminoglycoside concentrations early in the course of treatment wa...
Our experience of assisted ventilation in severe childhood asthma over a three year period is reviewed. One per cent of children with an acute attack of asthma required ventilatory support during this time. There were no deaths and no long term sequelae resulting from assisted ventilation. The number of children requiring this type of management ho...
A retrospective survey was conducted of all patients with severe aspiration pneumonitis requiring artificial ventilation in our Intensive Care Unit from 1982-1986 inclusive. Of 38 patients, 8 (21%) died. Five of these deaths were due to severe primary intracranial pathology, and occurred after complete or almost complete resolution of the pneumonit...
Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO 2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function.
There are several possible mech...
Citations
... Тому карбоксітерапія, використання CO 2 , може збільшити церебральну перфузію під час каротидної ендартеректомії, прискорювати вихід з наркозу, лікування оклюзії артерії сітківки [11] та інших патологій організму. Відомо, що високий об`єм дихання (ОД) викликає або потенціює пошкодження легень [7], тоді як менший ОД часто призводить до підвищеного PaCO 2 , так званої пермісивної гіперкапнії, яку пов'язують з кращим виживанням організму [21]. Ризик низького ОД не обмежується гострим ушкодженням легень або респіраторним дистрес-синдромом. ...
... As this change is visibly different for each person, the use of prediction methods tailored to a person's lung mechanics has significant potential in aiding clinical decisions and preventing overdistension. Currently, no effective standardised clinical method exists to determine optimal patient-specific PEEP, leading to uncertainty, variability, and increased risk [13,28,[30][31][32][33]. Model-based methods are one way of personalising care [28]. ...
... Over the past 10 years, a consensus has emerged concerning the need to limit plateau pressure during MV while maintaining a lung recruitment strategy with limitation of tidal volume (50). The so-called permissive hypercapnic acidosis observed at the "price" of this strategy has even been suggested to be one of the benefits of lung-protective ventilation (51). However, this point of view was challenged by several studies which suggested that hypercapnia may impair renal hemodynamics. ...
... Gentamycin clearance performed the best, being within 10% of the value on 44% of occasions and within 20% on 78% of occasions. Gentamycin clearance has previously been shown to be a better estimate of creatinine clearance than the 24-h urine estimate in a study using inulin as the comparator [63][64][65][66]. Giving aminoglycosides for the estimation of renal function alone may not be a wise option but in patients who are therapeutically prescribed aminoglycosides, their clearance may serve as one of the better options in estimating renal function. ...
... This 'permissive hypercapnia' (PaCO 2 >45 mmHg) has been adopted as the preferred approach versus normo-or hypocapnic targets in the setting of ALI/ARDS. Having been first demonstrated to be effective in the setting of acute severe asthma (52) in 1984, the strategy was then trialled by Hickling (53) for ARDS in the 1990s. This hypercapnia is accompanied by an acidosis in the acute phase, which is gradually then subjected to renal and tissue buffering. ...
... The low TV and low platform pressure of LPVS inevitably lead to an increase in PaCO 2 ; this increase in PaCO 2 is known as permissive hypercapnia. [30] However, this study found that CPAP combined with small-tidal-volume ventilation mode on the NL can effectively resist the occurrence of this event. In our study, compared with C group, patients in the LP and HP groups had significantly decreased PaCO 2 at T1 and T2 [P < 0.05, Table 2]. ...
... An excellent narrative review describes the history of nomograms and forecasting solutions for use in aminoglycoside dose adaptation [24]. Nomograms based on drug concentrations have been found to result in under-dosing in some patients [25,26], including in the critical care setting [27]. While superior to nomograms, Sawchuk and Zaske's computationally simple, one-compartment model for individualizing dosing requires several samples [28]. ...
... [10,11] Mortality rates ranging from 0% to 85% due to AP have been reported in the literature, and this rate increases with age in very elderly patients. [12] The aim of this study is to reveal the demographic and clinical parameters that affect the treatment results and mortality in the very elderly patient group hospitalized due to AP in the ICU in our clinic. ...
... ARDS can make effective ventilation management extremely difficult to achieve. Airway pressures and volumes are generally kept minimal in an effort to provide effective gas exchange without further damage or inflammation to the lungs (Hickling, Downward, Davis, & A'Court, 1986). ...
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... Some have suggested that trauma as an ARDSetiology may be followed by higher survival (59). It is the existence of such differences that makes interpretation of clinical outcomes difficult (60). The inclusion of concurrent control subjects and the control of medical care process (for example, through the use of computerized protocols) in clinical investigation are important responses to this problem. ...
