After admission to the ICU, patients were connected to Evita 4 ventilators (Dräger Medical, Lübeck, Germany). All patients were ventilated with volume-controlled ventilation in assist control mode for the first 30 min. The tidal volume was set to 6–8 ml/kg per kilogram of predicted body weight according to the plateau pressure (Pplat) (to maintain Pplat <30 cm H2O); the Pplat measured during conventional ventilation by using the ventilator’s inspiratory pause control. The levels of PEEP and FiO2 were based on the patient’s underlying clinical condition to obtain an SpO2 of 90%–95% or an arterial partial pressure of O2 (PaO2) of 60–80 mmHg. The respiratory rate was set to maintain a partial pressure of arterial carbon dioxide (PaCO2) between 35 and 45 mmHg. A stepwise maximum alveolar recruitment maneuver (RM) was performed in all patients.
Evita 4
Manufactured by Dräger
Sourced in Germany
The Evita 4 is a ventilator designed for intensive care units. It is a versatile device that provides respiratory support to patients. The Evita 4 offers a range of ventilation modes and features to meet the needs of various patient populations.
Automatically generated - may contain errors
Lab products found in correlation
Evita xl, by Dräger (2 mentions)
Propofol 1, by Fresenius (1 mentions)
Eit evaluation kit 2, by Dräger (1 mentions)
Dormicum, by Roche (1 mentions)
Fentanyl janssen, by Johnson & Johnson (1 mentions)
Midazolam, by Johnson & Johnson (1 mentions)
Optiflow, by Fisher & Paykel Healthcare (1 mentions)
Servo i, by Getinge (1 mentions)
12 protocols using evita 4
1
Ventilation Protocol for ICU Patients
2
Anesthesia Protocol for Porcine Studies
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In total, seven healthy German landrace hybrid pigs (bodyweight 62.5 ± 5.0 kg (mean ± SD), either sex) were included in the study. Each pig was fasted for 8 h and premedicated with 0.5 mg·kg− 1 midazolam (Dormicum, Roche, Grenzach- Wyhlen, Germany) and 20 mg·kg− 1 ketamine hydrochloride (Ketamin 10%, Intervet, Unterschleißheim, Germany). Anesthesia was induced by intravenous (i.v.) administration of 2 mg·kg− 1 propofol (Propofol 1%, Fresenius Kabi, Bad Homburg, Germany) and sustained with infusions of 1–2 mg·kg− 1·h− 1 midazolam, 4–6 mg·kg− 1·h− 1 ketamine hydrochloride and 10 μg·kg− 1·h− 1 fentanyl citrate (Fentanyl Janssen, Janssen-Cilag, Neuss, Germany). Vecuronium 0.5 mg·kg− 1·h− 1 (Vecuronium-Inresa, Inresa, Freiburg, Germany) was administered as a neuro-muscular blocking agent. Volume-controlled ventilation (Evita 4, Dräger Medical, Lübeck, Germany) was started after intubation with a respiratory frequency of 15 breaths per minute, tidal volume 8 ml·kg− 1 and PEEP 8 cm H2O. The I:E ratio was set to 1:1.5 and inspired oxygen fraction (FIO2) was kept at 0.21. All pigs were kept in the supine position throughout the procedure. For electrical impedance tomography (EIT) recordings (EIT Evaluation KIT II, Dräger Medical, Lübeck, Germany), each pig was equipped with an electrode belt placed transversally around the mid thorax.
3
Evaluating Ventilator Settings in Patients
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All patients were measured by an Evita 4 ventilator (Dräger Medical, Lübeck, Germany), which was connected to a laptop with Ventview (Dräger Medical, Lübeck, Germany) software for data collection. Appropriate sedation and muscle relaxation were given to patients with spontaneous respiration. Upon measurement, ventilators were set at volume-controlled mode with a constant flow which was adjusted to avoid harmfully high airway pressure. Inspiratory time was lengthened to generate an inspiratory hold long enough for measuring plateau pressure. Various combinations of VT (6, 8, and 10 ml per kg of body weight) and PEEPs (5 and 10 cmH2O) were set during measurement. Raw data of airway pressure, flow and volume during the measurement were downloaded to the laptop via Medibus protocol with a sampling rate of 67 Hz for subsequent offline analysis.
4
Fluid Responsiveness Assessment in Septic Shock
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This study was conducted in the 25-bed medical intensive care unit of Paris-Saclay university, Bicêtre hospital, from March to September 2018. It was approved by the institutional review board of our institution (Comité pour la protection des personnes Ile-de-France VII). Patients or their next of kin were informed about the study and accepted to participate.
Patients were included if they met all the following criteria: septic shock [7 (link)], continuous intravenous administration of NE, mechanical ventilation in the volume assist-control mode (Evita 4 or V500, Dräger, Lübeck, Germany), haemodynamic monitoring by a PiCCO2 device (PULSION Medical Systems, Feldkirchen, Germany), haemodynamic stability as defined by no change in the mean arterial pressure and in cardiac index (CI) > 10% for at least 30 min [2 (link)], decision of the attending physicians to decrease the dose of NE in order to reach a predefined target of mean arterial pressure (65–70 mmHg by default, 80–85 mmHg in previously hypertensive patients [8 (link)]). Patients were not included consecutively but depending on the availability of the investigators.
Patients were excluded in case of age < 18 years, pregnancy, head trauma (contraindication to PLR) and intra-abdominal hypertension [9 (link)] or venous compression stockings (both responsible for some false-negatives of the PLR test).
Patients were included if they met all the following criteria: septic shock [7 (link)], continuous intravenous administration of NE, mechanical ventilation in the volume assist-control mode (Evita 4 or V500, Dräger, Lübeck, Germany), haemodynamic monitoring by a PiCCO2 device (PULSION Medical Systems, Feldkirchen, Germany), haemodynamic stability as defined by no change in the mean arterial pressure and in cardiac index (CI) > 10% for at least 30 min [2 (link)], decision of the attending physicians to decrease the dose of NE in order to reach a predefined target of mean arterial pressure (65–70 mmHg by default, 80–85 mmHg in previously hypertensive patients [8 (link)]). Patients were not included consecutively but depending on the availability of the investigators.
Patients were excluded in case of age < 18 years, pregnancy, head trauma (contraindication to PLR) and intra-abdominal hypertension [9 (link)] or venous compression stockings (both responsible for some false-negatives of the PLR test).
5
Volatile Acetone Levels in ICU Patients
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With approval from the responsible ethics committee (identification number 232/14, Ärztekammer Saarland, Saarbrücken, Germany) and in accordance with the STROBE guidelines, volatile acetone concentrations were evaluated in ten sedated, intubated, and mechanically ventilated adults from a surgical intensive care unit. Written consent was obtained from either patients or legal guardians.
Patients were ventilated with an intensive care respirator (EVITA 4, Dräger, Lübeck, Germany) with ventilation parameters and oxygen concentrations adjusted to maintain physiological blood gas values. A polytetrafluoroethylene tube was connected near each patient's endotracheal tube. 10 ml mixed inspired and expired gas samples were aspirated from the breathing circuit at 30-minute intervals for a period of twelve hours.
Patients were ventilated with an intensive care respirator (EVITA 4, Dräger, Lübeck, Germany) with ventilation parameters and oxygen concentrations adjusted to maintain physiological blood gas values. A polytetrafluoroethylene tube was connected near each patient's endotracheal tube. 10 ml mixed inspired and expired gas samples were aspirated from the breathing circuit at 30-minute intervals for a period of twelve hours.
6
High-flow Oxygen and Non-invasive Ventilation Post-extubation
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In the HFNC group, a high-flow device (Optiflow; Fisher & Paykel Healthcare, Auckland, New Zealand) was utilized. The humidifier temperature was set at 37°C via large-bore bi-nasal prongs, and inspired oxygen (FiO2) was adjusted to maintain oxygen saturation by pulse oximetry (SpO2) ≥90%. The flow was initially set at 10 L/min and titrated upward in 5 L/min steps until patients experienced discomfort.
NIV was delivered with an oro-nasal mask (Fisher & Paykel Health-care) connected to an ICU ventilator with a dedicated NIV mode (Evita XL, Evita 4, or Evita 2 dura, Dräger, Lübeck, Germany) equipped with a heated humidifier. Patients were ventilated by NIV with a pressure support level targeting a tidal volume of 6–8 mL/kg; the inspiratory positive airway pressure (IPAP) was initiated at 10–12 cmH2O, and the expiratory positive airway pressure (EPAP) started at 4–5 cmH2O. FIO2 was adjusted to maintain SpO2 ≥90%.
We continuously monitored patients’ vital signs and arterial blood gases. We did not allow meals during the first 24 h after extubation to avoid aspiration. Cough and expectoration were assisted by respiratory therapists.
NIV was delivered with an oro-nasal mask (Fisher & Paykel Health-care) connected to an ICU ventilator with a dedicated NIV mode (Evita XL, Evita 4, or Evita 2 dura, Dräger, Lübeck, Germany) equipped with a heated humidifier. Patients were ventilated by NIV with a pressure support level targeting a tidal volume of 6–8 mL/kg; the inspiratory positive airway pressure (IPAP) was initiated at 10–12 cmH2O, and the expiratory positive airway pressure (EPAP) started at 4–5 cmH2O. FIO2 was adjusted to maintain SpO2 ≥90%.
We continuously monitored patients’ vital signs and arterial blood gases. We did not allow meals during the first 24 h after extubation to avoid aspiration. Cough and expectoration were assisted by respiratory therapists.
7
Anesthesia Induction and Monitoring Protocol
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After a fasting period of 12 h, the animals were premedicated with an intramuscular injection of ketamine (20 mg kg−1) and midazolam (0.5 mg kg−1). Anaesthesia was induced intravenously with propofol (2 to 4 mg kg−1) and vecuronium (0.4 mg kg−1) and was maintained via continuous infusions of midazolam (0.5 to 1.5 mg kg−1 h−1), ketamine (10 to 30 mg kg−1 h−1), vecuronium (0.2 to 0.4 mg kg−1 h−1) and fentanyl (3 to 6 μg kg−1 h−1). After orotracheal intubation with a standard endotracheal tube (ETT) with an inner diameter (ID) of 8.0 mm, VCV was started (Evita 4; Dräger Medical, Lübeck, Germany) with FiO2 of 0.3, PEEP of 5 cmH2O, tidal volume (VT) of 8 ml kg−1 and inspiration to expiration (I : E) ratio of 1 : 2. The respiratory rate was set to achieve an etCO2 of 4.7 to 6 kPa and was adjusted further as needed. For pulmonary arterial pressure monitoring a pulmonary artery catheter (7F; Edwards Lifesciences, Irvine, California, USA) was inserted via an 8F introducer sheath placed in the left external jugular vein. An arterial catheter (5F; Pulsion Medical Systems, Feldkirchen, Germany) was placed in the femoral artery for blood pressure (BP) measurement and trans-cardiopulmonary thermodilution (PiCCO2; Pulsion Medical Systems). A urinary catheter was inserted into the bladder via a mini laparotomy. No other surgical procedure was performed.
8
Breath Analysis in Mechanically Ventilated Patients
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With approval by the responsible ethics committee (Ärztekammer Saarland, Saarbrücken, Germany Ref-No. 232/14), five sedated and mechanically ventilated adults were each evaluated for 12 h. Legal guardians or the patients themselves subsequently agreed in written form to participate in this study.
Patients were ventilated with an intensive care respirator (EVITA 4, Dräger, Lübeck, Germany) with ventilation parameters and oxygen concentrations adjusted to maintain physiological partial pressures of carbon dioxide and oxygen. They were ventilated with either pressure-supported or pressure-controlled modes. A MCC-IMS aspiration tube was connected to the endotracheal tube distal to a heat-and-moisture exchanging filter (Humid-Vent Filter Compact S, Teleflex Medical, Athlone, Ireland) by a polytetrafluoroethylene tube (Bohlender, Grünsfeld, Germany). Samples were aspirated from the breathing circuit at 30-min intervals.
Patients were ventilated with an intensive care respirator (EVITA 4, Dräger, Lübeck, Germany) with ventilation parameters and oxygen concentrations adjusted to maintain physiological partial pressures of carbon dioxide and oxygen. They were ventilated with either pressure-supported or pressure-controlled modes. A MCC-IMS aspiration tube was connected to the endotracheal tube distal to a heat-and-moisture exchanging filter (Humid-Vent Filter Compact S, Teleflex Medical, Athlone, Ireland) by a polytetrafluoroethylene tube (Bohlender, Grünsfeld, Germany). Samples were aspirated from the breathing circuit at 30-min intervals.
9
Mechanical Ventilation of Newborn Piglets
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As previously reported (15, 16) , 1-2-d-old male piglets were intubated and then mechanically ventilated (Evita 4; Dräger, Lübeck, Germany). Initial ventilator settings were: PEEP 5 cmH 2 O, respiratory rate 30 bpm, inspiratory time 0.5 s, peak inspiratory pressure as required for a tidal volume of 6 ml/Kg, FiO 2 0.21. Ventilatory parameters (by the ventilator's computerized pneumotachography), end-tidal CO 2 concentration and O 2 saturation (SpO 2 ) (Ohmeda 5250 RGM, Louisville, CO). hemodynamic parameters, EVLW content, and
10
Electrical Impedance Tomography in ARDS and CTS Patients
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Between January 2015 and August 2016, EIT was performed in mechanically ventilated ARDS patients and patients who underwent cardiothoracic surgery (CTS) as healthy pulmonary controls. ARDS was defined according to the Berlin definition [16 (link)]. All patients were admitted to our 33-bed mixed intensive care unit of a university medical centre. All patients were invasively ventilated in a pressure-controlled, time-cycled mode at a fixed driving pressure (plateau pressure minus PEEP) using an Evita-4 or Evita-XL ventilator (Dräger Medical GmbH, Lübeck, Germany). Tidal volumes between 6- and 8-ml kg− 1 predicted body weight were pursued. No strict institutional guidelines on PEEP setting were in use, and PEEP was set at the treating physician’s discretion, using a lung-protective strategy. Post CTS patients were usually ventilated with a PEEP of 8 cmH2O. Patients with the known pulmonary disease were excluded from the control group. Data are analysed retrospectively.
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