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British Journal of Anaesthesia Jan 2023Patient self-inflicted lung injury may be associated with worse clinical outcomes and higher mortality. Patient-ventilator asynchrony is associated with increased...
Patient self-inflicted lung injury may be associated with worse clinical outcomes and higher mortality. Patient-ventilator asynchrony is associated with increased ventilator days and mortality, and it has been hypothesised as one of the important mechanisms leading to patient self-inflicted lung injury. However, given the observational nature of the key studies in the field so far, the hypothesis that patient-ventilator asynchrony causes patient self-inflicted lung injury has not been supported by evidence yet. Wittenstein and colleagues present a novel approach that enables controlling patient-ventilator asynchrony in a pig model of acute lung injury, to investigate the patient-ventilator asynchrony and patient self-inflicted lung injury causality. Their results suggest that increased patient-ventilator asynchrony associated with poor clinical outcomes reported in observational trials could be a marker, rather than a cause of patient self-inflicted lung injury. These findings on their own are not sufficient to justify a greater tolerance of patient-ventilator asynchrony amongst clinicians, a change for which further experimental work and clinical evidence is needed.
Topics: Swine; Animals; Lung; Ventilators, Mechanical; Acute Lung Injury; Respiration, Artificial
PubMed: 34903360
DOI: 10.1016/j.bja.2021.11.020 -
Respiratory Care May 2019Patients who require mechanical ventilation in the prehospital and emergency department environments experience high mortality and are at high risk of... (Review)
Review
Patients who require mechanical ventilation in the prehospital and emergency department environments experience high mortality and are at high risk of ventilator-associated ventilator-induced lung injury and ARDS. In addition, little attention has been given in the literature, trainee education, or clinical emphasis to ventilator management in these patients. ARDS and ventilator-induced lung injury are time-sensitive disease processes that develop early in mechanical ventilation and could potentially be prevented with early lung-protective ventilation. Prehospital and emergency department ventilation, in general, is characterized by potentially injurious tidal volume, high F , and low PEEP. Recent literature highlights improved subjects outcomes in the setting of early lung-protective ventilation in both subjects with and those without ARDS. This review of the literature led us to recommend that lung-protective ventilation with avoidance of hyperoxia be the default goal ventilator strategy for all patients with prehospital and emergency department mechanical ventilation. This can be achieved by delivering low tidal volumes with stepwise, concurrent titration of F and PEEP to facilitate adequate oxygenation.
Topics: Emergency Service, Hospital; Emergency Treatment; Humans; Hyperoxia; Respiration, Artificial; Time Factors; Ventilator-Induced Lung Injury
PubMed: 31023880
DOI: 10.4187/respcare.06888 -
The Journal of Medical Investigation :... 2022Mechanical ventilation injures not only the lungs but also the diaphragm, resulting in dysfunction associated with poor outcomes. The chief mechanisms of... (Review)
Review
Mechanical ventilation injures not only the lungs but also the diaphragm, resulting in dysfunction associated with poor outcomes. The chief mechanisms of ventilator-induced diaphragm dysfunction are : disuse atrophy due to insufficient contraction and excessive ventilatory support ; concentric load-induced injury due to excessive contraction and insufficient ventilatory support ; eccentric load-induced injury due to contraction during the expiratory phase ; and longitudinal atrophy caused by high positive end-expiratory pressure. To protect the diaphragm during mechanical ventilation, maintaining proper levels of diaphragm contraction is paramount ; thus, monitoring of respiratory effort and finely tuned ventilator settings are necessary. Furthermore, maintaining of synchronization between the patient and the ventilator is also important. As diaphragm dysfunction is more likely to occur in critically ill patients, diaphragm-protective mechanical ventilation strategies are essential to reduce the mortality rate of intensive care unit patients. This review outlines clinical evidence of ventilator-induced diaphragm dysfunction and its underlying mechanisms, and strategies to facilitate diaphragm-protective mechanical ventilation. J. Med. Invest. 69 : 165-172, August, 2022.
Topics: Diaphragm; Humans; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Insufficiency; Ventilators, Mechanical
PubMed: 36244765
DOI: 10.2152/jmi.69.165 -
Respiratory Care Apr 2015Mechanical ventilation is an important and ever-evolving component of everyday critical care. Clinicians can struggle to keep up with current literature and descriptions... (Review)
Review
Mechanical ventilation is an important and ever-evolving component of everyday critical care. Clinicians can struggle to keep up with current literature and descriptions of advancement in a way that they can apply these changes to their bedside patient care. This article serves as a review of important recent findings related to invasive mechanical ventilation and describes their relevance to bedside critical care.
Topics: Critical Care; Humans; Respiration, Artificial; Respiratory Insufficiency
PubMed: 25784772
DOI: 10.4187/respcare.04112 -
Respiratory Care Nov 2022Mechanical ventilation is commonly used in the pediatric intensive care unit. This paper reviews studies of pediatric mechanical ventilation published in 2021. Topics... (Review)
Review
Mechanical ventilation is commonly used in the pediatric intensive care unit. This paper reviews studies of pediatric mechanical ventilation published in 2021. Topics include physiology, ventilator modes, alarms, disease states, airway suctioning, ventilator liberation, prolonged ventilation, and others.
Topics: Humans; Child; Respiration, Artificial; Intensive Care Units, Pediatric; Respiratory Therapy; Respiration; Suction; Ventilator Weaning; Airway Extubation
PubMed: 36100276
DOI: 10.4187/respcare.10311 -
Anesthesiology Apr 2015
Topics: Humans; Lung; Perioperative Care; Respiration, Artificial; Respiratory Function Tests
PubMed: 25668412
DOI: 10.1097/ALN.0000000000000606 -
Current Opinion in Critical Care Feb 2019This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to... (Review)
Review
PURPOSE OF REVIEW
This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited.
RECENT FINDINGS
Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.
SUMMARY
The management of patients with acute respiratory failure in LMICs should focus on avoiding intubation where possible, improving the safety of mechanical ventilation and expediting weaning. Future directions should involve the development and trialing of robust and context-appropriate respiratory support technology.
Topics: Child; Continuous Positive Airway Pressure; Humans; Noninvasive Ventilation; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 30531535
DOI: 10.1097/MCC.0000000000000568 -
Jornal Brasileiro de Pneumologia :... 2015Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the... (Review)
Review
Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients.
Topics: Administration, Inhalation; Bronchodilator Agents; Drug Delivery Systems; Female; Humans; Lung; Male; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Respiration, Artificial
PubMed: 26578139
DOI: 10.1590/S1806-37132015000000035 -
Respiratory Care May 2017The fundamental goals of mechanical ventilation are to improve pulmonary gas exchange and relieve respiratory distress, thus permitting lung and airway healing, while at... (Review)
Review
The fundamental goals of mechanical ventilation are to improve pulmonary gas exchange and relieve respiratory distress, thus permitting lung and airway healing, while at the same time lessening the risk for iatrogenic complications. This review will summarize some of the advances in mechanical ventilation in 2016, with a particular focus on ventilator-associated clinical challenges and outcomes.
Topics: Humans; Pulmonary Gas Exchange; Respiration, Artificial; Respiratory Distress Syndrome; Ventilator Weaning; Ventilator-Induced Lung Injury
PubMed: 28442589
DOI: 10.4187/respcare.05545 -
Respiratory Care Apr 2018Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical... (Review)
Review
Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical ventilation and negatively affect patient comfort, duration of mechanical ventilation, length of ICU stays, and mortality. Identifying asynchronies requires careful attention to patients and their ventilator waveforms. This review discusses the different types of asynchronies, how they are generated, and their impact on patient comfort and outcome. Moreover, it discusses practical approaches for detecting, correcting, and preventing asynchronies. Current evidence suggests that the best approach to managing asynchronies is by adjusting ventilator settings. Proportional modes improve patient-ventilator coupling, resulting in greater comfort and less dyspnea, but not in improved outcomes with respect to the duration of mechanical ventilation, delirium, or cognitive impairment. Advanced computational technologies will allow smart alerts, and models based on time series of asynchronies will be able to predict and prevent asynchronies, making it possible to tailor mechanical ventilation to meet each patient's needs throughout the course of mechanical ventilation.
Topics: Humans; Periodicity; Pulmonary Ventilation; Respiration Disorders; Respiration, Artificial; Respiratory Mechanics; Ventilators, Mechanical
PubMed: 29487094
DOI: 10.4187/respcare.05949