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Emergencias : Revista de La Sociedad... Feb 2021
Topics: Emergency Service, Hospital; Humans; Noninvasive Ventilation; Respiration, Artificial
PubMed: 33496391
DOI: No ID Found -
Paediatric Anaesthesia Feb 2022Extraordinary progress has been made during the past few decades in the development of anesthesia machines and ventilation techniques. With unprecedented precision and... (Review)
Review
Extraordinary progress has been made during the past few decades in the development of anesthesia machines and ventilation techniques. With unprecedented precision and performance, modern machines for pediatric anesthesia can deliver appropriate mechanical ventilation for children and infants of all sizes and with ongoing respiratory diseases, ensuring very small volume delivery and compensating for circuit compliance. Along with highly accurate monitoring of the delivered ventilation, modern ventilators for pediatric anesthesia also have a broad choice of ventilation modalities, including synchronized and assisted ventilation modes, which were initially conceived for ventilation weaning in the intensive care setting. Despite these technical advances, there is still room for improvement in pediatric mechanical ventilation. There is a growing effort to minimize the harm of intraoperative mechanical ventilation of children by adopting the protective ventilation strategies that were previously employed only for prolonged mechanical ventilation. More than ever, the pediatric anesthesiologist should now recognize that positive-pressure ventilation is potentially a harmful procedure, even in healthy children, as it can contribute to both ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction. Therefore, careful choice of the ventilation modality and its parameters is of paramount importance to optimize gas exchange and to protect the lungs from injury during general anesthesia. The present report reviews the novel ventilation techniques used for children, discussing the advantages and pitfalls of the ventilation modalities available in modern anesthesia machines, as well as innovative ventilation modes currently under development or research. Several innovative strategies and devices are discussed. These novel modalities are likely to become part of the armamentarium of the pediatric anesthesiologist in the near future and are particularly relevant for challenging ventilation scenarios.
Topics: Anesthesia, General; Child; Humans; Infant; Lung; Positive-Pressure Respiration; Respiration, Artificial; Ventilators, Mechanical
PubMed: 34837438
DOI: 10.1111/pan.14344 -
Critical Care Medicine Nov 2023
Topics: Diaphragm; Respiration, Artificial; Lung
PubMed: 37902352
DOI: 10.1097/CCM.0000000000006013 -
Anesthesiology Oct 2022
Topics: Humans; Intraoperative Care; Positive-Pressure Respiration; Respiration, Artificial; Tidal Volume
PubMed: 36137258
DOI: 10.1097/ALN.0000000000004366 -
Current Opinion in Anaesthesiology Apr 2021The aim of this study was to review the most recent literature on mechanical ventilation strategies in patients with septic shock. (Review)
Review
PURPOSE OF REVIEW
The aim of this study was to review the most recent literature on mechanical ventilation strategies in patients with septic shock.
RECENT FINDINGS
Indirect clinical trial evidence has refined the use of neuromuscular blocking agents, positive end-expiratory pressure (PEEP) and recruitment manoeuvres in septic shock patients with acute respiratory distress syndrome. Weaning strategies and devices have also been recently evaluated. The role of lung protective ventilation in patients with healthy lungs, while recognized, still needs to be further refined. The possible detrimental effects of spontaneous breathing in patients who develop acute respiratory distress syndrome is increasingly recognized, but clinical trial evidence is still lacking to confirm this hypothesis. A new concept of lung and diaphragm protective is emerging in the critical care literature, but its application will need a complex intervention implementation approach to allow adequate scrutiny of this concept and uptake by clinicians.
SUMMARY
Many advances in the management of the mechanically ventilated patient with sepsis and septic shock have occurred in recent years, but clinical trial evidence is still necessary to translate new hypotheses to the bedside and find the right balance between benefits and risks of these new strategies.
Topics: Humans; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Septic
PubMed: 33470664
DOI: 10.1097/ACO.0000000000000955 -
Respiratory Care Mar 2023Intermittent mandatory ventilation (IMV) is one kind of breath sequence used to classify a mode of ventilation. IMV is defined as the ability for spontaneous breaths... (Review)
Review
Intermittent mandatory ventilation (IMV) is one kind of breath sequence used to classify a mode of ventilation. IMV is defined as the ability for spontaneous breaths (patient triggered and patient cycled) to exist between mandatory breaths (machine triggered or machine cycled). Over the course of more than a century, IMV has evolved into 4 distinct varieties, each with its own advantages and disadvantages in serving the goals of mechanical ventilation (ie, safety, comfort, and liberation). The purpose of this paper is to describe the evolution of IMV, review relevant supporting evidence, and discuss the rationales for each of the 4 varieties. Also included is a brief overview of the background information required for a proper perspective of the purpose and design of the innovations. Understanding these different forms of IMV is essential to recognizing the similarities and differences among many dozens of different modes of ventilation. This recognition is important for clinical application, education of caregivers, and research in mechanical ventilation.
Topics: Humans; Intermittent Positive-Pressure Ventilation; Respiration, Artificial; Respiration
PubMed: 36195349
DOI: 10.4187/respcare.10184 -
Anesthesia and Analgesia Nov 2022
Topics: Humans; Respiration, Artificial; Tidal Volume; Positive-Pressure Respiration; Intraoperative Care
PubMed: 36269986
DOI: 10.1213/ANE.0000000000006158 -
Respiratory Medicine Mar 2024Ventilator-induced diaphragm dysfunction is gaining increased recognition. Evidence of diaphragm weakness can manifest within 12 h to a few days after the initiation of... (Review)
Review
Ventilator-induced diaphragm dysfunction is gaining increased recognition. Evidence of diaphragm weakness can manifest within 12 h to a few days after the initiation of mechanical ventilation. Various noninvasive and invasive methods have been developed to assess diaphragm function. The implementation of diaphragm-protective ventilation strategies is crucial for preventing diaphragm injuries. Furthermore, diaphragm neurostimulation emerges as a promising and novel treatment option. In this rapid review, our objective is to discuss the current understanding of ventilator-induced diaphragm dysfunction, diagnostic approaches, and updates on strategies for prevention and management.
Topics: Humans; Diaphragm; Respiration, Artificial; Ventilators, Mechanical; Respiration; Lung
PubMed: 38290603
DOI: 10.1016/j.rmed.2024.107541 -
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 -
Air Medical Journal 2020
Review
Topics: Critical Care; Emergency Medical Services; Female; Humans; Male; Practice Guidelines as Topic; Respiration, Artificial; Ventilator Weaning
PubMed: 32044076
DOI: 10.1016/j.amj.2019.09.014