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Clinics in Perinatology Dec 2021For the newborns needing respiratory support at 36 weeks postmenstrual age, regardless of the type of ventilation used, it is critical to take into account the... (Review)
Review
For the newborns needing respiratory support at 36 weeks postmenstrual age, regardless of the type of ventilation used, it is critical to take into account the mechanics properties of both airways and lungs affected by severe bronchopulmonary dysplasia (sBPD). Ventilator strategies, settings, and weaning must change dramatically after sBPD is established, but to date there is almost no high-quality evidence base supporting a specific approach to guide the optimal ventilator management and weaning in patients with sBPD. Weaning from invasive mechanical ventilation, management of the immediately postextubation period, and weaning from noninvasive ventilation in patients with sBPD are the topics covered in this chapter.
Topics: Bronchopulmonary Dysplasia; Humans; Infant, Newborn; Noninvasive Ventilation; Respiration, Artificial; Ventilator Weaning; Ventilators, Mechanical
PubMed: 34774216
DOI: 10.1016/j.clp.2021.08.005 -
Pediatric Clinics of North America Jun 2022Children admitted to the pediatric intensive care unit often require respiratory support for the treatment of respiratory distress and failure. Respiratory support... (Review)
Review
Children admitted to the pediatric intensive care unit often require respiratory support for the treatment of respiratory distress and failure. Respiratory support comprises both noninvasive modalities (ie, heated humidified high-flow nasal cannula, continuous positive airway pressure, bilevel positive airway pressure, negative pressure ventilation) and invasive mechanical ventilation. In this article, we review the various essential elements and considerations involved in the planning and application of respiratory support in the treatment of the critically ill children.
Topics: Cannula; Child; Continuous Positive Airway Pressure; Humans; Intensive Care Units, Pediatric; Noninvasive Ventilation; Respiration, Artificial; Respiratory Insufficiency
PubMed: 35667763
DOI: 10.1016/j.pcl.2022.02.004 -
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 -
Critical Care Clinics Apr 2024Depending on the definitional criteria used, approximately 5% to 10% of critical adults will require prolonged mechanical ventilation with longer-term outcomes that are... (Review)
Review
Depending on the definitional criteria used, approximately 5% to 10% of critical adults will require prolonged mechanical ventilation with longer-term outcomes that are worse than those ventilated for a shorter duration. Outcomes are affected by patient characteristics before critical illness and its severity but also by organizational characteristics and care models. Definitive trials of interventions to inform care activities, such as ventilator weaning, upper airway management, rehabilitation, and nutrition specific to the prolonged mechanical ventilation patient population, are lacking. A structured and individualized approach developed by the multiprofessional team in discussion with the patient and their family is warranted.
Topics: Adult; Humans; Tracheostomy; Respiration, Artificial; Ventilator Weaning; Airway Management
PubMed: 38432703
DOI: 10.1016/j.ccc.2024.01.008 -
Seminars in Respiratory and Critical... Jun 2022A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation...
A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation from invasive mechanical ventilation is a critical aspect of patient care in the intensive care unit (ICU) and is a top research priority for patients and clinicians. In this article, we discuss how to (1) identify candidates for liberation from mechanical ventilation, (2) conduct spontaneous breathing trials (SBTs), and (3) optimize patients for liberation from mechanical ventilation. We also discuss the roles for (4) extubation to noninvasive ventilation and (5) newer modes of mechanical ventilation during liberation from mechanical ventilation. We conclude that, though substantial progress has been made in identifying patients who are likely to be liberated (e.g., through the use of SBTs) and management strategies that speed liberation from the ventilator (e.g., protocolized SBTs, lighter sedation, and early mobilization), many important questions regarding liberation from mechanical ventilation in clinical practice remain unanswered.
Topics: Airway Extubation; Critical Illness; Humans; Noninvasive Ventilation; Respiration, Artificial; Ventilator Weaning
PubMed: 35760299
DOI: 10.1055/s-0042-1747929 -
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 -
Driving Pressure and Mechanical Power: The Return of Physiology in Pediatric Mechanical Ventilation.Pediatric Critical Care Medicine : a... Oct 2021
Topics: Child; Humans; Positive-Pressure Respiration; Respiration, Artificial; Tidal Volume
PubMed: 34605787
DOI: 10.1097/PCC.0000000000002829 -
Computer Methods in Biomechanics and... May 2021In this paper, three different advanced mechanical ventilation modes, pressure regulated volume control ventilation (PRVC), proportional assist ventilation (PAV), and...
In this paper, three different advanced mechanical ventilation modes, pressure regulated volume control ventilation (PRVC), proportional assist ventilation (PAV), and adaptive support ventilation (ASV) are designed and simulated on the computer via MATLAB/Simulink. In the algorithms of advanced ventilation modes, a closed-loop control structure is used and recursive least squares method is considered for the estimation of respiratory mechanics. The designed algorithms are then applied to the human respiratory system model for the active and/or passive patient cases. Simulation results show that such algorithms can be designed and simulated on the computer successfully. In addition, the simulation environment helps us to understand the working principles of the advanced modes and to see the results such as ventilator waveforms, the effect of the parameter changes. Moreover, it also allows us to improve and test the algorithms and strategies quickly and efficiently.
Topics: Algorithms; Biomechanical Phenomena; Computer Simulation; Equipment Design; Humans; Interactive Ventilatory Support; Models, Biological; Respiration, Artificial
PubMed: 33164556
DOI: 10.1080/10255842.2020.1845319 -
Pediatric Research Nov 2021Neonatal respiratory failure is a common and serious clinical problem which in a considerable proportion of infants requires invasive mechanical ventilation. The basic... (Review)
Review
Neonatal respiratory failure is a common and serious clinical problem which in a considerable proportion of infants requires invasive mechanical ventilation. The basic goal of mechanical ventilation is to restore lung function while limiting ventilator-induced lung injury, which is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD). Over the last decades, new conventional mechanical ventilation (CMV) modalities have been introduced in clinical practice, aiming to assist clinicians in providing lung protective ventilation strategies. These modalities use more sophisticated techniques to improve patient-ventilator interaction and transfer control of ventilation from the operator to the patient. Knowledge on how these new modalities work and how they interact with lung physiology is essential for optimal and safe use. In this review, we will discuss some important basic lung physiological aspects for applying CMV, the basic principles of the old and new CMV modalities, and the evidence to support their use in daily clinical practice.
Topics: Bronchopulmonary Dysplasia; Humans; Infant, Newborn; Respiration, Artificial; Respiratory Insufficiency
PubMed: 31785591
DOI: 10.1038/s41390-019-0704-1 -
Nursing May 2024Mechanical ventilation is rarely a simple matter. Skill and knowledge are required to operate the ventilator modes, choose the optimal settings, and understand many...
Mechanical ventilation is rarely a simple matter. Skill and knowledge are required to operate the ventilator modes, choose the optimal settings, and understand many monitored variables. Supporting the patient safely and effectively is the top priority in providing mechanical ventilation. This article discusses mechanical ventilation in adults.
Topics: Adult; Humans; Respiration, Artificial; Ventilators, Mechanical
PubMed: 38640027
DOI: 10.1097/01.NURSE.0001009984.17145.03