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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 -
Respiratory Care Jul 2021Despite its life-saving nature, invasive mechanical ventilation does not come without risk, and the avoidance of invasive mechanical ventilation is the primary goal of... (Review)
Review
Despite its life-saving nature, invasive mechanical ventilation does not come without risk, and the avoidance of invasive mechanical ventilation is the primary goal of noninvasive respiratory support. Noninvasive respiratory support in the form of continuous or bi-level positive airway pressure were considered the only viable options to accomplish this for many years. Innovation and research have led to high-flow nasal cannula being added to the list of specialized therapies clinically shown to reduce escalation of care and intubation rates in patients presenting with acute respiratory failure. The amount of research being performed in this clinical space is impressive, to say the least, and it is rapidly evolving. It is the responsibility of the clinicians trained to use these therapies in the management of respiratory failure to understand the currently available evidence, benefits, and risks associated with the type of noninvasive respiratory support being used to treat our patients.
Topics: Cannula; Humans; Noninvasive Ventilation; Respiration, Artificial; Respiratory Insufficiency
PubMed: 34210742
DOI: 10.4187/respcare.09247 -
Anesthesiology Oct 2022
Topics: Humans; Intraoperative Care; Positive-Pressure Respiration; Respiration, Artificial; Tidal Volume
PubMed: 36137258
DOI: 10.1097/ALN.0000000000004366 -
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 -
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 -
Anaesthesiology Intensive Therapy 2013Mechanical ventilation of disease-affected lungs, as well as being an inadequate mode of ventilation for initially healthy lungs, can cause significant changes in their... (Review)
Review
Mechanical ventilation of disease-affected lungs, as well as being an inadequate mode of ventilation for initially healthy lungs, can cause significant changes in their structure and function. In order to differentiate these processes, two terms are used: ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). In both cases, lung injury primarily results from differences in transpulmonary pressure - a consequence of an imbalance between lung stress and strain. This paper focuses on changes in lung structure and function due to this imbalance. Moreover, in this context, barotrauma, volutrauma and atelectrauma are interpreted, and the importance of signal transduction as a process inducing local and systemic inflammatory responses (biotrauma), is determined. None of the assessed methods of reducing VALI and VILI has been found to be entirely satisfactory, yet studies evaluating oscillatory ventilation, liquid ventilation, early ECMO, super-protective ventilation or noisy ventilation and administration of certain drugs are under way. Low tidal volume ventilation and adequately adjusted PEEP appear to be the best preventive measures of mechanical ventilation in any setting, including the operating theatre. Furthermore, this paper highlights the advances in VILI/VALI prevention resulting from better understanding of pathophysiological phenomena.
Topics: Animals; Barotrauma; Humans; Lung; Positive-Pressure Respiration; Respiration, Artificial; Signal Transduction; Tidal Volume; Ventilator-Induced Lung Injury
PubMed: 24092514
DOI: 10.5603/AIT.2013.0034 -
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 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 -
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 -
Respiratory Care Jun 2013Patient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony... (Review)
Review
Patient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony between the patient and ventilator is complex and can be affected by the ventilator settings, type of ventilator, patient-ventilator interface, and sedation. Inspections of airway pressure and flow waveforms are reliable methods for detecting asynchrony, and automated detection seems accurate. A number of types of asynchronies have been defined, and asynchrony during invasive and noninvasive ventilation have different calling cards. There is a clear association between asynchrony, ventilator-induced diaphragmatic dysfunction, and duration of mechanical ventilation. Whether these are cause and effect or simply associated remains to be determined.
Topics: Dyspnea; Humans; Pulmonary Ventilation; Respiration, Artificial; Respiratory Mechanics; Respiratory Muscles; Ventilators, Mechanical; Work of Breathing
PubMed: 23709195
DOI: 10.4187/respcare.02507