Clinics in chest medicine
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Many new approaches to mechanical ventilation have been developed. This article discusses these new strategies and modes. These include lung protection conventional ventilation strategies, long inspiratory time strategies, pressure-targeted breath enhancements, airway pressure-related release ventilation, and proportional-assist ventilation.
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This article reviews selected topics relevant to the use of mechanical ventilation in patients with severe airflow obstruction. Areas discussed include the bedside assessment of respiratory system mechanics, the ventilatory determinants of dynamic pulmonary hyperinflation, the role of controlled hypoventilation with permissive hypercapnia, and the delivery of bronchodilators during mechanical ventilation.
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Patient-ventilator synchrony is important in the management of the ventilator-dependent patient. Factors inherent to the patient and the ventilator influence patient-ventilator synchrony. Detection of patient-ventilator synchrony may require monitoring of airway pressure and flow waveforms.
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Adjunctive ventilatory strategies have been developed to improve oxygenation and carbon dioxide (CO2) removal during mechanical ventilation of critically ill patients. These techniques allow clinicians to attain their clinical goals at lower levels of ventilatory support. In this article, the authors discuss extracorporeal CO2 removal, venovenous intravena caval oxygenator, and tracheal gas insufflation as adjuncts to CO2 removal and nitric oxide, surfactant replacement therapy, perfluorocarbon-associated gas exchange, and prone positioning as adjuncts to oxygenation.
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Clinics in chest medicine · Sep 1996
ReviewPressure-controlled and volume-cycled mechanical ventilation.
Pressure and volume modes of mechanical ventilation are available as options in the current generation of ventilators, giving clinicians many choices when managing a mechanically ventilated patient. In volume cycled ventilation, tidal volume is set and airway pressures are measured, whereas in pressure-controlled ventilation, pressure is set and volume is measured. This article reviews the characteristics of these two ventilatory modes and discusses in detail conversion from one mode to the other. Pertinent clinical studies and recent direct comparisons of volume-cycled and pressure-controlled ventilation are reviewed.