Critical care clinics
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This article provides a review of respiratory mechanics that can be monitored in ventilator-dependent patients during passive and spontaneous breathing. Special focus is placed on resistance, compliance, and work of breathing. A description of methods and techniques, and a summary of clinical observations and applications in critically-ill patients are also included.
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Critical care clinics · Oct 1998
ReviewNon-conventional respiratory support modalities applicable in the older child. High frequency ventilation and liquid ventilation.
HFV, LV, and several other novel therapies offer promise to adults and children that the mortality associated with respiratory failure may be affected. Although there are several forms of HFV, HFOV is presently gaining favor in the treatment of severe respiratory failure and has generally supplanted HFJV in pediatric critical care. HFOV has the advantage of having an active expiratory phase, which helps to minimize air trapping and better modulate mean lung volume. ⋯ Human trials are presently underway, but the optimal delivery of this novel therapy still necessitates extensive investigation. TLV is likely even more removed from general clinical application given the necessity of developing a new generation of ventilators for the delivery of liquid tidal volumes. How these and other modalities may piece together to improve the condition of our patients who have respiratory failure remains to be seen, but certainly, present and future investigation will be intriguing for years to come.
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When patients suffer prolonged mechanical ventilation, physicians are faced with a series of decisions beginning in the intensive care unit (ICU) and extending into a broadening spectrum of post-ICU levels of care. This article reviews current thinking and outcome data on when and how to perform the tracheostomy, as well as when and where the patient should be transferred from the ICU for continued weaning efforts or support. Decannulation after success in weaning and continuation of ventilation at home are also addressed.