Current opinion in critical care
-
To discuss the mechanisms of ventilator-induced lung injury and the pro and cons of the different approaches proposed by literature to minimize its impact in patients with acute respiratory distress syndrome. ⋯ If one of the essential teachings to young intensivists in the 1980s was to ensure mechanical ventilation restored being able to immediately drain a pneumothorax (barotrauma), nowadays priority we teach to young intensivists is to implement 'protective' ventilation to protect the lungs from the pulmonary and systemic effects of ventilator-induced lung injury (biotrauma). At the same time, priority of clinical research shifted from the search of optimal ventilator settings (best positive end-expiratory pressure) and to the evaluation of 'super-protective' ventilation that integrating partial or total extracorporeal support tries to minimize the use of mechanical ventilation.
-
Curr Opin Crit Care · Feb 2015
ReviewHow to ventilate patients without acute respiratory distress syndrome?
There is convincing evidence for benefit from lung-protective mechanical ventilation with lower tidal volumes in patients with the acute respiratory distress syndrome (ARDS). It is uncertain whether this strategy benefits critically ill patients without ARDS also. The present article summarizes the background and clinical evidence for ventilator settings that have the potential to protect against ventilator-induced lung injury. ⋯ There is increasing and convincing evidence that the use of lower tidal volumes during mechanical ventilation of patients without ARDS prevents against ventilator-induced lung injury.
-
Compared with the conventional forms of partial support, neurally adjusted ventilatory assist was repeatedly shown to improve patient-ventilator synchrony and reduce the risk of overassistance, while guaranteeing adequate inspiratory effort and gas exchange. A few animal studies also suggested the potential of neurally adjusted ventilatory assist in averting the risk of ventilator-induced lung injury. Recent work adds new information on the physiological effects of neurally adjusted ventilatory assist. ⋯ Several studies nowadays prove the physiological benefits of neurally adjusted ventilatory assist, as opposed to the conventional modes of partial support. Whether these advantages translate into improvement of clinical outcomes remains to be determined.
-
The paucity of effective therapeutic interventions in patients with the acute respiratory distress syndrome (ARDS) combined with overwhelming evidence on the importance of timely implementation of effective therapies to critically ill patients has resulted in a recent shift in ARDS research. Increasingly, efforts are being directed toward early identification of patients at risk with a goal of prevention and early treatment, prior to development of the fully established syndrome. The focus of the present review is on the prevention of ARDS in patients without this condition at the time of their healthcare encounter. ⋯ Recent improvements in clinical care delivery have been associated with a decrease in the incidence of hospital-acquired ARDS. Despite the initial challenges, research in ARDS prevention has become increasingly feasible with several randomized controlled trials on ARDS prevention completed or on the way.
-
This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. ⋯ Although patients with severe hypoxemic ARF are, in general, less likely to be intubated when NIV is used, the efficacy is different among these heterogeneous populations. Therefore, NIV is not routinely recommended in all patients with severe hypoxemic ARF.