Respiratory care
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Ventilator-induced lung injury (VILI) is a central confounder to improving outcomes from use of positive-pressure ventilation in critical illness. Therefore, with increasing use of positive-pressure ventilation, awareness to prevent VILI has grown. Because VILI cannot be diagnosed at the bedside, its prevention can only be attained by identifying the clinical mechanisms of harm, such as high tidal volume, high plateau pressure, and so forth, which, in turn, are derived from decades of laboratory work. ⋯ Although noninvasive ventilation prevents the complications of intubation, it has potential to cause harm, especially in patients with de novo respiratory failure. This review covers some of the classic and emerging concepts of VILI genesis and their role during noninvasive ventilation. Combined modulation of these mechanisms could have a potential to impact outcomes.
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For hypoxemic respiratory failure, the frontline treatment is supplemental oxygen. Since ARDS was first described, mechanical ventilation via an endotracheal tube (invasive ventilation) has no doubt saved many patients. During the 1990s, noninvasive ventilation was found to be superior to invasive ventilation for exacerbations of COPD, acute cardiogenic pulmonary edema, and acute respiratory failure in patients who were immunocompromised. ⋯ While NIV interfaces add to anatomic dead space, HFNC delivery actually decreases dead space. Although the use of HFNC in adults who are critically ill has been dramatically increasing, the advantages and disadvantages of each element have not been well discussed. For now, although functional differences among the different HFNC systems seem to be minor, to avoid adverse clinical events, it is essential to know the advantages and disadvantages of each element.