2016 Year in Review: Mechanical Ventilation

Pettenuzzo, Tommaso; Fan, Eddy

doi:10.4187/respcare.05545

Cited by 24 publications

(14 citation statements)

References 30 publications

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“…Optimal patient-ventilator interaction can help avoid excessive sedation, anxiety, dis-comfort, episodes of fighting with the ventilator, diaphragmatic dysfunction and atrophy due to disuse, potential cognitive alterations, prolonged mechanical ventilation, and additional lung or respiratory muscle injury. 1,2 Research has shown that patients ventilated for Ͼ 24 h who are able to trigger the ventilator have a high incidence of asynchrony during assisted mechanical ventilation. 3 Asynchronies are common throughout mechanical ventilation, occur in all mechanical ventilation modes, and might be associated with outcome, 4 especially when they occur in clusters.…”

Section: Introductionmentioning

confidence: 99%

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

et al. 2018

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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.

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Section: Introductionmentioning

confidence: 99%

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

et al. 2018

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“…Mechanical ventilation (MV) is a life support technique that is routinely used in the intensive care units (ICUs) for patients with life-threatening conditions [1]. Prolonged MV and failure of weaning from MV are two major risk factors for morbidity and mortality in ICU patients and incur high economic costs [2].…”

Section: Introductionmentioning

confidence: 99%

Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study

et al. 2021

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Background Prolonged mechanical ventilation (MV) induces diaphragm dysfunction in patients in the intensive care units (ICUs). Our study aimed to explore the therapeutic efficacy of early rehabilitation therapy in patients with prolonged MV in the ICU. Methods Eighty eligible patients who underwent MV for > 72 h in the ICU from June 2019 to March 2020 were enrolled in this prospective randomised controlled trial. The patients were randomly divided into a rehabilitation group (n = 39) and a control group (n = 41). Rehabilitation therapy included six levels of rehabilitation exercises. Diaphragm function was determined using ultrasound (US). Results Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were significantly decreased in all patients in both groups after prolonged MV (p < 0.001). The rehabilitation group had significantly higher DTF (p = 0.008) and a smaller decrease in DTF (p = 0.026) than the control group after 3 days of rehabilitation training. The ventilator duration and intubation duration were significantly shorter in the rehabilitation group than in the control group (p = 0.045 and p = 0.037, respectively). There were no significant differences in the duration of ICU stay, proportion of patients undergoing tracheotomy, and proportion of recovered patients between the two groups. Conclusions Early rehabilitation is feasible and beneficial to ameliorate diaphragm dysfunction induced by prolonged MV and advance withdrawal from the ventilator and extubation in patients with MV. Diaphragm US is suggested for mechanically ventilated patients in the ICU. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR1900024046, registered on 2019/06/23.

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“…Por otra parte, la lesión pulmonar asociada a la ventilación (VALI), la cual alude a la exacerbación de una lesión pulmonar preexistente debido a factores relacionados con la VM, mientas que VILI hace referencia a los pulmones previamente sanos. [5][6][7] Alrededor de 230 millones de cirugías mayores se realizan cada año en el mundo y la VM es esencial para la anestesia general. Se estima que aproximadamente 20% de los pacientes que recibe VM en estos procedimientos desarrollará VILI.…”

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