Evolving approaches to assessing and monitoring patient–ventilator interactions

Unroe, Mark; MacIntyre, Neil R.

doi:10.1097/mcc.0b013e328338661e

Cited by 23 publications

(16 citation statements)

References 32 publications

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“…Clinical evaluation (tachypnea, accessory muscle activity, agitation, and lack of cooperation) or waveform analysis can be useful in assessing the presence of patient-ventilator dyssynchrony. Electromyography tracings are cumbersome, but airway pressures and flows can be used to monitor patient efforts and identify 'autotriggering', premature cycling, or ineffective triggering [105]. Inspired and expired V T values can help to identify air leaks.…”

Section: Monitoring Systemsmentioning

confidence: 99%

Clinical review: Respiratory monitoring in the ICU - a consensus of 16

et al. 2012

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Monitoring plays an important role in the current management of patients with acute respiratory failure but sometimes lacks definition regarding which 'signals' and 'derived variables' should be prioritized as well as specifics related to timing (continuous versus intermittent) and modality (static versus dynamic). Many new techniques of respiratory monitoring have been made available for clinical use recently, but their place is not always well defined. Appropriate use of available monitoring techniques and correct interpretation of the data provided can help improve our understanding of the disease processes involved and the effects of clinical interventions. In this consensus paper, we provide an overview of the important parameters that can and should be monitored in the critically ill patient with respiratory failure and discuss how the data provided can impact on clinical management.

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Section: Monitoring Systemsmentioning

confidence: 99%

Clinical review: Respiratory monitoring in the ICU - a consensus of 16

et al. 2012

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“…Dyssynchrony can occur in any patient who is mechanically ventilated and in particular patients who are not sedated or who have a high drive to breathe. Although many types of patient-ventilator dyssynchrony occur, the most important for ARDS patients relates to flow dyssynchrony, which occurs when the volume or flow delivered to the patient fails to meet the respiratory demand or the neural drive to breathe [89]. Dyssynchrony cannot only cause intense patient anxiety and a sense of dyspnea, which occurs commonly in ventilated patients, but can increase the work of breathing and cause respiratory muscle fatigue [90–92].…”

Section: Challenges and Controversy To The Use Of Protective Ventimentioning

confidence: 99%

Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

Lipes

Bojmehrani

Lellouche

2012

Critical Care Research and Practice

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Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

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“…The recent commercial availability of NAVA (9,10) has also given the opportunity to obtain a simple and minimally invasive way to measure and display Eadi (11), and Eadi can be used to monitor the patient's inspiratory activity during any mode of ventilatory support (12).…”

mentioning

confidence: 99%