Mechanical ventilation in acute respiratory distress syndrome: The open lung revisited

Amado-Rodríguez, Laura; Busto, C. del; García-Prieto, Emilio; Albaiceta, Guillermo M.

doi:10.1016/j.medin.2016.12.012

Cited by 15 publications

(10 citation statements)

References 73 publications

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“…This concept facilitates understanding the contribution of mechanical power to ventilator-associated lung injury 8 . Understanding these concepts help to avoid perpetuating lung injury and facilitate lung recovery [9][10][11] .…”

Section: Pathophysiologymentioning

confidence: 99%

“…This concept is the most critical in the current management of PARDS. Mechanical ventilation is associated with different lung injuries, and parameters must be established to avoid these injuries' persistence and allow alveolar recovery 10,11 .…”

Section: Principles Of Pards Managementmentioning

confidence: 99%

“…In any of the chosen modes, parameters should be used to maintain the concept of open lung ventilation 11 . It is suggested to use the open lung and permissive hypercapnia strategy to avoid overdistension of the lung, causing further damage 9,10 .…”

Section: Mechanical Ventilationmentioning

confidence: 99%

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Pediatric acute respiratory distress syndrome: How to protect the lungs during mechanical ventilation?

Coronado-Munoz¹,

Escalante-Kanashiro²

2021

BMHIM

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Pediatric acute respiratory distress syndrome (PARDS) is a frequent diagnosis in critical care. This inflammatory process has different stages characterized by mild-to-severe hypoxia, and the management will vary according to the severity. New definitions for pediatric patients were published in 2015; new epidemiological evidence revising those definitions has helped understand the mortality associated with PARDS and the impact on ventilation. The strategies to protect the lungs during mechanical ventilation have been successful in reducing mortality and complications. In clinical situations where high levels of critical support are limited, other therapies with a lower level of evidence can be attempted to gain time without worsening the ongoing pulmonary injury. We offer a complete narrative revision of this syndrome, with the critical management of these patients as a priority.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Principles Of Pards Managementmentioning

confidence: 99%

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Pediatric acute respiratory distress syndrome: How to protect the lungs during mechanical ventilation?

Coronado-Munoz¹,

Escalante-Kanashiro²

2021

BMHIM

View full text Add to dashboard Cite

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“…Patient-ventilator asynchrony exposes the lungs to greater strain, alveolar overdistension, or cyclic collapse of poorly aerated regions, which induces tissue inflammation and the development of VALI. ( 5 , 6 )…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ventilatory asynchrony in patients with inspiratory effort

Martos-Benítez

Domínguez-Valdés

Burgos-Aragüez

et al. 2020

Revista Brasileira De Terapia Intensiva

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Objective To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. Methods This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. Results A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. Conclusion Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient’s interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.

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“…Some authors argue that these tests do not take into account the heterogeneity of lung injury and prefer other approaches to adjust the ventilation of these patients [5]. …”

mentioning

confidence: 99%