Prolonged Mechanical Ventilation: Outcomes and Management

Abstract

The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.

Lung infection by P. aeruginosa induces neuroinflammation and blood-brain barrier dysfunction in mice

“…The microvascular leakage and BBB hyperpermeability observed in PA-infected animals were associated with neuroin ammation, evidenced by immune cell recruitment and high expression of proin ammatory cytokines, chemokines and adhesion molecules in the brain of mice with pneumonia. It is known that lung infection or injury is associated with various neurological complications, from altered memory to cognitive decline (51)(52)(53)(54). In our model, even in the absence of direct penetration of PA into the brain, infected mice developed anxiety-like behaviors, which might result from cerebral microvascular dysfunction, BBB leakage, and systemic/local production of cytotoxic cytokines like IL-1β (55-57) and TNF-α (47, 58) as previously documented.…”

Risk Factors and Mortality in Elderly ARDS COVID-19 Compared to Patients without COVID-19

“…The prediction of mechanical ventilation duration could affect both clinical management and intensive care resource utilization. Additionally, comorbidities, such as the presence of chronic respiratory disease, heart failure, cerebrovascular diseases, malnutrition, and end-stage renal failure, affected the duration of mechanical ventilation and the final outcome [ 8 , 9 , 10 ]. Unfortunately, an accurate prediction of mechanical ventilation is quite difficult for critical care physicians according to clinical data at admission.…”

Factors Predicting Prolonged Mechanical Ventilation in Guillain–Barré Syndrome

“…5 From our consideration, the neuromuscular physical examination in ventilated patients with several days of hospitalization may be influenced by conditions typical of critically ill patients (delirium, hydro-metabolic alterations, sedation effects) that may alter an appropriate assessment. 23 Nerve conduction studies are very important as they establish the primary mechanism of peripheral nerve damage (demyelinating or axonal). 2 In some patients who undergo the very early studies (≤3 days of evolution within symptom onset), a second study is suggested because 20% of patients with AIDP fulfill criteria for axonal variants afterwards.…”

“…5 From our consideration, the neuromuscular physical examination in ventilated patients with several days of hospitalization may be influenced by conditions typical of critically ill patients (delirium, hydro-metabolic alterations, sedation effects) that may alter an appropriate assessment. 23…”