Mechanical ventilation

2021 ◽  
pp. 284-305
Author(s):  
Luigi Camporota ◽  
Francesco Vasques
Keyword(s):  
Heart Failure ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Gas Flow ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Positive Pressure ◽  
International Consensus ◽  
Mechanically Ventilated ◽  
Ventilation Modes

Acute respiratory failure is the most common cause of admission to critical care. Many patients presenting to ICU have pre-existing heart disease and 13.1% will be diagnosed with chronic, NYHA IV heart failure. In addition, global left ventricular hypokinesia frequently occurs in adults with septic shock and around 20% of patients with acute respiratory distress syndrome (ARDS) have acute pulmonary hypertension and right heart failure. The presence of heart failure adds significant challenges for the management of mechanically ventilated patients and increases their morbidity and mortality. Furthermore, positive pressure ventilation can exert profound cardiovascular effects through heart-lung interactions. It is thus essential for the cardiologist to have an appreciation of the assessment and management of patients with respiratory failure, particularly if mechanically ventilated. Mechanical ventilation is used to assist or replace spontaneous respiration. Gas flow can be generated by negative pressure techniques, but it is positive pressure ventilation that is the most efficacious and most commonly used in intensive care. There are numerous pulmonary and extrapulmonary indications for mechanical ventilation, and it is the underlying pathology that will determine the duration of ventilation required. Ventilation modes can broadly be classified as volume- or pressure-controlled, but modern ventilators combine the characteristics of both in order to complement the diverse requirements of individual patients. To avoid confusion, it is important to appreciate that there is no international consensus on the classification of ventilation modes. Ventilator manufacturers can use terms that are similar to those used by others that describe very different modes or have completely different names for similar modes. This chapter provides an introduction on mechanisms of respiratory failure, principles of physiological assessment, modes and strategies of invasive mechanical ventilation. Whenever possible we discuss the heart-lung interactions of relevance to the cardiologist.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

Mechanical ventilation

2016 ◽  
Author(s):  
Robert O Grounds ◽  
Andrew Rhodes
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Gas Flow ◽  
Spontaneous Respiration ◽  
Positive Pressure ◽  
International Consensus ◽  
Ventilation Modes ◽  
Protective Strategies ◽  
Pressure Controlled

Mechanical ventilation is used to assist or replace spontaneous respiration. Gas flow can be generated by negative pressure techniques, but it is positive pressure ventilation that is the most efficacious in intensive care. There are numerous pulmonary and extrapulmonary indications for mechanical ventilation, and it is the underlying pathology that will determine the duration of ventilation required. Ventilation modes can broadly be classified as volume- or pressure-controlled, but modern ventilators combine the characteristics of both in order to complement the diverse requirements of individual patients. To avoid confusion, it is important to appreciate that there is no international consensus on the classification of ventilation modes. Ventilator manufacturers can use terms that are similar to those used by others that describe very different modes or have completely different names for similar modes. It is well established that ventilation in itself can cause or exacerbate lung injury, so the evidence-based lung-protective strategies should be adhered to. The term acute lung injury has been abolished, whilst a new definition and classification for the acute respiratory distress syndrome has been defined.

Mechanical ventilation

2015 ◽  
Author(s):  
Gihan Abuella ◽  
Andrew Rhodes
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Gas Flow ◽  
Spontaneous Respiration ◽  
Positive Pressure ◽  
International Consensus ◽  
Ventilation Modes ◽  
Protective Strategies ◽  
Pressure Controlled

Mechanical ventilation is used to assist or replace spontaneous respiration. Gas flow can be generated by negative pressure techniques, but it is positive pressure ventilation that is the most efficacious in intensive care. There are numerous pulmonary and extrapulmonary indications for mechanical ventilation, and it is the underlying pathology that will determine the duration of ventilation required. Ventilation modes can broadly be classified as volume- or pressure-controlled, but modern ventilators combine the characteristics of both in order to complement the diverse requirements of individual patients. To avoid confusion, it is important to appreciate that there is no international consensus on the classification of ventilation modes. Ventilator manufacturers can use terms that are similar to those used by others that describe very different modes or have completely different names for similar modes. It is well established that ventilation in itself can cause or exacerbate lung injury, so the evidence-based lung-protective strategies should be adhered to. The term acute lung injury has been abolished, whilst a new definition and classification for the acute respiratory distress syndrome has been defined.

scholarly journals Rule-Based Cohort Definitions for Acute Respiratory Failure: Electronic Phenotyping Algorithm

10.2196/18402 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e18402 ◽  
Author(s):  
Patrick Essay ◽  
Jarrod Mosier ◽  
Vignesh Subbian
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
High Flow ◽  
Positive Pressure ◽  
Rule Based ◽  
Research Questions

Background Acute respiratory failure is generally treated with invasive mechanical ventilation or noninvasive respiratory support strategies. The efficacies of the various strategies are not fully understood. There is a need for accurate therapy-based phenotyping for secondary analyses of electronic health record data to answer research questions regarding respiratory management and outcomes with each strategy. Objective The objective of this study was to address knowledge gaps related to ventilation therapy strategies across diverse patient populations by developing an algorithm for accurate identification of patients with acute respiratory failure. To accomplish this objective, our goal was to develop rule-based computable phenotypes for patients with acute respiratory failure using remotely monitored intensive care unit (tele-ICU) data. This approach permits analyses by ventilation strategy across broad patient populations of interest with the ability to sub-phenotype as research questions require. Methods Tele-ICU data from ≥200 hospitals were used to create a rule-based algorithm for phenotyping patients with acute respiratory failure, defined as an adult patient requiring invasive mechanical ventilation or a noninvasive strategy. The dataset spans a wide range of hospitals and ICU types across all US regions. Structured clinical data, including ventilation therapy start and stop times, medication records, and nurse and respiratory therapy charts, were used to define clinical phenotypes. All adult patients of any diagnoses with record of ventilation therapy were included. Patients were categorized by ventilation type, and analysis of event sequences using record timestamps defined each phenotype. Manual validation was performed on 5% of patients in each phenotype. Results We developed 7 phenotypes: (0) invasive mechanical ventilation, (1) noninvasive positive-pressure ventilation, (2) high-flow nasal insufflation, (3) noninvasive positive-pressure ventilation subsequently requiring intubation, (4) high-flow nasal insufflation subsequently requiring intubation, (5) invasive mechanical ventilation with extubation to noninvasive positive-pressure ventilation, and (6) invasive mechanical ventilation with extubation to high-flow nasal insufflation. A total of 27,734 patients met our phenotype criteria and were categorized into these ventilation subgroups. Manual validation of a random selection of 5% of records from each phenotype resulted in a total accuracy of 88% and a precision and recall of 0.8789 and 0.8785, respectively, across all phenotypes. Individual phenotype validation showed that the algorithm categorizes patients particularly well but has challenges with patients that require ≥2 management strategies. Conclusions Our proposed computable phenotyping algorithm for patients with acute respiratory failure effectively identifies patients for therapy-focused research regardless of admission diagnosis or comorbidities and allows for management strategy comparisons across populations of interest.

Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

2018 ◽  
Vol 65 (4) ◽  
pp. 352-360 ◽  
Author(s):  
Mesut Dursun ◽  
Sinan Uslu ◽  
Ali Bulbul ◽  
Muhittin Celik ◽  
Umut Zubarioglu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Airway Pressure ◽  
Positive Pressure Ventilation ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure

Abstract Aims To compare the effect of early nasal intermittent positive pressure ventilation (nIPPV) and nasal continuous positive airway pressure (nCPAP) in terms of the need for endotracheal ventilation in the treatment of respiratory distress syndrome (RDS) in preterm infants born between 24 and 32 gestational weeks. Methods This is a randomized, controlled, prospective, single-centered study. Forty-two infants were randomized to nIPPV and 42 comparable infants to nCPAP (birth weight 1356 ± 295 and 1359 ± 246 g and gestational age 29.2 ± 1.7 and 29.4 ± 1.5 weeks, respectively). Results The need for endotracheal intubation and invasive mechanical ventilation was significantly lower in the nIPPV group than the nCPAP group (11.9% and 40.5%, respectively, p < 0.05). There were no differences in the duration of total nasal respiratory support, duration of invasive mechanical ventilation, bronchopulmonary dysplasia or other early morbidities. Conclusion nIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.

Sign in / Sign up

Export Citation Format

Share Document