open access
Basics of mechanical ventilation for non-aneasthetists. Part 2: Clinical aspects
open access
Abstract
Invasive and non-invasive mechanical ventilation (MV) continues to be the most significant life support method. It is, however, coupled with many risks. Historically, concepts of MV did focus on improving the arterial blood gas results rather than preventing harmful side-effects of positive pressure ventilation. Since then, multiple studies exploring this matter emerged and led to the protective MV concept. The golden mean between assuring the best oxygenation and limiting the ventilator-induced lung injury (VILI) is still a matter of debate. These considerations are especially impactful while treating patients with adult respiratory distress syndrome (ARDS), where the limitation of MV’s negative effect is specifically important. This paper explores the protective ventilation concept and clinical implications of the latter.
Abstract
Invasive and non-invasive mechanical ventilation (MV) continues to be the most significant life support method. It is, however, coupled with many risks. Historically, concepts of MV did focus on improving the arterial blood gas results rather than preventing harmful side-effects of positive pressure ventilation. Since then, multiple studies exploring this matter emerged and led to the protective MV concept. The golden mean between assuring the best oxygenation and limiting the ventilator-induced lung injury (VILI) is still a matter of debate. These considerations are especially impactful while treating patients with adult respiratory distress syndrome (ARDS), where the limitation of MV’s negative effect is specifically important. This paper explores the protective ventilation concept and clinical implications of the latter.
Keywords
mechanical ventilation; acute respiratory distress syndrome; non-invasive ventilation, invasive ventilation; protective ventilation; ventilator-induced lung injury
About this articleTitle
Basics of mechanical ventilation for non-aneasthetists. Part 2: Clinical aspects
Journal
Advances in Respiratory Medicine
Issue
Article type
Review paper
Pages
580-589
Published online
2020-11-03
DOI
10.5603/ARM.a2020.0159
Pubmed
Bibliographic record
Adv Respir Med 2020;88(6):580-589.
Keywords
mechanical ventilation
acute respiratory distress syndrome
non-invasive ventilation
invasive ventilation
protective ventilation
ventilator-induced lung injury
Authors
Zbigniew Putowski
Marcelina Czok
Piotr S Liberski
Łukasz J Krzych
References (50)- Ricard JD. Barotrauma during mechanical ventilation: why aren't we seeing any more? Intensive Care Med. 2004; 30(4): 533–535.
- Dreyfuss D, Basset G, Soler P, et al. Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats, Am Rev Respir Dis. 1985; 132: 880–884.
- Pierrakos C, Karanikolas M, Scolletta S, et al. Acute respiratory distress syndrome: pathophysiology and therapeutic options. J Clin Med Res. 2012; 4(1): 7–16.
- Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998; 338(6): 347–354.
- Tremblay L, Valenza F, Ribeiro SP, et al. Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest. 1997; 99(5): 944–952.
- Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970; 28(5): 596–608.
- Tremblay LN, Slutsky AS. Ventilator-induced injury: from barotrauma to biotrauma. Proc Assoc Am Physicians. 1998; 110(6): 482–488.
- Chu EK, Whitehead T, Slutsky AS. Effects of cyclic opening and closing at low- and high-volume ventilation on bronchoalveolar lavage cytokines. Crit Care Med. 2004; 32(1): 168–174.
- Slutsky AS, Tremblay LN. Multiple system organ failure. Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med. 1998; 157(6 Pt 1): 1721–1725.
- Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016; 42(10): 1567–1575.
- Suratt BT, Eisner MD, Calfee CS, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18): 1301–1308.
- Cressoni M, Gotti M, Chiurazzi C, et al. Mechanical power and development of ventilator-induced lung injury. Anesthesiology. 2016; 124(5): 1100–1108.
- Pelosi P. Close the lungs and keep them closed to minimize VILI:PRO, 8th Dräger Advanced Ventilation Symposium 2019. London 24.06.2019.
- Ferguson ND, Fan E, Camporota L, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012; 38(10): 1573–1582.
- Serpa Neto A, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012; 308(16): 1651–1659.
- Fuller BM, Mohr NM, Drewry AM, et al. Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review. Crit Care. 2013; 17(1): R11.
- Villar J, Martín-Rodríguez C, Domínguez-Berrot AM, et al. A quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung-protective ventilation. Crit Care Med. 2017; 45(5): 843–850.
- Amato MBP, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372(8): 747–755.
- Güldner A, Braune A, Ball L, et al. Comparative effects of volutrauma and atelectrauma on lung inflammation in experimental acute respiratory distress syndrome. Crit Care Med. 2016; 44(9): e854–e865.
- Maciejewski D. Podstawowe tryby wentylacji mechanicznej. In: Wentylacja mechaniczna — teoria i praktyka. Maciejewski D, Wojnar-Gruszka K (ed.). α-medica press, Bielsko-Biała 2016.
- Chiumello D, Cressoni M, Carlesso E, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008; 178(4): 346–355.
- Pelosi P, Rocco PR, Gama de Abreu M. Close down the lungs and keep them resting to minimize ventilator-induced lung injury. Crit Care. 2018; 22(1): 72.
- Schmitt JM, Vieillard-Baron A, Augarde R, et al. Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit Care Med. 2001; 29(6): 1154–1158.
- Puybasset L, Gusman P, Muller JC, et al. Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med. 2000; 26(7): 857–869.
- Hemmes SNT, Gama de Abreu M, Pelosi P, et al. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014; 384(9942): 495–503.
- Guo L, Wang W, Zhao N, et al. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis. Sci Rep. 2016; 6(1): 22855.
- Manzano F, Fernández-Mondéjar E, Colmenero M, et al. Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients. Crit Care Med. 2008; 36(8): 2225–2231.
- Cavalcanti A, Suzumura É, Laranjeira L, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome. JAMA. 2017; 318(14): 1335.
- Lachmann B. Open up the lung and keep the lung open. Intensive Care Med. 1992; 18(6): 319–321.
- ARDS Clinical Network Mechanical Ventilation Protocol Summary. Available online: www.ardsnet.org/files/ventilator_protocol_2008-07.pdf. [Last accessed: 14.12.2019].
- Normal Reference Range Table. Available online: https://web.archive.org/web/19981202040948/http://pathcuric1.swmed.edu:80/PathDemo/NRRT.html. [Last accessed: 10.01.2020].
- Gutkowski P, Konturek S. Fizjologia oddychania. W: Fizjologia człowieka. Podręcznik dla studentów medycyny. Konturek S (ed.). Elsevier, Wrocław 2013: 235–303.
- Cressoni M, Gotti M, Chiurazzi C, et al. Mechanical power and development of ventilator-induced lung injury. Anesthesiology. 2016; 124(5): 1100–1108.
- Mach WJ, Thimmesch AR, Pierce JT, et al. Consequences of hyperoxia and the toxicity of oxygen in the lung. Nurs Res Pract. 2011; 2011: 260482.
- Ni YN, Wang YM, Liang BM, et al. The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis. BMC Pulm Med. 2019; 19(1): 53.
- Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-icu randomized clinical trial. JAMA. 2016; 316(15): 1583–1589.
- Pierson DJ. History and epidemiology of noninvasive ventilation in the acute-care setting. Respir Care. 2009; 54(1): 40–52.
- Gregoretti C, Pisani L, Cortegiani A, et al. Noninvasive ventilation in critically ill patients. Crit Care Clin. 2015; 31(3): 435–457.
- Keenan SP, Sinuff T, Burns K, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. Canadian Medical Association Journal. 2011; 183(3): E195–E214.
- Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017; 50(2).
- Brochard L, Isabey D, Piquet J, et al. Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med. 1990; 323(22): 1523–1530.
- Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995; 333(13): 817–822.
- Pinsky MR, Summer WR, Wise RA, et al. Augmentation of cardiac function by elevation of intrathoracic pressure. J Appl Physiol Respir Environ Exerc Physiol. 1983; 54(4): 950–955.
- Huang HB, Xu B, Liu GY, et al. Use of noninvasive ventilation in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. Crit Care. 2017; 21(1): 4.
- Nava S, Gregoretti C, Fanfulla F, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med. 2005; 33(11): 2465–2470.
- Vianello A, Bevilacqua M, Arcaro G, et al. Non-invasive ventilatory approach to treatment of acute respiratory failure in neuromuscular disorders. A comparison with endotracheal intubation. Intensive Care Med. 2000; 26(4): 384–390.
- Gustafson T, Franklin KA, Midgren B, et al. Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home. Chest. 2006; 130(6): 1828–1833.
- Masa JF, Mokhlesi B, Benítez I, et al. Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet. 2019; 393(10182): 1721–1732.
- Peñuelas O, Frutos-Vivar F, Esteban A. Noninvasive positive-pressure ventilation in acute respiratory failure. CMAJ. 2007; 177(10): 1211–1218.
- Bello G, De Pascale G, Antonelli M, et al. Noninvasive ventilation for the immunocompromised patient: always appropriate? Curr Opin Crit Care. 2012; 18(1): 54–60.