Controversies in mechanical ventilation:
From the Publisher; Topics will include: "How should the tidal volume be set? Is 6 ml/kg the best for all patients?", "How should PEEP and FiO2 be set? Mechanics vs. gas exchange vs. other approaches", "Can the weaning/withdrawal process be automated?", "When shoul...
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2008
|
| Schriftenreihe: | Clinics in chest medicine
29,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Zusammenfassung: | From the Publisher; Topics will include: "How should the tidal volume be set? Is 6 ml/kg the best for all patients?", "How should PEEP and FiO2 be set? Mechanics vs. gas exchange vs. other approaches", "Can the weaning/withdrawal process be automated?", "When should a tracheostomy be placed?", "Are the new modes APRV and HFV of value in ALI/ARDS?", "How best to deliver aerosol medications to mechanically ventilated patients?", "Do newer monitors of exhaled gases, mechanics, and esophageal pressure add value?", "Can VAP be prevented?", "Do ventilator protocols hinder or help teaching?", "Does central venous oxygenation monitoring improve mechanical ventilatory support?", "PAV and NAVA-better approaches to patient ventilator synchrony?", and "Does closed loop control of assist control ventilation reduce VILI?" |
| Beschreibung: | XIII S., S. 225 - 356 Ill., graph. Darst. |
| ISBN: | 1416058672 9781416058670 |
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| 490 | 1 | |a Clinics in chest medicine |v 29,2 | |
| 520 | 3 | |a From the Publisher; Topics will include: "How should the tidal volume be set? Is 6 ml/kg the best for all patients?", "How should PEEP and FiO2 be set? Mechanics vs. gas exchange vs. other approaches", "Can the weaning/withdrawal process be automated?", "When should a tracheostomy be placed?", "Are the new modes APRV and HFV of value in ALI/ARDS?", "How best to deliver aerosol medications to mechanically ventilated patients?", "Do newer monitors of exhaled gases, mechanics, and esophageal pressure add value?", "Can VAP be prevented?", "Do ventilator protocols hinder or help teaching?", "Does central venous oxygenation monitoring improve mechanical ventilatory support?", "PAV and NAVA-better approaches to patient ventilator synchrony?", and "Does closed loop control of assist control ventilation reduce VILI?" | |
| 650 | 4 | |a Artificial respiration | |
| 650 | 4 | |a Respiratory Distress Syndrome, Adult |x therapy | |
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| 650 | 4 | |a Ventilators, Mechanical | |
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| adam_text | CONTROVERSIES IN MECHANICAL VENTILATION
CONTENTS
Erratum xi
Preface xiii
Neil R. Maclntyre
Is There a Best Way to Set Tidal Volume for Mechanical Ventilatory Support? 225
Neil R. Maclntyre
Tidal breaths are an important component of mechanical ventilation. However, an
inappropriate tidal volume setting can overstretch and injure the lung. Maximal stretch,
tidal stretch, frequency of stretch, and rate of stretch are all implicated in such injury.
Clinical trials have shown that limiting maximal and tidal stretch improves outcomes,
even if gas exchange is partially compromised. Thus, current strategies should focus on
limiting tidal and maximal stretch as much as possible.
Is There a Best Way to Set Positive Expiratory-End Pressure for Mechanical
Ventilatory Support in Acute Lung Injury? 233
Neil R. Maclntyre
Airspace collapse is a hallmark of parenchymal lung injury. Strategies to reopen and
maintain patency of these regions offer three advantages: improved gas exchange, less
lung injury, and improved lung compliance. Elevations in intrathoracic pressure to
achieve these goals, however, may overdistend healthier lung regions and compromise
cardiac function. Positive expiratory-end pressure is a widely used technique to maintain
alveolar patency, but its beneficial effects must be balanced against its harmful effects.
Protocol-Driven Ventilator Weaning: Reviewing the Evidence 241
Timothy D. Girard and E. Wesley Ely
Though seminal clinical trials have identified efficacious methods of liberating patients
from mechanical ventilation (ie, weaning), this knowledge is not applied often by
physicians in routine practice. Weaning protocols are a strategies by which research
results can be translated effectively and efficiently into clinical practice, but results of
clinical trials evaluating weaning protocols have not been uniform, and controversy
continues to surround this important area in critical care medicine. This article reviews
the rationale for and against the routine use of weaning protocols and highlights
informative details of many clinical trials that have evaluated such protocols.
VOLUME 29 • NUMBER 2 • JUNE 2008 v
Controversies in Mechanical Ventilation: When Should a Tracheotomy Be Placed? 253
Christopher King and Lisa K. Moores
With the large and increasing population of mechanically ventilated patients, critical care
physicians frequently face the dilemma of whether to perform tracheotomy. The decision
is a complex one, requiring a detailed understanding of the risks and benefits of both
tracheotomy and prolonged translaryngeal intubation (TLI). It also must be individu¬
alized, taking into consideration the patient s preferences and expected clinical course.
This article reviews the medical literature regarding the benefits and risks of
tracheotomy as compared with TLI. The authors then discuss current data regarding
the optimal timing for the procedure and propose an algorithm that may aid intensivists
in clinical decision making.
Current Role of High Frequency Oscillatory Ventilation and Airway
Pressure Release Ventilation in Acute Lung Injury and Acute Respiratory
Distress Syndrome 265
Chuin Siau and Thomas E. Stewart
Lung protective ventilatory strategies using conventional ventilators have resulted in
decreased mortality in adult patients who have acute lung injury and acute respiratory
distress syndrome. Conceptually, high frequency oscillatory ventilation and airway
pressure release ventilation appear not only able to fulfill the goals of lung protection,
but also to offer some additional advantages over conventional ventilation. Although
early data for each of these modes in adults have been encouraging, their widespread
use—particularly outside of a rescue situation—cannot be recommended without further
evidence.
How Best to Deliver Aerosol Medications to Mechanically Ventilated Patients 277
Rajiv Dhand and Vamsi P. Guntur
Pressurized metered-dose inhalers (pMDIs) and nebulizers are employed routinely for
aerosol delivery to ventilator-supported patients, but the ventilator circuit and artificial
airway previously were thought to be major barriers to effective delivery of aerosols to
patients receiving mechanical ventilation. In the past two decades, several investigators
have shown that careful attention to many factors, such as the position of the patient, the
type of aerosol generator and its configuration in the ventilator circuit, aerosol particle
size, artificial airway, conditions in the ventilator circuit, and ventilatory parameters, is
necessary to optimize aerosol delivery during mechanical ventilation. The best
techniques for aerosol delivery during noninvasive positive-pressure ventilation are
not well established as yet, and the efficiency of aerosol delivery in this setting is lower
than that during invasive mechanical ventilation. The most efficient methods of using
the newer hydrofluoroalkane-pMDIs and vibrating mesh nebulizers in ventilator-
supported patients also require further evaluation. When optimal techniques of
administration are employed, the efficiency of aerosolized drug delivery in mechanically
ventilated patients is comparable to that achieved in ambulatory patients.
Do Newer Monitors of Exhaled Gases, Mechanics, and Esophageal
Pressure Add Value? 297
Robert L. Owens, William S. Stigler, and Dean R. Hess
The current understanding of lung mechanics and ventilator-induced lung injury
suggests that patients who have acute respiratory distress syndrome should be
vi CONTENTS
ventilated in such a way as to minimize alveolar over-distension and repeated alveolar
collapse. Clinical trials have used such lung protective strategies and shown a reduction
in mortality; however, there is data that these one-size fits all strategies do not work
equally well in all patients. This article reviews other methods that may prove useful in
monitoring for potential lung injury: exhaled breath condensate, pressure-volume
curves, and esophageal manometry. The authors explore the concepts, benefits,
difficulties, and relevant clinical trials of each.
Effects of Respiratory-Therapist Driven Protocols on House-Staff Knowledge
and Education of Mechanical Ventilation 313
Jessica Y. Chia and Alison S. Clay
High practice variability in critical care medicine contributes to medical errors and the
high cost of ICU care. Clinical guidelines and protocol-based strategies can reduce the
variation and cost of ICU medicine, increase adherence to evidence-based interventions,
and reduce error, thereby improving the morbidity and mortality of critically ill patients.
There are various barriers to guideline adherence, and protocols often are more
successful when implemented by nonphysicians. However, this has potential con¬
sequences for house-staff knowledge and education. This article discusses the
implications of mechanical ventilation protocols on patient care and medical education,
and this article offers suggestions for synchronizing the processes for improving patient
care to improve medical education.
Mechanical Ventilation in an Airborne Epidemic 323
Ghee-Chee Phua and Joseph Govert
With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is
important for intensive care providers to be prepared to meet the challenge of large-scale
airborne epidemics causing mass casualty respiratory failure. The severe acute
respiratory syndrome outbreak exposed the vulnerability of health care workers and
highlighted the importance of establishing stringent infection control and crisis
management protocols. Patients who have acute lung injury and acute respiratory
distress syndrome who require mechanical ventilation should receive a lung protective,
low tidal volume strategy. Controversy remains regarding the use of high-frequency
oscillatory ventilation and noninvasive positive pressure ventilation. Standard, contact,
and airborne precautions should be instituted in intensive care units, with special care
taken when aerosol-generating procedures are performed.
Proportional Assist Ventilation and Neurally Adjusted Ventilatory
Assist—Better Approaches to Patient Ventilator Synchrony? 329
Christer Sinderby and Jennifer Beck
Understanding the regulation of breathing in the critical care patient is multifaceted,
especially in ventilator-dependent patients who must interact with artificial respiration.
Mechanical ventilation originally consisted of simple, manually-driven pump devices,
but it has developed into advanced positive pressure ventilators for continuous support
of patients in respiratory failure. This evolution has resulted in mechanical ventilators
that deliver assist intermittently, attempting to mimic natural breathing. Recently, modes
of mechanical ventilation that synchronize not only the timing, but also the level of assist
to the patient s own effort, have been introduced. This article describes the concepts
related to proportional assist ventilation and neurally adjusted ventilatory assist, and
how they relate to conventional modes in terms of patient-ventilator synchrony.
CONTENTS vii
Does Closed Loop Control of Assist Control Ventilation Reduce
Ventilator-Induced Lung Injury? 343
Richard D. Branson and Kenneth Davis, Jr
The standard of care for mechanical ventilation of the patient who has acute lung injury
remains volume control ventilation at 6 mL/kg. Despite this fact, clinicians often employ
pressure control ventilation and adaptive pressure control ventilation in an attempt
to improve synchrony and limit the possibility for overdistension. Adaptive pressure
control uses pressure control breaths to guarantee a minimum delivered tidal volume.
Other techniques (such as adaptive support ventilation) use pressure-limited breaths,
switching between time and (low cycling based on patient effort. Neither of these
techniques has been compared with volume control in a randomized setting. Under¬
standing operation of these techniques is essential for determining any impact on
outcome or ventilator induced lung injury.
Index 351
viii CONTENTS
|
| adam_txt |
CONTROVERSIES IN MECHANICAL VENTILATION
CONTENTS
Erratum xi
Preface xiii
Neil R. Maclntyre
Is There a Best Way to Set Tidal Volume for Mechanical Ventilatory Support? 225
Neil R. Maclntyre
Tidal breaths are an important component of mechanical ventilation. However, an
inappropriate tidal volume setting can overstretch and injure the lung. Maximal stretch,
tidal stretch, frequency of stretch, and rate of stretch are all implicated in such injury.
Clinical trials have shown that limiting maximal and tidal stretch improves outcomes,
even if gas exchange is partially compromised. Thus, current strategies should focus on
limiting tidal and maximal stretch as much as possible.
Is There a Best Way to Set Positive Expiratory-End Pressure for Mechanical
Ventilatory Support in Acute Lung Injury? 233
Neil R. Maclntyre
Airspace collapse is a hallmark of parenchymal lung injury. Strategies to reopen and
maintain patency of these regions offer three advantages: improved gas exchange, less
lung injury, and improved lung compliance. Elevations in intrathoracic pressure to
achieve these goals, however, may overdistend healthier lung regions and compromise
cardiac function. Positive expiratory-end pressure is a widely used technique to maintain
alveolar patency, but its beneficial effects must be balanced against its harmful effects.
Protocol-Driven Ventilator Weaning: Reviewing the Evidence 241
Timothy D. Girard and E. Wesley Ely
Though seminal clinical trials have identified efficacious methods of liberating patients
from mechanical ventilation (ie, weaning), this knowledge is not applied often by
physicians in routine practice. Weaning protocols are a strategies by which research
results can be translated effectively and efficiently into clinical practice, but results of
clinical trials evaluating weaning protocols have not been uniform, and controversy
continues to surround this important area in critical care medicine. This article reviews
the rationale for and against the routine use of weaning protocols and highlights
informative details of many clinical trials that have evaluated such protocols.
VOLUME 29 • NUMBER 2 • JUNE 2008 v
Controversies in Mechanical Ventilation: When Should a Tracheotomy Be Placed? 253
Christopher King and Lisa K. Moores
With the large and increasing population of mechanically ventilated patients, critical care
physicians frequently face the dilemma of whether to perform tracheotomy. The decision
is a complex one, requiring a detailed understanding of the risks and benefits of both
tracheotomy and prolonged translaryngeal intubation (TLI). It also must be individu¬
alized, taking into consideration the patient's preferences and expected clinical course.
This article reviews the medical literature regarding the benefits and risks of
tracheotomy as compared with TLI. The authors then discuss current data regarding
the optimal timing for the procedure and propose an algorithm that may aid intensivists
in clinical decision making.
Current Role of High Frequency Oscillatory Ventilation and Airway
Pressure Release Ventilation in Acute Lung Injury and Acute Respiratory
Distress Syndrome 265
Chuin Siau and Thomas E. Stewart
Lung protective ventilatory strategies using conventional ventilators have resulted in
decreased mortality in adult patients who have acute lung injury and acute respiratory
distress syndrome. Conceptually, high frequency oscillatory ventilation and airway
pressure release ventilation appear not only able to fulfill the goals of lung protection,
but also to offer some additional advantages over conventional ventilation. Although
early data for each of these modes in adults have been encouraging, their widespread
use—particularly outside of a rescue situation—cannot be recommended without further
evidence.
How Best to Deliver Aerosol Medications to Mechanically Ventilated Patients 277
Rajiv Dhand and Vamsi P. Guntur
Pressurized metered-dose inhalers (pMDIs) and nebulizers are employed routinely for
aerosol delivery to ventilator-supported patients, but the ventilator circuit and artificial
airway previously were thought to be major barriers to effective delivery of aerosols to
patients receiving mechanical ventilation. In the past two decades, several investigators
have shown that careful attention to many factors, such as the position of the patient, the
type of aerosol generator and its configuration in the ventilator circuit, aerosol particle
size, artificial airway, conditions in the ventilator circuit, and ventilatory parameters, is
necessary to optimize aerosol delivery during mechanical ventilation. The best
techniques for aerosol delivery during noninvasive positive-pressure ventilation are
not well established as yet, and the efficiency of aerosol delivery in this setting is lower
than that during invasive mechanical ventilation. The most efficient methods of using
the newer hydrofluoroalkane-pMDIs and vibrating mesh nebulizers in ventilator-
supported patients also require further evaluation. When optimal techniques of
administration are employed, the efficiency of aerosolized drug delivery in mechanically
ventilated patients is comparable to that achieved in ambulatory patients.
Do Newer Monitors of Exhaled Gases, Mechanics, and Esophageal
Pressure Add Value? 297
Robert L. Owens, William S. Stigler, and Dean R. Hess
The current understanding of lung mechanics and ventilator-induced lung injury
suggests that patients who have acute respiratory distress syndrome should be
vi CONTENTS
ventilated in such a way as to minimize alveolar over-distension and repeated alveolar
collapse. Clinical trials have used such lung protective strategies and shown a reduction
in mortality; however, there is data that these "one-size fits all" strategies do not work
equally well in all patients. This article reviews other methods that may prove useful in
monitoring for potential lung injury: exhaled breath condensate, pressure-volume
curves, and esophageal manometry. The authors explore the concepts, benefits,
difficulties, and relevant clinical trials of each.
Effects of Respiratory-Therapist Driven Protocols on House-Staff Knowledge
and Education of Mechanical Ventilation 313
Jessica Y. Chia and Alison S. Clay
High practice variability in critical care medicine contributes to medical errors and the
high cost of ICU care. Clinical guidelines and protocol-based strategies can reduce the
variation and cost of ICU medicine, increase adherence to evidence-based interventions,
and reduce error, thereby improving the morbidity and mortality of critically ill patients.
There are various barriers to guideline adherence, and protocols often are more
successful when implemented by nonphysicians. However, this has potential con¬
sequences for house-staff knowledge and education. This article discusses the
implications of mechanical ventilation protocols on patient care and medical education,
and this article offers suggestions for synchronizing the processes for improving patient
care to improve medical education.
Mechanical Ventilation in an Airborne Epidemic 323
Ghee-Chee Phua and Joseph Govert
With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is
important for intensive care providers to be prepared to meet the challenge of large-scale
airborne epidemics causing mass casualty respiratory failure. The severe acute
respiratory syndrome outbreak exposed the vulnerability of health care workers and
highlighted the importance of establishing stringent infection control and crisis
management protocols. Patients who have acute lung injury and acute respiratory
distress syndrome who require mechanical ventilation should receive a lung protective,
low tidal volume strategy. Controversy remains regarding the use of high-frequency
oscillatory ventilation and noninvasive positive pressure ventilation. Standard, contact,
and airborne precautions should be instituted in intensive care units, with special care
taken when aerosol-generating procedures are performed.
Proportional Assist Ventilation and Neurally Adjusted Ventilatory
Assist—Better Approaches to Patient Ventilator Synchrony? 329
Christer Sinderby and Jennifer Beck
Understanding the regulation of breathing in the critical care patient is multifaceted,
especially in ventilator-dependent patients who must interact with artificial respiration.
Mechanical ventilation originally consisted of simple, manually-driven pump devices,
but it has developed into advanced positive pressure ventilators for continuous support
of patients in respiratory failure. This evolution has resulted in mechanical ventilators
that deliver assist intermittently, attempting to mimic natural breathing. Recently, modes
of mechanical ventilation that synchronize not only the timing, but also the level of assist
to the patient's own effort, have been introduced. This article describes the concepts
related to proportional assist ventilation and neurally adjusted ventilatory assist, and
how they relate to conventional modes in terms of patient-ventilator synchrony.
CONTENTS vii
Does Closed Loop Control of Assist Control Ventilation Reduce
Ventilator-Induced Lung Injury? 343
Richard D. Branson and Kenneth Davis, Jr
The standard of care for mechanical ventilation of the patient who has acute lung injury
remains volume control ventilation at 6 mL/kg. Despite this fact, clinicians often employ
pressure control ventilation and adaptive pressure control ventilation in an attempt
to improve synchrony and limit the possibility for overdistension. Adaptive pressure
control uses pressure control breaths to guarantee a minimum delivered tidal volume.
Other techniques (such as adaptive support ventilation) use pressure-limited breaths,
switching between time and (low cycling based on patient effort. Neither of these
techniques has been compared with volume control in a randomized setting. Under¬
standing operation of these techniques is essential for determining any impact on
outcome or ventilator induced lung injury.
Index 351
viii CONTENTS |
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| index_date | 2024-07-02T21:06:35Z |
| indexdate | 2024-07-09T21:16:41Z |
| institution | BVB |
| isbn | 1416058672 9781416058670 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-016538317 |
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| series2 | Clinics in chest medicine |
| spelling | Controversies in mechanical ventilation guest ed. Neil R. MacIntyre Philadelphia [u.a.] Saunders 2008 XIII S., S. 225 - 356 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 29,2 From the Publisher; Topics will include: "How should the tidal volume be set? Is 6 ml/kg the best for all patients?", "How should PEEP and FiO2 be set? Mechanics vs. gas exchange vs. other approaches", "Can the weaning/withdrawal process be automated?", "When should a tracheostomy be placed?", "Are the new modes APRV and HFV of value in ALI/ARDS?", "How best to deliver aerosol medications to mechanically ventilated patients?", "Do newer monitors of exhaled gases, mechanics, and esophageal pressure add value?", "Can VAP be prevented?", "Do ventilator protocols hinder or help teaching?", "Does central venous oxygenation monitoring improve mechanical ventilatory support?", "PAV and NAVA-better approaches to patient ventilator synchrony?", and "Does closed loop control of assist control ventilation reduce VILI?" Artificial respiration Respiratory Distress Syndrome, Adult therapy Tracheotomy Ventilator Weaning Ventilators, Mechanical MacIntyre, Neil R. Sonstige oth Clinics in chest medicine 29,2 (DE-604)BV000001084 29,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016538317&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Controversies in mechanical ventilation Clinics in chest medicine Artificial respiration Respiratory Distress Syndrome, Adult therapy Tracheotomy Ventilator Weaning Ventilators, Mechanical |
| title | Controversies in mechanical ventilation |
| title_auth | Controversies in mechanical ventilation |
| title_exact_search | Controversies in mechanical ventilation |
| title_exact_search_txtP | Controversies in mechanical ventilation |
| title_full | Controversies in mechanical ventilation guest ed. Neil R. MacIntyre |
| title_fullStr | Controversies in mechanical ventilation guest ed. Neil R. MacIntyre |
| title_full_unstemmed | Controversies in mechanical ventilation guest ed. Neil R. MacIntyre |
| title_short | Controversies in mechanical ventilation |
| title_sort | controversies in mechanical ventilation |
| topic | Artificial respiration Respiratory Distress Syndrome, Adult therapy Tracheotomy Ventilator Weaning Ventilators, Mechanical |
| topic_facet | Artificial respiration Respiratory Distress Syndrome, Adult therapy Tracheotomy Ventilator Weaning Ventilators, Mechanical |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016538317&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000001084 |
| work_keys_str_mv | AT macintyreneilr controversiesinmechanicalventilation |