Intensive care medicine
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Intensive care medicine · Dec 2020
Randomized Controlled Trial Multicenter StudyNeurally adjusted ventilatory assist in acute respiratory failure: a randomized controlled trial.
We hypothesized that neurally adjusted ventilatory assist (NAVA) compared to conventional lung-protective mechanical ventilation (MV) decreases duration of MV and mortality in patients with acute respiratory failure (ARF). ⋯ NAVA decreased duration of MV although it did not improve survival in ventilated patients with ARF.
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Intensive care medicine · Dec 2020
ReviewClinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort.
Mechanical ventilation may have adverse effects on both the lung and the diaphragm. Injury to the lung is mediated by excessive mechanical stress and strain, whereas the diaphragm develops atrophy as a consequence of low respiratory effort and injury in case of excessive effort. The lung and diaphragm-protective mechanical ventilation approach aims to protect both organs simultaneously whenever possible. ⋯ A number of potential future adjunctive strategies including extracorporeal CO2 removal, partial neuromuscular blockade, and neuromuscular stimulation are also discussed. While clinical trials to confirm the benefit of these approaches are awaited, clinicians should become familiar with assessing and managing patients' respiratory effort, based on existing physiological principles. To protect the lung and the diaphragm, ventilation and sedation might be applied to avoid excessively weak or very strong respiratory efforts and patient-ventilator dysynchrony.