Current opinion in critical care
-
The purpose of this review is to examine the current state of the evidence, including several recent systematic reviews and meta-analyses, to determine if proportional modes of ventilation have the potential to hasten weaning from mechanical ventilation for adult critically ill patients, compared to pressure support ventilation (PSV), the current standard of care during the recovery and weaning phases of mechanical ventilation. ⋯ The current state of the evidence suggests that proportional modes may hasten weaning from mechanical ventilation, but larger, multicentre RCTS are needed to confirm these preliminary findings.
-
Curr Opin Crit Care · Feb 2025
ReviewHow to protect the diaphragm and the lung with diaphragm neurostimulation.
In the current review, we aim to highlight the evolving evidence on using diaphragm neurostimulation to develop lung and diaphragm protective mechanical ventilation. ⋯ Scientific interest in temporary diaphragm neurostimulation has dramatically evolved in the last few years. Despite a solid physiological rationale and promising preliminary findings confirming a beneficial effect on the diaphragm and lungs, more studies and further technological advances will be needed to establish optimal standardized settings and lead to clinical implementation and improved outcomes.
-
Curr Opin Crit Care · Feb 2025
ReviewAdvances in achieving lung and diaphragm-protective ventilation.
Mechanical ventilation may have adverse effects on diaphragm and lung function. Lung- and diaphragm-protective ventilation is an approach that challenges the clinician to facilitate physiological respiratory efforts, while maintaining minimal lung stress and strain. Here, we discuss the latest advances in monitoring and interventions to achieve lung- and diaphragm protective ventilation. ⋯ Achieving lung- and diaphragm-protective ventilation may require more than a single intervention; it demands a comprehensive understanding of the (neuro)physiology of breathing and mechanical ventilation, along with the application of a series of interventions under close monitoring. We suggest a bedside-approach to achieve lung- and diaphragm protective ventilation targets.
-
Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation. ⋯ Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.
-
Curr Opin Crit Care · Feb 2025
ReviewMonitoring respiratory muscles effort during mechanical ventilation.
To summarize basic physiological concepts of breathing effort and outline various methods for monitoring effort of inspiratory and expiratory muscles. ⋯ Different tools are available for monitoring the respiratory muscles' effort during mechanical ventilation - from noninvasive screening tools to more invasive quantification methods. This could facilitate a lung and respiratory muscle-protective ventilation approach.