Current opinion in critical care
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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.
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Curr Opin Crit Care · Feb 2025
ReviewMonitoring and modulating respiratory drive in mechanically ventilated patients.
Respiratory drive is frequently deranged in the ICU, being associated with adverse clinical outcomes. Monitoring and modulating respiratory drive to prevent potentially injurious consequences merits attention. This review gives a general overview of the available monitoring tools and interventions to modulate drive. ⋯ Monitoring and modulating respiratory drive are feasible based on physiological principles presented in this review. However, evidence arising from clinical trials will help determine precise thresholds and optimal interventions.
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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.
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Past observational studies have reported the association between patient-ventilator asynchronies and poor clinical outcomes, namely longer duration of mechanical ventilation and higher mortality. But causality has remained undetermined. During the era of lung and diaphragm protective ventilation, should we revolutionize our clinical practice to detect and treat dyssynchrony? ⋯ Most recent evidence on the topic suggests that synchrony between the patient and the mechanical ventilator is a critical element for protecting lung and diaphragm during the time of invasive mechanical ventilation or may reflect inadequate settings or sedation. Therefore, it is a complex situation, and clinical trials are still needed to test the effectiveness of keeping patient-ventilator interaction synchronous on clinical outcomes.
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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.