Respiratory care
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Research in the area of adult invasive mechanical ventilation is rich and diverse. With more than 3,200 articles on mechanical ventilation published in 2018, isolating the most relevant literature is a challenge. Separated into 5 themes (ie, ventilatory support, hyperoxia, ventilator-associated events, prevention of events, and ventilator liberation), this article will describe the most important papers published on adult invasive mechanical ventilation in 2018.
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Patients who require mechanical ventilation in the prehospital and emergency department environments experience high mortality and are at high risk of ventilator-associated ventilator-induced lung injury and ARDS. In addition, little attention has been given in the literature, trainee education, or clinical emphasis to ventilator management in these patients. ARDS and ventilator-induced lung injury are time-sensitive disease processes that develop early in mechanical ventilation and could potentially be prevented with early lung-protective ventilation. ⋯ Recent literature highlights improved subjects outcomes in the setting of early lung-protective ventilation in both subjects with and those without ARDS. This review of the literature led us to recommend that lung-protective ventilation with avoidance of hyperoxia be the default goal ventilator strategy for all patients with prehospital and emergency department mechanical ventilation. This can be achieved by delivering low tidal volumes with stepwise, concurrent titration of FIO2 and PEEP to facilitate adequate oxygenation.