Articles: mechanical-ventilation.
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Curr Opin Crit Care · Feb 2025
ReviewSpontaneous breathing-induced lung injury in mechanically ventilated patients.
Recent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury. ⋯ Several potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.
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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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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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Journal of critical care · Feb 2025
Multicenter Study Comparative Study Observational StudyA tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients.
The novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmH2O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH2O. ⋯ A tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH2O. This finding should be interpreted cautiously due to the retrospective study design.
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The aim of this review is to summarize available data, including the most recent ones, to help develop the best possible strategy regarding the use of tracheostomy in ICU patients requiring prolonged mechanical ventilation or who experience loss of airway-protecting mechanisms. ⋯ A step-by-step individualized approach based on the available evidence allows identifying the best strategy regarding the use of tracheostomy in ICU patients.