Review of mechanical ventilation for the non-critical care trained practitioner. Part 2

Rebeca Shimabukuri, Ehab G. Daoud

Cite

Shimabukuri R, Daoud EG. Review of mechanical ventilation for the non-critical care trained practitioner. Part 2. J Mech Vent 2021; 2(1)1-16.

Abstract

There have been a recent shortage of both critical care physicians and respiratory therapists with training in mechanical ventilation that is accentuated by the recent COVID-19 crisis. Hospitalists find themselves more often dealing with and treating critically ill patients on mechanical ventilation without specific training.

The first part of this review attempted to explain and simplify some of the physiologic concepts and basics of mechanical ventilation. This second part of the review we will discuss some of the common modes used for support and weaning during mechanical ventilation and to address some of the adverse effects associated with mechanical ventilation.

We understand the complexity of the subject and this review would not be a substitute of seeking appropriate counselling, further training, and medical knowledge about mechanical ventilation.

Further free resources are available to help clinicians who feel uncomfortable making decisions with such technology

Keywords

COPD, ARDS, Weaning, VCV, PCV, ASV, MMV, NAVA, PSV, ATC, VSV, PRVC, APRV

References

1 . Halpern NA, Pastores SM, Oropello JM, et al. Critical care medicine in the United States: addressing the intensivist shortage and image of the specialty. Crit Care Med 2013; 41:2754-2761.
https://doi.org/10.1097/CCM.0b013e318298a6fb
PMid:24132037
2 . Hester TB, Cartwright JD, DiGiovine DG, et al. Training and deployment of medical students as respiratory therapist extenders during COVID-19. ATS Scholar 2020; 1(2):145-151.
https://doi.org/10.34197/ats-scholar.2020-0049PS
PMid:33870278 PMCid:PMC8043304
3 . Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical ventilation: 10 fundamental maxims. Respir Care 2014; 59(11):1747-1763.
https://doi.org/10.4187/respcare.03057
PMid:25118309
4 . Daoud EG, Shimabukuro R. Mechanical ventilation for the non-critical care trained practitioner. Part 1. J Mech Vent 2020; 1(2):39-51.
https://doi.org/10.53097/JMV.10011
5 . Pham T, Telias I, Piraino T, et al. Asynchrony consequences and management. Crit Care Clin 2018; 34:325-341.
https://doi.org/10.1016/j.ccc.2018.03.008
PMid:29907268
6 . Marik PE, Krikorian J. Pressure-controlled ventilation in ARDS: a practical approach. Chest 1997; 112(4):1102-1106.
https://doi.org/10.1378/chest.112.4.1102
PMid:9377923
7 . Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care 2002; 47(4):416-424.
8 . Needham M, Smith R, Bauchmuller K. Pressure-regulated volume control ventilation as a means of improving lung-protective ventilation. J Intensive Care Soc 2019; 20(1):NP6-NP7.
https://doi.org/10.1177/1751143718798586
PMid:30792774 PMCid:PMC6376575
9 . Guthrie, S., Lynn, C., LaFleur, B. et al. A Crossover analysis of mandatory minute ventilation compared to synchronized intermittent mandatory ventilation in neonates. J Perinatol 2005; 25:643-646.
https://doi.org/10.1038/sj.jp.7211371
PMid:16079905
10 . Daoud EG, Farag HL, Chatburn RL. Airway pressure release ventilation: what do we know? Respir Care 2012; 57(2):282-292.
https://doi.org/10.4187/respcare.01238
PMid:21762559
11 . Fernández J, Miguelena D, Mulett H, et al. Adaptive support ventilation: State of the art review. Indian J Crit Care Med 2013; 17(1):16-22.
https://doi.org/10.4103/0972-5229.112149
PMid:23833471 PMCid:PMC3701392
12 . Huang CT, Lin HH, Ruan SY, et al. Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis. Crit Care 2014; 18(3):R102.
https://doi.org/10.1186/cc13880
PMid:24886674 PMCid:PMC4075239
13 . Meyers M, Rodrigues N, Ari A. High-frequency oscillatory ventilation: A narrative review. Can J Respir Ther 2019; 55:40-46.
https://doi.org/10.29390/cjrt-2019-004
PMid:31297448 PMCid:PMC6591785
14 . Kacmarek RM. Proportional assist ventilation and neurally adjusted ventilatory assist. Respir Care 2011; 56:(2)140-152.
https://doi.org/10.4187/respcare.01021
PMid:21333175
15 . MacIntyre NR. Respiratory function during pressure support ventilation. Chest 1986; 89(5):677-683.
https://doi.org/10.1378/chest.89.5.677
PMid:3698697
16 . Ghamloush M, Hill NS. Synchronized intermittent mandatory ventilation: time to send this workhorse out to pasture. Respir Care 2013; 58(11) 1992-1994.
https://doi.org/10.4187/respcare.02880
PMid:24155359
17 . Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995; 332(6):345-350.
https://doi.org/10.1056/NEJM199502093320601
PMid:7823995
18 . Sancar NK, Özcan PE, Şentürk E, et al. The comparison of pressure (psv) and volume support ventilation (vsv) as a ‘weaning’ mode. Turk J Anaesthesiol Reanim 2014; 42(4):170-175.
https://doi.org/10.5152/TJAR.2014.61687
PMid:27366416 PMCid:PMC4894144
19 . Guttmann J, Haberthür C, Mols G, et al. Automatic tube compensation (ATC). Minerva Anestesiol 2002; 68(5):369-377.
20 . Capra, S., Manera, S. Proportional pressure support in acute lung injury: an observational study. Crit Care 2000; 4:111.
https://doi.org/10.1186/cc831
PMCid:PMC3333035
21 . Taniguchi C, Victor ES, Pieri, T et al. Smart Care versus respiratory physiotherapy-driven manual weaning for critically ill adult patients: a randomized controlled trial. Crit Care 2005; 19:246-254.
https://doi.org/10.1186/s13054-015-0978-6
PMid:26580673 PMCid:PMC4511442
22 . Klompas M. Ventilator-Associated Events: what they are and what they are not. Respir Care 2019; 64(8):953-961.
https://doi.org/10.4187/respcare.07059
PMid:31346070
23 . Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 1;63(5):e61-e111.
https://doi.org/10.1093/cid/ciw353
PMid:27418577 PMCid:PMC4981759
24 . Beitler JR, Malhotra A, Thompson BT. Ventilator-induced lung injury. Clin Chest Med 2016; 37(4):633-646.
https://doi.org/10.1016/j.ccm.2016.07.004
PMid:27842744 PMCid:PMC5131805
25 . Hamahata NT, Sato R, Yamasaki K, et al. Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec. J Mech Vent 2020; 1(1):8-13.
https://doi.org/10.53097/JMV.10003
26 . De HaroC, Ochagavia A, López-Aguilar J, et al. Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities. Intensive Care Medicine Experimental 2019; 7(Suppl 1):43-56.
https://doi.org/10.1186/s40635-019-0234-5
PMid:31346799 PMCid:PMC6658621