Review
Physiology
Fernando Suarez-Sipmann, Jesus Villar, Carlos Ferrando, Juan A. Sanchez-Giralt, Gerardo Tusman
Summary: Mechanical ventilation is crucial in managing acute respiratory distress syndrome, but it can contribute to ventilation-induced lung injury. Detecting VILI, especially cyclic overdistension, is challenging due to the insensitivity of routine monitoring methods.
FRONTIERS IN PHYSIOLOGY
(2021)
Article
Critical Care Medicine
Elias Baedorf Kassis, Henry K. Su, Alexander R. Graham, Victor Novack, Stephen H. Loring, Daniel S. Talmor
Summary: Reverse triggering is an underexplored form of dyssynchrony with important clinical implications in patients with acute respiratory distress syndrome. Different phenotypes of reverse triggering have varying effects on lung inflation and transpulmonary pressure, emphasizing the importance of understanding these events for clinical management.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)
Review
Medicine, General & Internal
Gary F. Nieman, David W. Kaczka, Penny L. Andrews, Auyon Ghosh, Hassan Al-Khalisy, Luigi Camporota, Joshua Satalin, Jacob Herrmann, Nader M. Habashi
Summary: Acute respiratory distress syndrome (ARDS) is characterized by heterogeneous lung injury, causing atelectasis and repetitive alveolar collapse and expansion (RACE). Previous ventilation strategies aimed to protect the lung by reducing overdistension or opening collapsed tissue. However, a new understanding of ARDS pathophysiology suggests that regional alveolar instability and collapse are primary mechanisms of ventilator-induced lung injury (VILI). A stabilize lung approach (SLA) using time-controlled adaptive ventilation (TCAV) is proposed, which stabilizes the lung and gradually reopens collapsed tissue. Animal studies and clinical analysis support the efficacy of TCAV as a lung protective strategy.
JOURNAL OF CLINICAL MEDICINE
(2023)
Review
Medicine, General & Internal
Po-Lan Su, Zhanqi Zhao, Yen-Fen Ko, Chang-Wen Chen, Kuo-Sheng Cheng
Summary: Acute respiratory distress syndrome (ARDS) is characterized by rapid-deteriorating lung injury. Vigorous spontaneous breathing may aggravate lung injury. Increased lung stress and pendelluft are important mechanisms of patient self-inflicted lung injury.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Physiology
Thijs A. Lilien, David M. P. Van Meenen, Marcus J. Schultz, Lieuwe D. J. Bos, Reinout A. Bem
Summary: The interest in oxygen toxicity has led to numerous studies, but there is still no consensus on the clinical impact of hyperoxia and hyperoxemia. This article explores the importance of hyperoxia-induced lung injury in current critical care practice, suggesting that it may be less important than other ventilator-related factors in patients with acute respiratory distress syndrome.
AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY
(2023)
Article
Critical Care Medicine
Erta Beqiri, Peter Smielewski, Claude Guerin, Marek Czosnyka, Chiara Robba, Lars Bjertnaes, Shirin K. Frisvold
Summary: This study investigated whether low tidal volume ventilation is associated with increased intracranial pressure and deranged cerebral autoregulation in patients with acute brain injury. The majority of patients did not experience adverse effects, but a quarter of patients had an increase in intracranial pressure. Baseline intracranial pressure, brain compensatory reserve, and mechanical power can be used to personalize ventilator settings.
Article
Medicine, General & Internal
Mark E. Seubert, Marco Goeijenbier
Summary: ARDS in COVID-19 patients often requires mechanical ventilation. The use of support mode during invasive mechanical ventilation can provide potential benefits and reduce the occurrence of ventilator-induced lung injury.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Critical Care Medicine
Colin K. Grissom, Michael J. Lanspa, Danielle Groat, Jason R. Jacobs, Lori Carpenter, Kathryn G. Kuttler, Lindsay Leither, Ithan D. Peltan, Samuel M. Brown, Rajendu Srivastava
Summary: This study implemented a computerized protocol for low tidal volume ventilation to improve the management and outcomes of mechanically ventilated patients. After the implementation, the set tidal volume decreased and more patients received the protocol. However, no improvement in clinical outcomes was observed.
CRITICAL CARE MEDICINE
(2023)
Article
Physiology
Nada Ismaiel, Sara Whynot, Laurette Geldenhuys, Zhaolin Xu, Arthur S. Slutsky, Valerie Chappe, Dietrich Henzler
Summary: The study found that low tidal volume ventilation reduces mechanical damage to the lung and attenuates ventilator-associated lung injury (VALI), while hypercapnia reduces inflammation and biochemical mechanisms of injury to attenuate VALI. Both lung-protective ventilation and hypercapnia may have a synergistic effect in preventing VALI.
FRONTIERS IN PHYSIOLOGY
(2022)
Article
Physiology
Harry Ramcharran, Jason H. T. Bates, Joshua Satalin, Sarah Blair, Penny L. Andrews, Donald P. Gaver, Louis A. Gatto, Guirong Wang, Auyon J. Ghosh, Benjamin Robedee, James Vossler, Nader M. Habashi, Nirav Daphtary, Michaela Kollisch-Singule, Gary F. Nieman
Summary: Ventilator-induced lung injury is a significant risk for patients with ARDS. Avoiding cyclic recruitment and derecruitment may be more important than overdistension in managing ARDS patients.
JOURNAL OF APPLIED PHYSIOLOGY
(2022)
Article
Anesthesiology
Jakob Wittenstein, Robert Huhle, Mark Leiderman, Marius Moebius, Anja Braune, Sebastian Tauer, Paul Herzog, Giulio Barana, Alessandra de Ferrari, Andrea Corona, Thomas Bluth, Thomas Kiss, Andreas Gueldner, Marcus J. Schultz, Patricia R. M. Rocco, Paolo Pelosi, Marcelo Gama de Abreu, Martin Scharffenberg
Summary: The study found that subject-ventilator asynchrony during spontaneous breathing did not exacerbate lung or diaphragm injury and dysfunction in experimental porcine ARDS.
BRITISH JOURNAL OF ANAESTHESIA
(2021)
Article
Critical Care Medicine
Gary Nieman, Michaela Kollisch-Singule, Harry Ramcharran, Joshua Satalin, Sarah Blair, Louis A. Gatto, Penny Andrews, Auyon Ghosh, David W. Kaczka, Donald Gaver, Jason Bates, Nader M. Habashi
Summary: Time-controlled adaptive ventilation (TCAV) is a novel ventilator approach that considers the temporal aspects of dynamic lung mechanics. It aims to reduce the risk of ventilator-induced lung injury (VILI) by adjusting the duration of expiration and inspiration, leading to improved survival rate of patients.
Article
Critical Care Medicine
Christoph Boesing, Peter T. Graf, Fabian Schmitt, Manfred Thiel, Paolo Pelosi, Patricia R. M. Rocco, Thomas Luecke, Joerg Krebs
Summary: The study demonstrates that prone positioning combined with appropriate PEEP levels can increase transpulmonary pressures, improve oxygenation, and stabilize hemodynamics in patients with moderate to severe ARDS. Using a lower PEEP strategy (PEEPARDSNetwork) in conjunction with prone positioning may be an effective lung protective ventilation strategy for these patients.
Article
Critical Care Medicine
Haruka Hashimoto, Takeshi Yoshida, Andi Muhammad Fadlillah Firstiogusran, Hiroki Taenaka, Ryota Nukiwa, Yukiko Koyama, Akinori Uchiyama, Yuji Fujino
Summary: Patient-ventilator asynchrony during mechanical ventilation may lead to lung and diaphragm injury. Breath stacking has a more detrimental effect on oxygenation, lung compliance, and lung injury compared to assist control, while reverse triggering predominantly causes diaphragm injury. Therefore, careful monitoring and management of patient-ventilator asynchrony is crucial in minimizing lung and diaphragm injury in ARDS patients.
CRITICAL CARE MEDICINE
(2023)
Article
Physiology
Gabriel C. Motta-Ribeiro, Tilo Winkler, Eduardo L. V. Costa, Nicolas de Prost, Mauro R. Tucci, Marcos F. Vidal Melo
Summary: Lung perfusion redistribution is associated with increased inflammation, nondependent capillary obliteration, and lung derecruitment susceptibility depending on endotoxemia level and ventilation strategy during pre-ARDS protective ventilation in animals.
JOURNAL OF APPLIED PHYSIOLOGY
(2023)