Pulmonology
Mechanical ventilation
Mechanical ventilation is a lifesaving intervention in critical care, supporting patients with acute respiratory failure, chronic respiratory conditions, or perioperative respiratory insufficiency. It encompasses both noninvasive respiratory support and invasive mechanical ventilation, each with distinct applications and benefits.
This section is divided into:
- Noninvasive respiratory support (NIV & HFNC): Techniques such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) help optimize oxygenation and ventilation while avoiding intubation-related complications.
- Invasive mechanical ventilation: When noninvasive methods fail, invasive ventilation provides precise control over oxygenation and ventilation but requires careful management to prevent ventilator-induced lung injury (VILI) and facilitate timely weaning.
By integrating evidence-based guidelines and expert recommendations, this section provides a structured approach to ventilation management, helping clinicians make informed decisions to optimize respiratory support and improve patient outcomes.
Noninvasive respiratory support
High-flow nasal cannula (HFNC)
High-flow nasal cannula
ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure
Simon Oczkowski et al., European Respiratory Journal (2022)
What’s inside
This article presents the European Respiratory Society's clinical practice guidelines on the use of high-flow nasal cannula (HFNC) therapy in adults with acute respiratory failure. It offers evidence-based recommendations comparing HFNC with conventional oxygen therapy (COT) and noninvasive ventilation (NIV) across various clinical scenarios.
Why it’s relevant
HFNC has become a widely used noninvasive respiratory support modality in acute care settings. These guidelines assist clinicians in making informed decisions about the appropriate use of HFNC, aiming to improve patient outcomes in acute respiratory failure.
Key focus
- Recommendations favoring HFNC over COT in hypoxemic acute respiratory failure.
- Guidance on choosing between HFNC and NIV in different patient populations, including postoperative patients and those at risk of extubation failure.
- Considerations for HFNC use during breaks from NIV and in patients with chronic obstructive pulmonary disease (COPD) experiencing hypercapnic respiratory failure.
Takeaway
The guidelines provide conditional recommendations supporting the use of HFNC in specific clinical situations involving acute respiratory failure. Clinicians should consider these recommendations to optimize respiratory support strategies tailored to individual patient needs.
Noninvasive mechaninal ventilation: CPAP & BiPAP
Noninvasive ventilation
Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure
Bram Rochwerg et al., European Respiratory Journal (2017)
What’s inside
This article presents the official clinical practice guidelines from the European Respiratory Society (ERS) and the American Thoracic Society (ATS) on the use of noninvasive ventilation (NIV) for acute respiratory failure (ARF). It provides evidence-based recommendations for various clinical scenarios, including chronic obstructive pulmonary disease (COPD) exacerbations, cardiogenic pulmonary edema, and postoperative respiratory failure.
Why it’s relevant
NIV is a critical intervention in managing ARF, offering benefits such as reduced intubation rates and improved patient outcomes. These guidelines assist clinicians in making informed decisions regarding the appropriate application of NIV across different patient populations.
Key focus
- Recommendations for NIV use in COPD exacerbations, highlighting its role in reducing mortality and intubation rates.
- Guidance on NIV application in cardiogenic pulmonary edema, emphasizing rapid improvement in respiratory distress.
- Considerations for NIV in de novo hypoxemic respiratory failure, including potential benefits and limitations.
- Use of NIV in immunocompromised patients, postoperative care, and during weaning from invasive ventilation.
Takeaway
The ERS/ATS guidelines provide comprehensive, evidence-based recommendations for the use of NIV in various forms of acute respiratory failure, aiding clinicians in optimizing patient care and improving clinical outcomes.
Peri-operative/periprocedural noninvasive ventilation
Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline
Marc Leone et al., Intensive Care Medicine (2020)
What’s inside
This joint guideline from the European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) provides evidence-based recommendations on the use of noninvasive respiratory support techniques—such as high-flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV), and continuous positive airway pressure (CPAP)—for hypoxaemic patients in peri-operative and periprocedural settings.
Why it’s relevant
Hypoxaemia is a common and potentially life-threatening complication during the peri-operative and periprocedural periods. Implementing appropriate noninvasive respiratory support can improve oxygenation, reduce postoperative complications, and enhance patient outcomes.
Key focus
- Recommendations favoring NIPPV or CPAP over conventional oxygen therapy (COT) to improve oxygenation in hypoxaemic peri-operative patients.
- Guidance on using NIPPV or CPAP immediately post-extubation for patients at risk of developing acute respiratory failure after abdominal surgery.
- Considerations for selecting appropriate noninvasive respiratory support techniques based on patient-specific factors and clinical scenarios.
- Emphasis on clinician competence in airway management and ventilation when administering noninvasive respiratory support.
Takeaway
Adhering to these guidelines can assist clinicians in selecting and implementing the most effective noninvasive respiratory support strategies for hypoxaemic patients during the peri-operative and periprocedural periods, thereby enhancing patient safety and clinical outcomes.
Invasive mechanical ventilation
Settings and modes
The basics of mechanical ventilation
The basics of mechanical ventilation in adults
Bill Pruitt, Nursing (2023)
What’s inside
This article provides an overview of mechanical ventilation in adults, focusing on the fundamental concepts, indications, and management strategies. It discusses the types of ventilators, modes of ventilation, and the role of healthcare providers in monitoring and adjusting ventilator settings to ensure optimal patient outcomes.
Why it’s relevant
Mechanical ventilation is a critical intervention for patients with respiratory failure or insufficiency. Understanding its principles and applications is essential for healthcare professionals to provide effective respiratory support, prevent complications, and facilitate patient recovery.
Key focus
- Indications for initiating mechanical ventilation, including acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD) exacerbations, and postoperative respiratory failure.
- Different modes of ventilation, such as volume-controlled and pressure-controlled modes, and their clinical applications.
- Monitoring parameters like tidal volume, respiratory rate, and oxygenation to assess patient status and ventilator performance.
- Strategies for weaning patients off mechanical ventilation and recognizing potential complications.
Takeaway
A solid understanding of mechanical ventilation principles enables healthcare providers to deliver safe and effective respiratory support, tailor interventions to individual patient needs, and improve overall patient care in critical settings.
Taxonomy for mechanical ventilation modes
A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims
Robert L. Chatburn et al., Respiratory Care (2014)
What’s inside
This article introduces a structured taxonomy for classifying mechanical ventilation modes, based on ten fundamental principles. It aims to standardize the understanding and application of various ventilatory strategies by defining key concepts and providing a systematic approach to categorize ventilation modes.
Why it’s relevant
The proliferation of mechanical ventilation modes has led to confusion and inconsistency in their application. A standardized taxonomy assists clinicians in accurately identifying, comparing, and selecting appropriate ventilation modes, enhancing patient care and facilitating effective communication among healthcare providers.
Key focus
- Definition and classification of breaths, including distinctions between assisted and unassisted breaths.
- Explanation of control variables (pressure and volume) in ventilation, grounded in the equation of motion for the respiratory system.
- Criteria for triggering and cycling events, differentiating between patient-initiated and ventilator-initiated breaths.
- Categorization of breath sequences and ventilatory patterns, such as continuous mandatory ventilation (CMV) and intermittent mandatory ventilation (IMV).
- Introduction of targeting schemes that define how ventilators achieve set targets during ventilation.
Takeaway
Implementing this taxonomy enables healthcare professionals to systematically classify and understand mechanical ventilation modes, promoting consistency in ventilatory support strategies and improving patient outcomes in critical care settings.
Selecting modes of ventilation
A Rational Framework for Selecting Modes of Ventilation
Eduardo Mireles-Cabodevila et al., Respiratory Care (2013)
What’s inside
This article introduces a systematic nomenclature for mechanical ventilation modes, categorizing them based on control variables, breath sequences, and targeting schemes.
Why it’s relevant
The framework improves clinician understanding and selection of ventilation strategies, enhancing decision-making and patient outcomes.
Key focus
- Development of a logical taxonomy for mechanical ventilation modes.
- Alignment of ventilation modes with three primary clinical goals: safety, comfort, and liberation.
- Comparison of existing ventilation modes using the proposed framework.
Takeaway
Implementing a systematic nomenclature for ventilation modes can enhance patient care by improving the selection and application of mechanical ventilation strategies.