Current issues in mechanical ventilation for respiratory failure.

The morbidity and mortality associated with respiratory failure is, to a certain extent, iatrogenic. Mechanical ventilation, although the mainstay of treatment for respiratory distress syndrome, can result in physical trauma to lung tissue (ventilator-induced lung injury [VILI]). Strategies to alleviate VILI are often termed lung-protective strategies and are aimed at reducing overstretching and shear stresses associated with repetitive alveolar collapse and reopening. Lower tidal volumes during ventilation, maintenance of positive-end expiratory pressure, and high-frequency ventilation are the best-studied lung-protective strategies that appear to reduce VILI. Faster withdrawal from mechanical ventilation could also improve outcomes and lower the costs associated with care. To enhance the success of weaning from mechanical ventilation, the cooperative efforts of physicians and respiratory therapists are needed. These efforts involve the initiation of spontaneous-breathing trials, implementation of systematic weaning protocols, and optimization of individual patient interventions.

[1]  Charles Natanson,et al.  Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. , 2002, American journal of respiratory and critical care medicine.

[2]  J. Wetterslev,et al.  [Incidence, severity and mortality of acute respiratory failure in Denmark]. , 2000, Ugeskrift for laeger.

[3]  C. Goss,et al.  Incidence of acute lung injury in the United States. , 2003, Critical care medicine.

[4]  D Hess,et al.  Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. , 2001, Chest.

[5]  Arthur S Slutsky,et al.  Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. , 1997, The Journal of clinical investigation.

[6]  A. Artigas,et al.  Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany. , 1995, American journal of respiratory and critical care medicine.

[7]  Kristian Antonsen,et al.  Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark, and Iceland , 1999 .

[8]  S. Peters,et al.  A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. , 1992, The American review of respiratory disease.

[9]  J B Wong,et al.  Effect of failed extubation on the outcome of mechanical ventilation. , 1997, Chest.

[10]  M. Griffiths,et al.  Ventilator-associated lung injury , 2003, The Lancet.

[11]  D. Tierney,et al.  Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. , 2015, The American review of respiratory disease.

[12]  A S Slutsky,et al.  Mechanical ventilation affects local and systemic cytokines in an animal model of acute respiratory distress syndrome. , 1999, American journal of respiratory and critical care medicine.

[13]  A. Pesenti,et al.  Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. , 1987, The American review of respiratory disease.

[14]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[15]  L. Puybasset,et al.  Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung , 2003, Critical care medicine.

[16]  F. Battistella,et al.  Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. , 2000, Chest.

[17]  Sangeeta Mehta,et al.  High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. , 2002, American journal of respiratory and critical care medicine.

[18]  J. Marini.  Evolving concepts in the ventilatory management of acute respiratory distress syndrome. , 1996, Clinics in chest medicine.

[19]  F Lemaire,et al.  Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. , 1998, American journal of respiratory and critical care medicine.

[20]  S. Epstein,et al.  Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. , 1998, American journal of respiratory and critical care medicine.

[21]  S Sauer,et al.  A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. , 1997, Critical care medicine.

[22]  Arthur S Slutsky,et al.  Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. , 1998, The New England journal of medicine.

[23]  E F Haponik,et al.  Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. , 1996, The New England journal of medicine.

[24]  David M. Shade,et al.  Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. , 1999, Critical care medicine.

[25]  I. L. Cohen,et al.  Clinical and economic outcome of mechanically ventilated patients in New York State during 1993: analysis of 10,473 cases under DRG 475. , 1998, Chest.

[26]  C. Carvalho,et al.  Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. , 1998, The New England journal of medicine.