Modern mechanical ventilation strategies for the acute care surgeon: What you need to know.

Abstract

Acute respiratory failure (ARF) is associated with significant morbidity and mortality in trauma and emergency surgery patients. Pulmonary complications following surgery among the most frequent and costly postoperative events. ARF support with mechanical ventilation is life-saving but may lead to ventilator-induced lung injury (VILI), worsening secondary injury. Decades of randomized clinical trials have demonstrated that evidence-based ventilator management can improve outcomes, but one-size-fits-all mechanical ventilation protocols fail to achieve true individualized, personalized care for ARF. This review presents the current evidence for mechanical ventilation support strategies for ARF including lung protective ventilation, judicious target setting, conservative fluid management appropriate light sedation, strategies to prevent ventilator-associated pneumonia and early attempts at ventilator weaning and extubation to be deployed to optimized patient outcomes. Specific mechanical ventilation strategies for patients with traumatic brain injury, obesity and acute respiratory distress syndrome will also be reviewed.