Prevention Of Ventilator-associated Lung Injury Research Articles

Protective ventilation from ICU to operating room: state of art and new horizons.

The prevention of ventilator-associated lung injury (VALI) and postoperative pulmonary complications (PPC) is of paramount importance for improving outcomes both in the operating room and in the intensive care unit (ICU). Protective respiratory support includes a wide spectrum of interventions to decrease pulmonary stress–strain injuries. The motto ‘low tidal volume for all’ should become routine, both during major surgery and in the ICU, while application of a high positive end-expiratory pressure (PEEP) strategy and of alveolar recruitment maneuvers requires a personalized approach and warrants further investigation. Patient self-inflicted lung injury is an important type of VALI, which should be diagnosed and mitigated at the early stage, during restoration of spontaneous breathing.This narrative review highlights the strategies used for protective positive pressure ventilation. The emerging concepts of damaging energy and power, as well as pathways to personalization of the respiratory settings, are discussed in detail. In the future, individualized approaches to protective ventilation may involve multiple respiratory settings extending beyond low tidal volume and PEEP, implemented in parallel with quantifying the risk of VALI and PPC.

High-frequency oscillatory ventilation for adult patients with acute respiratory distress syndrome

Background As a new kind of ventilatory mode, high-frequency oscillatory ventilation(HFOV) is characterized by the rapid delivery of small tidal volumes cycling and high mean airway pressure. It has been successfully used in adults with the acute respiratory distress syndrome(ARDS). It has been shown that HFOV has advantages over conventional mechanical ventilation(CMV) in improving oxygenation and reducing the incidence of ventilator associated lung injury(VILI). However, the effect of HFOV on mortality still needs to be characterized. Objective To summarize the trials evaluating HFOV in adults with ARDS and reveal both the strengths and weaknesses of HFOV. Content HFOV is associated with significant improvement in oxygenation and prevention of VILI, however, not associated with reduction of mortality. Further researches are needed to identify optimal patient selection, timing, ventilator settings, and the role of combining HFOV with other interventions. Trend Further researches and explorations are needed to define the role of HFOV in adult ARDS. Key words: High-frequency oscillatory ventilation; Acute respiratory distress syndrome; Adult; Mortality

Preventing Ventilator-Associated Lung Injury: A Perioperative Perspective

Research into the prevention of ventilator-associated lung injury (VALI) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has resulted in the development of a number of lung protective strategies, which have become commonplace in the treatment of critically ill patients. An increasing number of studies have applied lung protective ventilation in the operating room to otherwise healthy individuals. We review the history of lung protective strategies in patients with acute respiratory failure and explore their use in patients undergoing mechanical ventilation during general anesthesia. We aim to provide context for a discussion of the benefits and drawbacks of lung protective ventilation, as well as to inform future areas of research. We completed a database search and reviewed articles investigating lung protective ventilation in both the ICU and in patients receiving general anesthesia through May 2015. Lung protective ventilation was associated with improved outcomes in patients with acute respiratory failure in the ICU. Clinical evidence is less clear regarding lung protective ventilation for patients undergoing surgery. Lung protective ventilation strategies, including low tidal volume ventilation and moderate positive end-expiratory pressure, are well established therapies to minimize lung injury in critically ill patients with and without lung disease, and may provide benefit to patients undergoing general anesthesia.

The mechanism of Glutathione in the prevention of ventilator-associated lung injury

Objective To investigate the mechanism of Glutathione in the prevention of ventilator-associated lung injury. Methods 30 mechanical ventilation patients who were healthy before were selected and randomly divided into the two groups. Group A was the high tidal volume group:10mL/kg;group B was used the tidal volume plus the injection of Glutathione(2.4g/d). After 48 hours,we collected lavage fluid and use Coomassie brilliant blue to detect the protein content of alveolar lavage fluid of the two groups. Results There was a significant difference(P<0.01) between the two groups. The protein content in group A[(9.90±2.25)g/L]was higher than that of group B[(4.17± 0.39)g/L],and there was statistically significant(P<0.01). Conclusion Glutathione can reduce the incidence of ventilator-associated lung injury and prevent the occurrence of ventilator-associated lung injury. Key words: Glutathione; Ventilator-associated lung injury; Mechanical ventilation

ESA Clinical Trials Network 2012

Mechanical ventilation is frequently used as a supportivestrategy in intensive care medicine and anaesthesiologydespite its potential to aggravate or even initiate lunginjury. Indeed, overdistension of nondependent lungregions and repetitive opening and closing of dependentlung regions may cause mechanical stress and strain,eventually worsening or causing lung damage.

Long-term membrane oxygenator use to support an infant with acute respiratory distress syndrome on biventricular assist device†

Ventricular assist devices (VADs) are used in children with severe heart failure as a bridge to heart transplantation or recovery. Severe pulmonary dysfunction may preclude their use, leaving extracorporeal membrane oxygenation (ECMO) as the most frequently used option for combined cardiac and respiratory failure. There are few case reports describing the use of an oxygenator in combination with VAD support, but none that describes long-term utilization. We report the successful use of a low-resistance oxygenator placed into the right-sided VAD (RVAD) circuit of an infant with life-threatening respiratory failure. The oxygenator enabled immediate reversal of hypoxaemia and hypercarbia and recovery of the RVAD function. The oxygenator remained within the VAD circuit for 15 days, facilitating complete lung recovery. An oxygenator used in conjunction with a VAD may be a life-saving therapy, allowing adequate oxygenation and ventilation in severe respiratory and cardiac failure. Extended use may facilitate the prevention of ventilator-associated lung injury and organ dysfunction. This therapy may be an attractive intermediate step in the transition from, or alternative to ECMO, in patients requiring VAD placement with associated acute lung injury.

Recent advances in strategy for prevention and treatment of lung injury: prevention of ventilator-associated lung injury

30 cmH2O is commonly accepted, it is still controversial which restriction is more important, tidal volume or plateau pressure. By re-analyzing ARDSnet data, Deans et al. [4] suggested that an increase in tidal volume was associated with decreased mortality in a subgroup with high compliance (>0.6 ml·cmH2O·kg), whereas the increase was associated with increased mortality in a subgroup with low compliance (<0.6 ml·cmH2O·kg). In patients after PTE surgery, we initially applied a large tidal volume (12.5 ± 1.4 ml·kg−1). We adopted this setting because large tidal volume is thought to be helpful in avoiding hypercapnia-induced pulmonary hypertension after the surgery. In fact, the plateau pressure in these patients remained low (25.1 ± 3.8 cmH2O) and seemed safe because their compliance was high (0.70 ml·cmH2O·kg).