Modes, effects, humidification, patients’ experiences
(See also – WEANING, TRACHEOSTOMY)

TUTORIAL on MV
www.ccmtutorials.com/rs/mv/index.htm

AARC GUIDELINE (2012): Humidification during invasive and non invasive mechanical ventilation
www.rcjournal.com/cpgs/pdf/12.05.0782.pdf

AARC GUIDELINE (2011): Capnography/capnometry during mechanical ventilation
www.rcjournal.com/cpgs/pdf/04.11.0503.pdf


Banki F, Estrera AL, Harrison RG et al (2013) Pneumomediastinum: etiology and a guide to diagnosis and treatment. Am J Surg; 206(6):1001-1006

Beloncle F, Piquilloud L, Rittayamai N et al (2017) A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing. Crit Care; 21:21
ccforum.biomedcentral.com/articles/10.1186/s13054-017-1599-z

Beurskens CJ, Brevoord D, Lagrand WK et al (2016) Heliox improves carbon dioxide removal during lung protective mechanical ventilation. Crit Care Res Pract; 2014:954814. doi: 10.1155/2014/954814
www.ncbi.nlm.nih.gov/pmc/articles/PMC4274833/

Caironi P (2016) Driving pressure and intraoperative protective ventilation. Lancet Respir Med; 4(4): 243–245. doi: dx.doi.org/10.1016/S2213-2600(16)00108-9

Chiumello D (2013) Time to reach a new steady state after changes of positive end expiratory pressure. Int Care Med; 39(8):1377-8

De Beer JM, Gould T (2013) Principles of artificial ventilation. Anaesth Int Care Med, 14(3):83–93

De Prost N (2013) Effects of ventilation strategy on distribution of lung inflammatory cell activity. Crit Care, 17:R175. doi: 10.1186/cc12854

Di mussi R, Spadaro S, Mirabella L et al (2016) Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care; 20:1. doi: 10.1186/s13054-015-1178-0
ccforum.biomedcentral.com/articles/10.1186/s13054-015-1178-0
• NAVA is best

Dres M, Rittayamai N, Brochard L (2016) Monitoring patient–ventilator asynchrony. Curr Opinion Crit Care; 22(3):246–253. doi: 10.1097/MCC.0000000000000307

Dries DJ (2016) Assisted ventilation. J Burn Care Res; 37(2):75-85. doi: 10.1097/BCR.0000000000000231

Facchin F, Fan E (2015) Airway pressure release ventilation and high-frequency oscillatory ventilation: potential strategies to treat severe hypoxemia and prevent ventilator-induced lung injury. Respir Care; 60(10):1509-1521

Fortis S, Florindez J, Balasingham S et al (2015) Ventilator settings can substantially impact patients' comfort. J Intensive Care Med; 30(5):286-91. doi: 10.1177/0885066613519574
• ventilator settings impact patient synchrony and comfort

Gattinoni L (2016) Ultra-protective ventilation and hypoxemia. Crit Care; 20(1):130. doi: 10.1186/s13054-016-1310-9
www.ncbi.nlm.nih.gov/pmc/articles/PMC4865006/
• atelectasis is a risk with ultra-protective ventilation, which can be reduced by at least one normal tidal volume delivered every 2 mins. Other risks relate to people with ARDS, e.g. 30-40% of recruitable lung remains closed and newly formed atelectasis cannot be reopened

Grap MJ, Munro CL, Wetzel PA et al (2016) Backrest elevation and tissue interface pressure by anatomical location during mechanical ventilation. Am J Crit Care; 25(3):e56-63. doi: 10.4037/ajcc2016317.

Guo L, Wang W, Zhao N et al (2016) Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care; 20:226. doi: 10.1186/s13054-016-1396-0.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4957383/

Haberthur C (2009) Expiratory automatic endotracheal tube compensation reduces dynamic hyperinflation in a physical lung model. Crit Care, 13, R4
ccforum.com/content/pdf/cc7693.pdf

Hamilton V, Grap MJ (2012) The role of the endotracheal tube cuff in microaspiration. Heart Lung, 41, 2, 167-72

Hedenstierna G et al (2002) Gas exchange in the ventilated patient. Curr Opin Crit Care, 8, 39-44
• effect on gas exchange of positioning, recruitment manoeuvres, modes with spontaneous breathing and nitric oxide

Hosokawa K, Nishimura M, Egi M et al (2015) Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care; 19:424. doi: 10.1186/s13054-015-1138-8
ccforum.biomedcentral.com/articles/10.1186/s13054-015-1138-8
• early tracheotomy is associated with better outcomes, more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy

Huhle R, Pelosi P, de Abreu M (2016) Variable ventilation from bench to bedside. Crit Care; 20:62. doi: 10.1186/s13054-016-1216-6
ccforum.biomedcentral.com/articles/10.1186/s13054-016-1216-6

Jablonski RS (1994) The experience of being mechanically ventilated. Qual Health Res, 4, 2, 186-207
• revealing interviews with patients.

Jaeger JM (2002) The role of tracheostomy in weaning from mechanical ventilation. Respir Care, 47, 469-80
www.rcjournal.com/contents/04.02/04.02.0469.asp
• tracheostomy should be done within three days of intubation if prolonged mechanical ventilation is anticipated, except in children who sustain greater long term damage from tracheostomy than adults

Jorens PG (2016) Sticking to an old definition of ventilator-associated pneumonia is not old-fashioned. Respir Care; 61(3):390-392
• VAP occurs in up to 27% of patients, leading to increased length of ICU and hospital stay, and higher mortality

Kalil AC, Metersky ML, Klompas M et al (2016) Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis; 63(5):e61-e111.

Kallet RH (2015) The complexity of interpreting plateau pressure in AR. Respir Care; 60(1):147-149

Khan R, Al-Dorzi HM, Al-Attas K et al (2016) The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. Am J Infect Control; 44(3):320-6. doi: 10.1016/j.ajic.2015.09.025

Khan RM, Aljuaid M, Aqeel H et al (2017) Introducing the comprehensive unit-based safety program for mechanically ventilated patients in Saudi Arabian intensive care units. Ann Thorac Med; 12(1):11-6
www.thoracicmedicine.org/text.asp?2017/12/1/11/197765
• VAP is the most common healthcare-associated infection in ICU, incidence is 9-28%
• ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization)
• head elevation is used because of its simplicity, ubiquity and low cost, but not from evidence

Lamb, Keith D (2015) Year in review 2014: mechanical ventilation. Respir Care; 60(4):606-608

Lizy C et al (2014) Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care; 23(1):e1-8

MacIntyre N (2013) Patient-ventilator trigger dys-synchrony: a common phenomenon with important implications. Crit Care, 17:157. doi:10.1186/cc12729

Mahmood NA, Chaudry FA, Azam H (2013) Frequency of hypoxic events in patients on a mechanical ventilator. Int J Crit Illn Inj Sci; 3(2):124-9

Marini AL, Khan R, Mundekkadan S (2016) Multifaceted bundle interventions shown effective in reducing VAP rates in our multidisciplinary ICUs. BMJ Qual Improv Rep; 5(1):u205566.w2278. doi: 10.1136/bmjquality.u205566.w2278
www.ncbi.nlm.nih.gov/pmc/articles/PMC4822021/

Medrinal C, Prieur G, Frenoy E et al (2016) Respiratory weakness after mechanical ventilation is associated with one-year mortality - a prospective study. Crit Care; 20:231. doi: 10.1186/s13054-016-1418-y
https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1418-y?utm_campaign=BMC40264C&utm_medium=BMCemail&utm_source=Teradata

Mellema MS (2015) Ventilator waveforms. Top Companion Anim Med; 28(3):112-23. doi: 10.1053/j.tcam.2013.04.001

Mellott KG, Grap MJ, Munro CL et al (2014) Patient ventilator asynchrony in critically ill adults: frequency and types. Heart Lung; 43(3):231-43. doi: 10.1016/j.hrtlng.2014.02.002

Méndez VMF (2017) Hemodynamics and tissue oxygenation effects after increased positive end-expiratory pressure in coronary artery bypass surgery. Arch Physiother; 7:2.
• PEEP may increase arterial oxygenation but reduce oxygen delivery

Modrykamien AM, Killian L, Walters RW (2016) Liberal manipulation of ventilator settings and its impact on tracheostomy rate and ventilator-free days. Respir Care; 61(1):30-5. doi: 10.4187/respcare.03887

Mongodi S, Via G, Girard M et al (2016) Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest; 149(4):969-980. doi: 10.1016/j.chest.2015.12.012

Murias G, Lucangelo U, Blanch L (2016) Patient-ventilator asynchrony. Curr Opin Crit Care; 22(1):53-9. doi: 10.1097/MCC.0000000000000270

Naik BI, Lynch III, Carl D et al (2015) Variability in mechanical ventilation: what's all the noise about? Respir Care; 60(8):1203-1210

Natalini G, Tuzzo D, Rosano A et al (2016) Assessment of factors related to auto-PEEP. Respir Care; 61(2):134-14

Neto AS, Schultz MJ, Festic E (2016) Ventilatory support of patients with sepsis or septic shock in resource-limited settings. Int Care Med; 42(1): 100 - 103 

Nishimura M (2015) For critically ill patients, is high-flow nasal cannula oxygen delivery a suitable alternative to mechanical ventilation? Respir Care; 60(2): 307-308

Ntoumenopoulos G, Shannon H, Main E (2011) Do commonly used ventilator settings for mechanically ventilated adults have the potential to embed secretions or promote clearance? Respir Care, 56, 12, 1887-92
• commonly used settings generate an inspiratory flow bias that may promote secretion retention.

Panwar R, Hardie M, Bellomo R et al (2016) Conservative versus liberal oxygenation targets for mechanically ventilated patients. a pilot multicenter randomized controlled trial. Am J Respir Crit Care Med; 193(1):43-51. doi: 10.1164/rccm.201505-1019OC

Prigent H, Lejaille M, Terzi N et al (2012) Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Int Care Med; 38(1):85-90. doi: 10.1007/s00134-011-2417-8
• speaking tracheostomy tube facilitates protective expiration after swallowing to help protect against aspiration

Puah AH, Sze CTP (2017) Lung herniation after positive pressure ventilation. Respir Med Case Rep; 20:61-63

Ramirez II, Arellano DH, Adasme RS et al (2017) Ability of ICU health-care professionals to identify patient-ventilator asynchrony using waveform analysis. Respir Care; 62(2):144-9

Robertson TE (2016) Ventilator management: a systematic approach to choosing and using new modes. Adv Surg; 50(1):173-186
ac.els-cdn.com/S0065341116000142/1-s2.0-S0065341116000142-main.pdf?_tid=49502d0c-8c72-11e6-ae25-00000aab0f01&acdnat=1475833496_43e08d95ff1870c0e83dc36e46b34c21

Ronchi CF (2014) Interactive effects of mechanical ventilation, inhaled nitric oxide and oxidative stress in acute lung injury. Resp Physiol Neurobiol; 190(1):118-123

Roussos M (2010) Can we improve sleep quality by changing the way we ventilate patients? Lung, 188, 1, 1
resources.metapress.com/pdf-preview.axd?code=r4417537k5256272&size=largest
• sleep deprivation increases risk of impaired respiratory, cognitive, cardiovascular, endocrine and immune function, and (in women) diabetes

Schellekens WM, van Hees HW, Kox M et al (2014) Hypercapnia attenuates ventilator-induced diaphragm atrophy and modulates dysfunction. Crit Care; 18:R28. doi: 10.1186/cc13719
• hypercapnia partly protects the diaphragm against ventilator-induced inflammation, atrophy and function

Schwaiberger D, Karcz M, Menk M et al (2016) Respiratory failure and mechanical ventilation in the pregnant patient. Crit Care Clinics; 32(1):85–95. doi: dx.doi.org/10.1016/j.ccc.2015.08.001

Sen O, Umutoglu T, Aydın N et al (2016) Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy. SpringerPlus; 5:298. doi: 10.1186/s40064-016-1963-5.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4783310/
• pressure control delivers lower peak airway pressure and reduced risk of barotrauma

Shan L, Hao P, Xu F et al (2013) Benefits of early tracheotomy: a meta-analysis based on 6 observational studies. Respir Care; 58(11):1856-62
• tracheostomy 3–7 days after intubation reduces mortality and hospital stay

Sinclair SE (2010) Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion. BMC Pulm Med, 10, 25. doi:10.1186/1471-2466-10-25
www.biomedcentral.com/content/pdf/1471-2466-10-25.pdf
• cyclical collapse and recruitment tends to preferentially damage lower lobes
• risk is reduced by ensuring that PEEP is above functional residual capacity
• outcomes are improved if distending pressures are limited by reduced tidal volumes

Spiegel R, Haney Mallemat H (2016) Emergency department treatment of the mechanically ventilated patient. Emerg Med Clin; 34(1):63–75. doi: dx.doi.org/10.1016/j.emc.2015.08.005

Sütterlin R, Priori R, Larsson A et al (2014) Frequency dependence of lung volume changes during superimposed high-frequency jet ventilation and high-frequency jet ventilation
Br J Anaesth; 112(1):141-149 doi:10.1093/bja/aet260

Taiga I, Yuuki N, Nao O et al (2015) Hyperoxemia in mechanically ventilated, critically ill subjects: incidence and related factors. Respir Care; 60(3):335-340

Uchiyama A, Yoshida T, Yamanaka H et al (2013) Estimation of tracheal pressure and imposed expiratory work of breathing by the endotracheal tube, heat and moisture exchanger, and ventilator during mechanical ventilation. Respir Care; 58(7):1157-69. doi: 10.4187/respcare.01698

Vaschetto R, Cammarota G, Colombo D et al (2014) Effects of propofol on patient-ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med; 42(1):74-82. doi: 10.1097/CCM.0b013e31829e53dc

Volpe MS, Adams AB, Amato MBP (2008) Ventilation patterns influence airway secretion movement. Respir Care, 53, 10, 1287-94

Weijs PJM, Looijaard WGPM, Dekker IM et al (2014) Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care; 18:R12. doi:10.1186/cc13189
ccforum.com/content/18/1/R12/abstract
• low skeletal muscle area during the early stage of critical illness is a risk factor for mortality in mechanically ventilated patients

Yusuke S, Hideo Y, Hiroki M et al (2015) The dose-response relationship between body mass index and mortality in subjects admitted to the ICU with and without mechanical ventilation. Respir Care; 60(7):983-991

Zhang X, Wu W, Zhu Y et al (2016) Abdominal muscle activity during mechanical ventilation increases lung injury in severe acute respiratory distress syndrome. PLoS One. Jan 8;11(1):e0145694. doi: 10.1371/journal.pone.0145694

Zoremba M, Kalmus G, Dette F (2010) Effect of intra-operative pressure support vs pressure controlled ventilation on oxygenation and lung function in moderately obese adults. Anaesthesia, 65, 2, 124-9
• pressure support leads to better VA/Q match than pressure control


AARC = American Association for Respiratory Care
ARDS = acute respiratory distress syndrome
MV = mechanical ventilation
NAVA = neurally adjusted ventilator assist
PCV = pressure-controlled ventilation
PEEP = positive end-expiratory pressure
VA/Q = ventilation/perfusion
VAP = ventilator-associated pneumonia
VT = tidal volume
WOB = work of breathing