Erschienen in:
22.11.2018 | Editorial
Focus on ventilation management
verfasst von:
Audrey De Jong, Samir Jaber
Erschienen in:
Intensive Care Medicine
|
Ausgabe 12/2018
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Excerpt
In this article, we summarize ten important developments in the field of mechanical ventilation. Recommendations have been made through the past decades for optimizing the ventilation of intensive care unit (ICU) patients [
1], and in particular in 2017 in acute respiratory distress syndrome (ARDS) patients [
2], including low tidal volume, positive end-expiratory pressure (PEEP), and early extubation. Asehnoune et al. [
3] found that adherence to these recommendations in the specific population of brain-injured patients increased the number of ventilator-free days. However, inconsistent adoption limited their impact [
3]: implementation of this nationwide quality project promoting lung-protective ventilation and systemic approach to early extubation did not result in a significant improvement in liberating brain-injured patients from mechanical ventilation. This point underlines the need for monitoring the implementation of the multifaceted approach and of promoting application. In these ventilated brain injury patients, advances have been made in the comprehension of pulmonary modifications. Brain-injured patients are particularly prone to lung impairment, in part because of a poorly understood but fundamental concept: lung–brain cross talk [
4]. Acquired sepsis and respiratory failure are more frequent in brain-injured ICU patients than in other ICU patients without brain injury. On the one hand, injury from brain to lung involves increase in intracranial pressure, catecholamine release, neuroinflammation (humoral, neural, cellular), failure of cholinergic anti-inflammatory pathway, hyperdopaminergic states, and hyperosmolar therapy [
4]. On the other hand, injury from lung to brain also involves the release of mediators, and ventilatory disturbances such as hyper/hypocapnia and hypoxemia [
4]. …