Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 9 , ISSUE 4 ( October, 2005 ) > List of Articles

REVIEW ARTICLE

Mechanical ventilation: changing concepts

Laurent Brochard, Pablo Rodriguez, Michel Dojat

Keywords : Acute respiratory failure, Mechanical ventilation, Ventilator modes

Citation Information : Brochard L, Rodriguez P, Dojat M. Mechanical ventilation: changing concepts. Indian J Crit Care Med 2005; 9 (4):235-243.

DOI: 10.4103/0972-5229.19765

License: CC BY-ND 3.0

Published Online: 01-04-2010

Copyright Statement:  Copyright © 2005; The Author(s).


Abstract

Mechanical ventilation is routinely delivered to patients admitted in intensive care units to reduce work of breathing, improve oxygenation, or correct respiratory acidosis. Although traditional modes of mechanical ventilation achieve many of these goals, they have important limitations. Alternative modes are supposed to handle some of these limitations and are now available on modern ventilators. This article reviews general aspects of functioning and limitations of traditional modes of mechanical ventilation, and the potential interest of some new promising modes.


PDF Share
  1. Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, et al, Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345-55.
  2. Leung P, Jubran A, Tobin MJ. Comparison of assisted ventilator modes on triggering, patient effort and dyspnea. Am J Respir Crit Care Med 1997;155:1940-8.
  3. Brochard L, Harf A, Lorino H, Lemaire F. Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 1989;139:513-21.
  4. Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky P, Choi YS, et al, Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 2003;167:120-7.
  5. Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M. Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 1997;112:1592-9.
  6. Nava S, Bruschi C, Fracchia C, Braschi A, Rubini F, Patient-ventilator interaction and inspiratory effort during pressure support ventilation in patients with different pathologies. Eur Respir J 1997;10:177-83.
  7. Parthasarathy S, Tobin MJ. Effect of ventilator mode on sleep quality in critically ill patients. Am J Respir Crit Care Med 2002;166:1423-9.
  8. Chatburn RL, Classification of Mechanical Ventilators, in Principles and Practice of Mechanical Ventilation, M.J. Tobin, Editor. McGraw-Hill, Inc: New York, USA; 1994. p. 37-64.
  9. Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, et al, How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 2000;161:1450-8.
  10. Mador MJ, Assist-Control Ventilation, in Principles and Practice of Mechanical Ventilation, M.J. Tobin, Editor. McGraw-Hill, Inc: New York, USA; 1994. p. 207-20.
  11. The Acute Respiratory Distress Syndrome Network, Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med 2000;342:1301-8.
  12. Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, et al, The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med 1998;157:1332-47.
  13. Kress JP, Pohlman AS, O′Connor MF, Hall JB, Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation. N Engl J Med 2000;342:1471-7.
  14. Sassoon CS, Foster GT. Patient-ventilator asynchrony. Curr Opin Crit Care 2001;7:28-33.
  15. Cinnella G, Conti G, Lofaso F, Lorino H, Harf A, Lemaire F, et al, Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am J Respir Crit Care Med 1996;153:1025-33.
  16. Brochard L, Pressure Support Ventilation, in Principles and Practice of Mechanical Ventilation, MJ Tobin, Editor. McGraw-Hill, Inc: New York, USA; 1994. p. 239-57.
  17. Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C, Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intens Care Med 1999;25:662-7.
  18. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al, Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903.
  19. Esteban A, Frutos F, Tobin MJ, Alia I, Solsona JF, Valverdu I, et al, A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995;332:345-50.
  20. Brochard L, Pressure-support ventilation:still a simple mode? Intens Care Med 1996;22:1137-8.
  21. Nava S, Bruschi C, Rubini F, Palo A, Iotti G, Braschi A, Respiratory response and inspiratory effort during pressure support ventilation in COPD patients. Intens Care Med 1995;21:871-9.
  22. Chiumello D, Pelosi P, Croci M, Bigatello LM, Gattinoni L, The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation. Eur Respir J 2001;18:107-14.
  23. Jubran A, Van de Graaff WB, Tobin MJ. Variability of patient-ventilator interaction with pressure support ventilation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152:129-36.
  24. Parthasarathy S, Jubran A, Tobin MJ. Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med 1998;158:1471-8.
  25. Branson RD, New modes of mechanical ventilation. Curr Opin Crit Care 1999;5:33-42.
  26. Amato MB, Barbas CS, Bonassa J, Saldiva PH, Zin WA, de Carvalho CR, Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest 1992;102:1225-34.
  27. Jaber S, Delay JM, Matecki S, Sebbane M, Eledjam JJ, Brochard L, Volume-guaranteed pressure-support ventilation facing acute changes in ventilatory demand. Intensive Care Med 2005;31:1181-8.
  28. Piotrowski A, Sobala W, Kawczynski P. Patient-initiated, pressure-regulated, volume-controlled ventilation compared with intermittent mandatory ventilation in neonates: a prospective, randomised study. Intensive Care Med 1997;23:975-81.
  29. Alvarez A, Subirana M, Benito S. Decelerating flow ventilation effects in acute respiratory failure. J Crit Care 1998;13:21-5.
  30. Younes M, Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 1992;145:114-20.
  31. Younes M, Puddy A, Roberts D, Light RB, Quesada A, Taylor K, et al, Proportional assist ventilation. Results of an initial clinical trial. Am Rev Respir Dis 1992;145:121-9.
  32. Younes M. Proportional Assist Ventilation (PAV), in Principles and Practice of Mechanical Ventilation, Tobin MJ, Editor. McGraw-Hill Inc: New York, USA; 1994. p. 349-70.
  33. Bigatello LM, Nishimura M, Imanaka H, Hess D, Kimball WR, Kacmarek RM et al, Unloadiing of the work of breathing by proportional assist ventilation in a lung model. Crit Care Med 1997;25:267-72.
  34. Delaere S, Roeseler J, D′hoore W, Matte P, Reynaert M, Jolliet P, et al, Respiratory muscle workload in intubated, spontaneously breathing patients without COPD: pressure support vs proportional assist ventilation. Intensive Care Med 2003;29:949-54.
  35. Appendini L, Purro A, Gudjonsdottir M, Baderna P, Patessio A, Zanaboni S, et al, Physiologic response of ventilator-dependent patients with chronic obstructive pulmonary disease to proportional assist ventilation and continuous positive airway pressure. Am J Respir Crit Care Med 1999;159:1510-7.
  36. Ranieri VM, Giuliani R, Mascia L, Grasso S, Petruzzelli V, Puntillo N, et al, Patient-ventilator interaction during acute hypercapnia: pressure-support vs. proportional-assist ventilation. J Appl Physiol 1996;81:426-36.
  37. Marantz S, Patrick W, Webster K, Roberts D, Oppenheimer L, Younes M, Response of ventilator-dependent patients to different levels of proportional assist. J Appl Physiol 1996;80:397-403.
  38. Giannouli E, Webster K, Roberts D, Younes M, Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med 1999;159:1716-25.
  39. Wysocki M, Richard JC, Meshaka P. Noninvasive proportional assist ventilation compared with noninvasive pressure support ventilation in hypercapnic acute respiratory failure. Crit Care Med 2002;30:323-9.
  40. Gay PC, Hess DR, Hill NS. Noninvasive proportional assist ventilation for acute respiratory insufficiency. Comparison with pressure support ventilation. Am J Respir Crit Care Med 2001;164:1606-11.
  41. Winck JC, Vitacca M, Morais A, Barbano L, Porta R, Teixeira-Pinto A, et al, Tolerance and physiologic effects of nocturnal mask pressure support vs proportional assist ventilation in chronic ventilatory failure. Chest 2004;126:382-8.
  42. Vitacca M, New things are not always Better: proportional assist ventilation vs. pressure support ventilation. Intensive Care Med 2003;29:1038-40.
  43. Fernandez-Vivas M, Caturla-Such J, Gonzalez de la Rosa J, Acosta-Escribano J, Alvarez-Sanchez B, Canovas-Robles J. Noninvasive pressure support versus proportional assist ventilation in acute respiratory failure. Intensive Care Med 2003;29:1126-33.
  44. Wrigge H, Golisch W, Zinserling J, Sydow M, Almeling G, Burchardi H. Proportional assist versus pressure support ventilation: effects on breathing pattern and respiratory work of patients with chronic obstructive pulmonary disease. Intensive Care Med 1999;25:790-8.
  45. Wysocki M, Meshaka P, Richard JC, Similowski T. Proportional-assist ventilation compared with pressure-support ventilation during exercise in volunteers with external thoracic restriction. Crit Care Med 2004;32:409-14.
  46. Younes M, Webster K, Kun J, Roberts D, Masiowski B. A method for measuring passive elastance during proportional assist ventilation. Am J Respir Crit Care Med 2001;164:50-60.
  47. Younes M, Kun J, Masiowski B, Webster K, Roberts D. A method for noninvasive determination of inspiratory resistance during proportional assist ventilation. Am J Respir Crit Care Med 2001;163:829-39.
  48. Huszczuk A, A respiratory pump controlled by phrenic nerve activity. J Physiol 1970;210:183.
  49. Sharshar T, Desmarais G, Louis B, Macadou G, Porcher R, Harf A, et al, Transdiaphragmatic pressure control of airway pressure support in healthy subjects. Am J Respir Crit Care Med 2003;168:760-9.
  50. Sinderby C, Ventilatory assist driven by patient demand. Am J Respir Crit Care Med 2003;168:729-30.
  51. Navalesi P, Costa R. New modes of mechanical ventilation: proportional assist ventilation, neurally adjusted ventilatory assist and fractal ventilation. Curr Opin Crit Care 2003;9:51-8.
  52. Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, et al, Neural control of mechanical ventilation in respiratory failure. Nat Med 1999;5:1433-6.
  53. Brunner JX, Iotti GA. Adaptive Support Ventilation (ASV). Minerva Anestesiol 2002;68:365-8.
  54. Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. J Appl Physiol 1950;2:592-607.
  55. Lourens MS, van den Berg B, Aerts JG, Verbraak AF, Hoogsteden HC, Bogaard JM. Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 2000;26:1612-8.
  56. Cassina T, Chiolero R, Mauri R, Revelly JP. Clinical experience with adaptive support ventilation for fast-track cardiac surgery. J Cardiothorac Vasc Anesth 2003;17:571-5.
  57. Laubscher TP, Frutiger A, Fanconi S, Jutzi H, Brunner JX. Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as start up procedure for closed-loop controlled ventilation. Int J Clin Monit Comput 1994;11:19-30.
  58. Sulzer CF, Chiolero R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology 2001;95:1339-45.
  59. Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med 2002;30:801-7.
  60. Weiler N, Eberle B, Heinrichs W. Adaptive lung ventilation (ALV) during anesthesia for pulmonary surgery: automatic response to transitions to and from one-lung ventilation. J Clin Monit Comput 1998;14:245-52.
  61. Nemoto T, Hatzakis GE, Thorpe CW, Olivenstein R, Dial S, Bates JH. Automatic control of pressure support mechanical ventilation using fuzzy logic. Am J Respir Crit Care Med 1999;160:550-6.
  62. Strickland JH Jr, Hasson JH. A computer-controlled ventilator weaning system. Chest 1991;100:1096-9.
  63. Strickland JH Jr, Hasson JH. A computer-controlled ventilator weaning system. A clinical trial. Chest 1993;103:1220-6.
  64. Dojat M, Harf A, Touchard D, Laforest M, Lemaire F, Brochard L. Evaluation of a knowledge-based system providing ventilatory management and decision for extubation. Am J Respir Crit Care Med 1996;153:997-1004.
  65. Dojat M, Harf A, Touchard D, Lemaire F, Brochard L. Clinical evaluation of a computer-controlled pressure support mode. Am J Respir Crit Care Med 2000;161:1161-6.
  66. Bouadma L, Lellouche F, Cabello B, Taille S, Mancebo J, Dojat M, et al. Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study. Intensive Care Med 2005;31:1446-50.
  67. Lellouche F. Computer-driven ventilation reduces duration of weaning: a multicenter randomized controlled study. Intensive Care Med 2004;30:S69.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.