medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2003, Number 3

<< Back Next >>

Cir Gen 2003; 25 (3)

Mechanical ventilation in acute lung injury. Is there anything new?

Richardson CJ, Rodríguez JL

Language: English
References: 29
Page: 255-260
PDF size: 66.32 Kb.


ABSTRACT

Objective: To review current advances in mechanical ventilation and treatment of patients with Acute Lung Injury (ALI).
Data collection: Selective review of the literature (29 articles).
Data selection: The most relevant papers dealing with mechanical ventilation and acute lung injury were selected.
Results: Acute lung injury can result from direct or indirect insults to the alveolar tissue. Direct injury to the airspace is caused primarily by the aspiration of gastric contents, which results in a local inflammatory response. In addition, indirect insults may result from widespread systemic inflammatory states such as sepsis and trauma. The management of ALI has been a difficult problem for surgeons in the care of the acutely injured trauma patient. Despite technologic advancement and improved pharmacotherapy, ALI still leads to lengthy intensive care stays, prolonged mechanical ventilation, and all too often, death. The most common cause of death in patients with ALI is sepsis and multiple system organ failure (MSOF), not respiratory failure. Laboratory and clinical research has provided several new and innovative treatment strategies that show significant promise in the treatment of this difficult pathologic process. The use of improved ventilatory strategies, permissive hypercapnia, protective ventilation, liquid ventilation, and extracorporeal membrane oxygenation all appear to demonstrate effectiveness at various stages of ALI. Hopefully, continued research in these fields will better define the pathophysiology, indications, and effectiveness of all treatment modalities and provide improved patient care for the trauma patient.
Conclusion: Despite the better understanding of the pathologic processes of ALI and the etiologies, our ability to treat patients with ALI remains primarily supportive. Mechanical ventilation is the most important intervention in the management of ALI. An improved understanding of the pathophysiologic processes of ALI has to modification of the existing practices of mechanical ventilation in this difficult patient population.


REFERENCES

  1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149(3 pt 1): 818-24.

  2. Knaus WA, Sun X, Hakim RB, Wagner DP. Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 150: 311-7.

  3. Krafft P, Fridrich P, Pernerstorfer T, Fitzgerald RD, Koc D, Schneider B, et al. The acute respiratory distress syndrome: definitions, severity and clinical outcome. An analysis of 101 clinical investigations. Intensive Care Med 1996; 22: 519-29.

  4. Schuster DP. What is acute lung injury? What is ARDS? Chest 1995; 107: 1721-6.

  5. Bell RC, Coalson JJ, Smith JD, Johanson WG Jr. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 1983; 99: 293-8.

  6. Tobin MJ. Mechanical ventilation. N Engl J Med 1994; 330: 1056-61.

  7. Sessler CN. Mechanical ventilation of patients with acute lung injury. Crit Care Clin 1998; 14: 707-29, vii.

  8. Burchardi H. New strategies in mechanical ventilation for acute lung injury. Eur Respir J 1996; 9: 1063-72.

  9. Matamis D, Lemaire F, Harf A, Brun-Buisson C, Ansquer JC, Atlan G. Total respiratory pressure-volume curves in the adult respiratory distress syndrome. Chest 1984; 86: 58-66.

  10. Amato MB, Barbas CS, Medeiros DM, Schettino G de P, Lorenzi Filho G, Kairalla RA, et al. Beneficial effects of the “open lung approach” with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med 1995; 152(6 pt 1): 1835-46.

  11. Hudson LD. Protective ventilation for patients with acute respiratory distress syndrome. N Engl J Med 1998; 338: 385-7.

  12. Pelosi P, Crotti S, Brazzi L, Gattinoni L. Computed tomography in adult respiratory distress syndrome: what has it taught us? Eur Respir J 1996; 9: 1055-62.

  13. Papazian L, Bregeon F, Gaillat F, Thirion X, Gainnier M, Gregoire R, et al. Respective and combined effects of prone position and inhaled nitric oxide in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 157: 580-5.

  14. Marini JJ. Evolving concepts in the ventilatory management of acute respiratory distress syndrome. Clin Chest Med 1996; 17: 555-75.

  15. Muscedere JG, Mullen JB, Gan K, Slutsky AS. Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 1994; 149: 1327-34.

  16. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338: 347-54.

  17. Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, et al. Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure-and volume-limited ventilation strategy group. N Engl J Med 1998; 338: 355-61.

  18. Davis K Jr, Branson RD, Campbell RS, Porembka DT. Comparison of volume control and pressure control ventilation: is flow waveform the difference? J Trauma 1996; 41: 808-14.

  19. Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M, Rossi F, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 1998; 69: 824-32.

  20. Marcy TW, Marini JJ. Inverse ratio ventilation in ARDS. Rationale and implementation. Chest 1991; 100: 494-504.

  21. Tharratt RS, Allen RP, Albertson TE. Pressure controlled inverse ratio ventilation in severe adult respiratory failure. Chest 1998; 94: 755-62.

  22. Zavala E, Ferrer M, Polese G, Masclans JR, Planas M, Milic-Emili J, et al. Effect of inverse I:E ratio ventilation on pulmonary gas exchange in acute respiratory distress syndrome. Anesthesiology 1998; 88: 35-42.

  23. Abraham E, Yoshihara G. Cardiorespiratory effects of pressure controlled inverse ratio ventilation in severe respiratory failure. Chest 1989; 96: 1356-9.

  24. Weis CM, Fox WW. Current status of liquid ventilation. Curr Opin Pediatr 1999; 11: 126-32.

  25. Hirschl RB, Pranikoff T, Gauger P, Schreiner RJ, Dechert R, Bartlett RH. Liquid ventilation in adults, children, and full-term neonates. Lancet 1995; 346: 1201-2.

  26. Greenspan JS, Fox WW, Rubenstein SD, Wolfson MR, Spinner SS, Shaffer TH. Partial liquid ventilation in critically ill infants receiving extracorporeal life support. Philadelphia Liquid Ventilation Consortium: Pediatrics 1997; 99: E2.

  27. Wolfson MR, Greenspan JS, Deoras KS, Rubenstein SD, Shaffer TH. Comparison of gas and liquid ventilation: clinical, physiological, and histological correlates. J Appl Physiol 1992; 72: 1024-31.

  28. ECMO Registry Report of the Extracorporeal Life Support Organization. Ann Arbor, MI, January 1995

  29. Michaels AJ, Schriener RJ, Kolla S, Awad SS, Rich PB, Reickert C, et al. Extracorporeal life support in pulmonary failure after trauma. J Trauma 1999; 46: 638-45.




2020     |     www.medigraphic.com