TY - JOUR
T1 - Monitoring respiratory mechanics during assisted ventilation
AU - Grasselli, Giacomo
AU - Brioni, Matteo
AU - Zanella, Alberto
N1 - Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Purpose of reviewAccurate monitoring of the mechanical properties of the respiratory system is crucial to understand the pathophysiological mechanisms of respiratory failure in mechanically ventilated patients, to optimize mechanical ventilation settings and to reduce ventilator-induced lung injury. However, although the assessment of respiratory mechanics is simple in patients undergoing fully controlled ventilation, it becomes quite challenging in the presence of spontaneous breathing activity. Aim of the present review is to describe how the different components of respiratory mechanics [resistance, static compliance, and intrinsic positive end-expiratory pressure (PEEP)] can be measured at the bedside during assisted modes of ventilation.Recent findingsAvailable techniques for bedside measurement of resistance during assisted ventilation are complex and not commonly implemented. On the contrary, an increasing number of reports indicate that measurement of static compliance and intrinsic PEEP can be easily obtained, both with advanced monitoring systems (esophageal and gastric manometry, diaphragm electromyography, electrical impedance tomography) and, with some limitations, with simple airways occlusion maneuvers.SummaryAssessment of respiratory mechanics in spontaneously breathing patients, with some limitations, is feasible and should be included in everyday clinical practice; however, more data are needed to understand the clinical relevance of the measures obtained during assisted ventilation.
AB - Purpose of reviewAccurate monitoring of the mechanical properties of the respiratory system is crucial to understand the pathophysiological mechanisms of respiratory failure in mechanically ventilated patients, to optimize mechanical ventilation settings and to reduce ventilator-induced lung injury. However, although the assessment of respiratory mechanics is simple in patients undergoing fully controlled ventilation, it becomes quite challenging in the presence of spontaneous breathing activity. Aim of the present review is to describe how the different components of respiratory mechanics [resistance, static compliance, and intrinsic positive end-expiratory pressure (PEEP)] can be measured at the bedside during assisted modes of ventilation.Recent findingsAvailable techniques for bedside measurement of resistance during assisted ventilation are complex and not commonly implemented. On the contrary, an increasing number of reports indicate that measurement of static compliance and intrinsic PEEP can be easily obtained, both with advanced monitoring systems (esophageal and gastric manometry, diaphragm electromyography, electrical impedance tomography) and, with some limitations, with simple airways occlusion maneuvers.SummaryAssessment of respiratory mechanics in spontaneously breathing patients, with some limitations, is feasible and should be included in everyday clinical practice; however, more data are needed to understand the clinical relevance of the measures obtained during assisted ventilation.
KW - airway resistance
KW - assisted mechanical ventilation
KW - driving pressure
KW - intrinsic positive end-expiratory pressure
KW - static respiratory system compliance
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U2 - 10.1097/MCC.0000000000000681
DO - 10.1097/MCC.0000000000000681
M3 - Review article
C2 - 31738232
AN - SCOPUS:85077121771
VL - 26
SP - 11
EP - 17
JO - Current Opinion in Critical Care
JF - Current Opinion in Critical Care
SN - 1070-5295
IS - 1
ER -