Advanced Ventilation Research Nicole Lee

Ventilation modes SIMV PS BIPAP CPAP APRV HFOV

VQ match

What can we do to help? Positioning Good mouth care Cuff pressures Suction Sedation holds Walk them up to breathe Manual hyperinflation?

Early versus late tracheostomy for critically ill patients 2015 Authors conclusions The whole findings of this systematic review are no more than suggestive of the superiority of early over late tracheostomy because no information of high quality is available for specific subgroups with particular characteristics.

Prone Prone position for acute respiratory failure in adults 2015 Authors' conclusions We found no convincing evidence of benefit nor harm from universal application of PP in adults with hypoxaemia mechanically ventilated in intensive care units (ICUs).

Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) 2015 Authors' conclusions Currently available data from RCTs are insufficient to confirm or refute whether pressure-controlled or volume-controlled ventilation offers any advantage for people with acute respiratory failure due to acute lung injury or acute respiratory distress syndrome. More studies including a larger number of people given PCV and VCV may provide reliable evidence on which more firm conclusions can be based.

Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation 2016 Authors' conclusions We identified significant clinical heterogeneity in the 10 included trials. Results are based upon the findings of several (five) trials that included an "open lung ventilation strategy", whereby the intervention group differed from the control group in aspects other than the recruitment manoeuvre (including co-interventions such as higher PEEP, different modes of ventilation and higher plateau pressure), making interpretation of the results difficult. A ventilation strategy that included recruitment manoeuvres in participants with ARDS reduced intensive care unit mortality without increasing the risk of barotrauma but had no effect on 28-day and hospital mortality. We downgraded the quality of the evidence to low, as most of the included trials provided co-interventions as part of an open lung ventilation strategy, and this might have influenced results of the outcome.

High-frequency oscillatory ventilation versus conventional ventilation for acute respiratory distress syndrome 2016 Authors' conclusions The findings of this systematic review suggest that HFO does not reduce hospital and 30-day mortality due to ARDS; the quality of evidence was very low. Our findings do not support the use of HFO as a first-line strategy in people undergoing mechanical ventilation for ARDS.

Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure 2013 Authors' conclusions Summary estimates from 16 trials of moderate to good quality that included predominantly participants with COPD suggest that a weaning strategy that includes NPPV may reduce rates of mortality and ventilator-associated pneumonia without increasing the risk of weaning failure or reintubation.

Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome 2013 Authors conclusion No evidence supports the use of PLV in ALI or ARDS; some evidence suggests an increased risk of adverse events associated with its use.