(See also – WEANING, TRACHEOSTOMY)


TUTORIAL on IPPV
www.ccmtutorials.com/rs/mv/index.htm

AARC GUIDELINE: Humidification during mechanical ventilation (1992) Respir Care, 8, 37, 887–890
www.rcjournal.com/cpgs/hdmvcpg.html


Arslanian-Engoren C, Scott LD (2003) The lived experience of survivors of prolonged mechanical ventilation: a phenomenological study. Heart Lung, 32, 5, 328-34
• surviving prolonged mechanical ventilation described as frightening and traumatic, but comfort and resolve

Broden CC (2009) Acute renal failure and mechanical ventilation: reality or myth? Crit Care Nurse, 29, 2, 62–75
ccn.aacnjournals.org/cgi/content/full/29/2/62
• kidneys receive 20% to 25% of cardiac output  any decrease in cardiac output caused by IPPV and/or high PEEP affects renal blood flow

Campbell RS, Davis BR (2002) Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care, 47, 416-24
• PCV may cause lower work of breathing and improved comfort

Curtis JR (2002) The long-term outcomes of mechanical ventilation. Respir Care, 47, 496-505

Determann RM, Royakkers AANM, Haitsma JJ (2010) Plasma levels of surfactant protein D and KL-6 for evaluation of lung injury in critically ill mechanically ventilated patients. BMC Pulm Med, 10, 6, doi:10.1186/1471-2466-10-6
www.biomedcentral.com/1471-2466/10/6
• lung injury can be identified early by the presence of biological markers at the onset of mechanical ventilation

Dezfulian C (2005) Subglottic secretion drainage for preventing ventilator-associated pneumonia. Am J Med, 118, 11-18
• risk of chest infection is reduced by subglottic secretion drainage

Ewig S et al (2002) Prevention and management of ventilator-associated pneumonia. Curr Opin Crit Care, 8, 58-69

Gentile MA, Siobal MS (2010) Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia? Respir Care, 55, 2, 184-96
www.rcjournal.com/contents/02.10/02.10.0184.pdf

Gattinoni L et al (2002) Reduced tidal volumes and lung protective ventilatory strategies. Curr Opin Crit Care, 8, 45-50
• mechanism of barotrauma

Haberthur C (2009) Expiratory automatic endotracheal tube compensation reduces dynamic hyperinflation in a physical lung model. Crit Care, 13, R4
ccforum.com/content/pdf/cc7693.pdf

Hedenstierna G et al (2002) Gas exchange in the ventilated patient. Curr Opin Crit Care, 8, 39-44
• effect on gas exchange of positioning, recruitment manoeuvres, modes with spontaneous breathing and nitric oxide

Heininger A et al (2002) Ventilator-associated pneumonia. Curr Opin Anaesthesiol, 15, 153-9
• update on prevention and management.

Hess DR (2002) Mechanical ventilation strategies: what’s new and what’s worth keeping? Respir Care, 47, 1007-17
www.rcjournal.com/contents/09.02/09.02.1007.cfm
• patient-important outcomes are more relevant than short-term physiological outcomes such as blood gases

Huckle D, Hughes P (2010) Simple monitoring of cuff tracheal pressures. Anaesthesia, 65, 2, 215 (letter)
• fluctuations in cuff pressue may trigger an ischaemia-reperfusion-ischaemia cycle, which could damage tracheal mucosa

Jablonski RS (1994) The experience of being mechanically ventilated. Qual Health Res, 4, 2, 186-207
• revealing interviews with patients.

Kallet RH (2000) The effects of pressure control versus volume control assisted ventilation on patient work of breathing. Resp Care, 45, 1085-96
• PS reduces WOB in ARDS

Kuhlen R, Rossaint R (2002) The role of spontaneous breathing during mechanical ventilation. Resp Care, 47, 296-303
www.rcjournal.com/contents/03.02/03.02.0296.cfm
• review of the effects of preserved spontaneous breathing during mechanical ventilation with different ventilatory modalities.
• BEWARE confusion of BIPAP with BiPAP.

Kuipers MT (2011) Bench-to-bedside review: Damage-associated molecular patterns in the onset of ventilator-induced lung injury. Crit Care, 15, 235, doi:10.1186/cc10437
ccforum.com/content/15/6/235/abstract

Luecke T (2004) Effects of end-inspiratory and end-expiratory pressures on alveolar recruitment and derecruitment in induced lung injury. Acta Anaesth Scand, 48, 82-92
• lung protective ventilation by limiting pressures and volumes does not derecruit alveoli so long as PEEP is sufficient

Lucato JJJ (2005) Evaluation of resistance in 8 different heat-and-moisture exchangers. Resp Care, 50, 636-43
• saturation affects resistance in hydrophobic or hygroscopic/hydrophobic models, but not with hygroscopic models

MacIntyre NR (2002) Invasive mechanical ventilation in adults. Respir Care, 47, 508-18
• modes, settings, PEEP, recruitment manouevres, tracheostomy, weaning, outcomes

Ntoumenopoulos G, Shannon H, Main E (2011) Do commonly used ventilator settings for mechanically ventilated adults have the potential to embed secretions or promote clearance? Respir Care, 56, 12, 1887-92
• commonly used settings generate an inspiratory flow bias that may promote secretion retention.

Pierson DJ (2002) Indications for mechanical ventilation in adults with acute respiratory failure. Respir Care, 47, 249-62
www.rcjournal.com/contents/03.02/03.02.0249.asp

Porhomayon J (2010) Applications of airway pressure release ventilation. Lung, 188, 2, 87

Roussos M (2010) Can we improve sleep quality by changing the way we ventilate patients? Lung, 188, 1, 1
resources.metapress.com/pdf-preview.axd?code=r4417537k5256272&size=largest
• sleep deprivation increases risk of impaired respiratory, cognitive, cardiovascular, endocrine and immune function, and (in women) diabetes

Sinclair SE (2010) Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion. BMC Pulm Med, 10, 25. doi:10.1186/1471-2466-10-25
www.biomedcentral.com/content/pdf/1471-2466-10-25.pdf
• cyclical collapse and recruitment tends to preferentially damage lower lobes
• risk is reduced by ensuring that PEEP is above functional residual capacity
• outcomes are improved if distending pressures are limited by reduced VT

Slutzky AS (2005) Ventilator-induced lung injury: from barotrauma to biotrauma. Resp Care, 50, 646-59
www.rcjournal.com/contents/05.05/05.05.0646.pdf
• biochemical injury, e.g. inflammatory mediators, resulting from IPPV

Tripathi VN, Misra S (2001) Mechanical ventilation in pediatric practice. Indian Pediatrics, 38, 147-156
www.indianpediatrics.net/feb2001/feb-147-156.htm
• for paediatrics, but provides clear explanation of terminology, modes and complications.

Van Heerde M, Roubik K, Kopelent V (2010) Spontaneous breathing during high-frequency oscillatory ventilation improves regional lung characteristics in experimental lung injury. Acta Anaesthesiol Scand, 54, 10, 1248–56
• spontaneous breathing during HFO should be encouraged because it preserves lung volume and can improve ventilation of the dependent lung areas

Walshe BK, Crotwell DN, Restrepo RD (2011) Capnography/capnometry during mechanical ventilation. Respir Care, 56, 4, 503–9
www.rcjournal.com/cpgs/pdf/04.11.0503.pdf
• AARC Guidelines

Wolfe JA (2003) Lung protection strategies for mechanical ventilation. RT The Journal for Respiratory Care practitioners, Dec/Jan.
www.rtmagazine.com/article.php?s=RT/2002/12&p=2

Wolthuis EK (2009) Mechanical ventilation using non-injurious ventilation settings causes lung injury in the absence of pre-existing lung injury in healthy mice. Crit Care, 13, R1
ccforum.com/content/pdf/cc7688.pdf

Zoremba M, Kalmus G, Dette F (2010) Effect of intra-operative pressure support vs pressure controlled ventilation on oxygenation and lung function in moderately obese adults. Anaesthesia, 65, 2, 124-9
• pressure support leads to better VA/Q match than pressure control


AARC = American Association for Respiratory Care
ARDS = acute respiratory distress syndrome
IPPV = intermittent positive pressure breathing
PCV = pressure-controlled ventilation
PEEP = positive end-expiratory pressure
PS = pressure support
VA/Q = ventilation/perfusion
VT = tidal volume
WOB = work of breathing