Background There has been an exponential increase in modes of mechanical ventilation over the last couple decades. With this increase, there have been paucity of evidence of which mode is superior to others or much guidance to use a mode in different disease status causing respiratory failure. Methods: An international survey of six questions was posted on the “society of mechanical ventilation” website and advertised on social media over the period of four months. This is a descriptive study, results are presented in two different ways. First as the total modes used and secondly, per the geographical areas as the preferred mode, mode used mostly in ARDS, COPD, and Spontaneous weaning trials. Results: Conventional older modes, Volume-controlled and Pressure-controlled ventilation were used significantly more in general and in different disease states irrespective of geographical location. Four other modes were used almost equally in all disease states irrespective of geographical location. Pressure support ventilation was the most common mode used during the spontaneous breathing trial. Conclusion: There was large heterogenicity of modes used between clinicians in general, in different disease states and in between different international geographical locations. Mechanical ventilation modes utilization varies widely and remains a personal preference with no consensus between clinicians globally. Keywords: Modes of mechanical ventilation, ARDS, COPD, SBT, survey
Figure: Waveforms for a patient undergoing mechanical ventilation with volume controlled mode. Tidal Volume of 500 ml, PEEP 15, Constant inspiratory flow of 45 l/min A: Airway pressure in cmH2O, B: Esophageal pressure in cmH2O, C: Trans-pulmonary pressure in cmH2O, D: Flow in l/min, E: Tidal volume in ml Red dashed horizontal line: values at end of expiratory occlusion maneuver, White solid horizontal line: values at end of inspiratory occlusion maneuver, Green dashed horizontal line: values during peak inspiratory pressure.
Electrical Impedance Tomography is a rapidly evolving technology used for bedside lung imaging. Although EIT devices have been commercially available for the past decade, they are still not commonly used in everyday clinical practice. EIT has multiple benefits over standard chest imaging techniques; it is non-invasive, it can be used at bedside and it allows continuous monitoring of the patient’s condition. EIT can change the standard practice for monitoring lung function and caring for patients on mechanical ventilation. In this concise review, we will discuss the general concepts of EIT and its clinical applications. As this technology keeps developing and becomes more available for clinical use, it might revolutionize the way we practice mechanical ventilation. Additional studies need to be performed to compare its benefits to our current practice. Keywords: EIT, Mechanical ventilation, PEEP, Overdistention
A: Patient with little effort. Top: Volume Controlled Ventilation: airway pressure in cmH2O in yellow, constant flow in L/min in pink. Middle: Pressure controlled ventilation: airway pressure in cmH2O in yellow, decelerating flow in L/min in pink. Bottom: Esophageal pressure in cmH2O. B: Patient with high effort. Top: Volume Controlled Ventilation: airway pressure with convex negative deflection during trigger and first half of inspiration (blue arrow). Middle: Pressure controlled ventilation: airway pressure with negative deflection during the trigger (yellow arrow) and slight convex deflection (green arrow), concave deflection in the flow (orange arrow). Bottom: Convex deflection in esophageal pressure (grey arrow).
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