Advanced Point-of-care Bedside Monitoring for Acute Respiratory Failure

Abstract

Advanced respiratory monitoring involves several mini- or noninvasive tools, applicable at bedside, focused on assessing lung aeration and morphology, lung recruitment and overdistention, ventilation–perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient–ventilator asynchrony, in dealing with acute respiratory failure. Compared to a conventional approach, advanced respiratory monitoring has the potential to provide more insights into the pathologic modifications of lung aeration induced by the underlying disease, follow the response to therapies, and support clinicians in setting up a respiratory support strategy aimed at protecting the lung and respiratory muscles. Thus, in the clinical management of the acute respiratory failure, advanced respiratory monitoring could play a key role when a therapeutic strategy, relying on individualization of the treatments, is adopted.

An Initial Investigation of Diaphragm Neurostimulation in Patients with Acute Respiratory Distress Syndrome

“…Fourth, phrenic nerve capture was determined by palpation of the abdomen that is a less sensitive but a more practical method than using electromyogram. 33 conclusion This proof-of-concept study showed the feasibility of short-term diaphragm neurostimulation in conjunction with mechanical ventilation in ARDS patients. Diaphragm neurostimulation was associated with positive effects on lung mechanics and on hemodynamics.…”

Effects of awake prone position vs. usual care on acute hypoxemic respiratory failure in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials

“…Out of all the people hospitalized with COVID-19, 15–30% will go on to develop COVID-19-associated acute respiratory distress syndrome ( 42 ). In the supine position, pleural pressure develops along a vertical gradient from the non-dependent to the dependent chest, which is magnified in patients with ARDS ( 43 ). Therefore, it is beneficial to carry out the prone position for patients with ARDS.…”

Pressure‐ and time‐dependent alveolar recruitment/derecruitment in a spatially resolved patient‐specific computational model for injured human lungs

“…However, note that the model then operates on an artificial pleural pressure level, restricting its ability to represent actual lung stresses. As mentioned earlier, measured esophageal pressure qualitatively reflects pleural pressure behavior, although not quantitatively 62,63 . Thus, using measured esophageal pressure might equally introduce a discrepancy in absolute values.…”

“…62,63 Thus, using measured esophageal pressure might equally introduce a discrepancy in absolute values. Moreover, measurements in the esophagus are strongly influenced by various factors, 63 potentially leading to further inaccuracies. Despite these uncertainties, neither the parametrization nor the simulation results have been significantly compromised in this work.…”