European Respiratory Society International Congress 2018: highlights from Assembly 2 on respiratory intensive care

Abstract

The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions held at the International Congress in Paris in 2018. For the highly esteemed reader who may have missed the Congress, a concise review was written on three topics: the state-of-the-art session on respiratory critical care, hot topics in weaning and the best abstracts in noninvasive ventilation.

Rehabilitation of Difficult-to-Wean, Tracheostomized Patients Admitted to Specialized Unit: Retrospective Analyses over 10-Years

“…Invasive mechanical ventilation (iMV) is the most common intervention in patients admitted to these units [ 2 ]. Numerous patient-related factors and the causes underlying ARF often make the weaning process from MV difficult [ 3 , 4 ]. These patients usually present with a compromised health status, which can last long after hospital discharge [ 5 ].…”

Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation – A Concise Review

“…With the limit that nPPV is now questioned for the treatment of acute "de novo" hypoxemic patients [5], it has dramatically changed the treatment of both acute and chronic respiratory failure in the last 2 decades [3,4,[6][7][8][9][10][11][12][13][14][15][16]. The use of NIV has also been largely applied in the treatment of stable chronic hypercapnic respiratory failure as well as in the treatment patients with obstructive sleep apnoea and central sleep disorders [17][18][19][20][21][22][23]. The success of NIV is correlated to the application of the "best ingredients" of a patient's "tailored recipe," including the appropriate choice of the selected candidate, the ventilator setting, the interface, the expertise of the team, and the education of the caregiver [1,3,24,[26][27][28].…”

“…The success of NIV is correlated to the application of the "best ingredients" of a patient's "tailored recipe," including the appropriate choice of the selected candidate, the ventilator setting, the interface, the expertise of the team, and the education of the caregiver [1,3,24,[26][27][28]. As a consequence, the choice of interface has been recognized to be a major determinant of NIV success, mainly because the interface strongly influences patient's comfort and other important correlated aspects [23][24][25], such as air leaks, claustrophobia, facial skin damage, eyes irritation, and abdomen distension [29][30][31][32][33][34][35][36]. Concerning the air leak issue, the distinction between nCPAP and nPPV is very important because even if the same interface may be used during both modalities, the likelihood of unintentional air leaks [26], the type of exhalation system, the amount of skin breakdown, and the degree of patient's tolerance may be deeply different.…”

“…Concerning the air leak issue, the distinction between nCPAP and nPPV is very important because even if the same interface may be used during both modalities, the likelihood of unintentional air leaks [26], the type of exhalation system, the amount of skin breakdown, and the degree of patient's tolerance may be deeply different. Although in the acute setting, comfort seems to be less important than the efficacy of the treatment, mask fit and care are needed to prevent interface-related complications as in patient candidates for long-term domiciliary NIV [20][21][22][23]37]. Furthermore, a poorly fitting interface generating excessive air leaks that are not compensated by the ventilator may decrease the clinical effectiveness of nPPV and induce air leaks patient-ventilatory dyssynchrony (through loss of triggering sensitivity or auto-triggering or hindering achievement of the inspiration-termination criterion in pressure support mode).…”