Lung- and Diaphragm-Protective Ventilation

Abstract

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Continuous assessment of neuro-ventilatory drive during 12 hours of pressure support ventilation in critically ill patients 

“…First: the EAdi PEAK thresholds applied in the present study to classify the neuro-ventilatory drive are empirical, although based on previous studies [7,25,28,29] and on the manufacturer's instructions (Maquet Critical Care AB, NAVA ow chart MX-6462 Rev 02/2015). Indeed, the EAdi signal is burdened by interindividual variability [64]. Nevertheless, we identi ed a rather broad "Normal" EAdi PEAK range similar to the one recently observed by Piquilloud and coworkers in healthy volunteers supported with different level of PSV [25] and by Liu and coworkers in patients [65].…”

Continuous assessment of neuro-ventilatory drive during 12 hours of pressure support ventilation in critically ill patients

“…First: the EAdi PEAK thresholds applied in the present study to classify the neuro-ventilatory drive are empirical, although based on previous studies [7,24,28,29] and on the manufacturer's instructions (Maquet Critical Care AB, NAVA ow chart MX-6462 Rev 02/2015). Indeed, the EAdi signal is burdened by interindividual variability [62]. Nevertheless, we identi ed a rather broad "Normal" EAdi PEAK range and recently Piquilloud and coworkers observed an EAdi PEAK between 5 and 15 µV in healthy volunteers supported with different level of PSV and Liu and coworkers documented similar values in patients [63].…”

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

“…Taken together, these considerations suggest that the diaphragm might be protected by titrating ventilation and sedation to restore early diaphragm activity while avoiding excess respiratory effort. The various lines of physiological and clinical evidence suggesting that a respiratory effort level similar to that of resting quiet breathing is probably optimal for both lung and diaphragm protection were recently summarized elsewhere [ 16 ].…”