Why Use Anything But a Standard Spontaneous Breathing Trial to Determine Readiness for Ventilator Discontinuation?

Kacmarek, Robert M.; Villar, Jesús; Blanch, Lluís

doi:10.4187/respcare.04535

Cited by 4 publications

(3 citation statements)

References 17 publications

(16 reference statements)

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“…We do not know yet whether favoring early spontaneous ventilation in ARDS improves outcome when compared to controlled MV plus sedation and proning [ 45 , 46 ]. In managing ARDS, the underlying disorders lead to a high respiratory drive and should be addressed immediately following intubation.…”

Section: Future Directionsmentioning

confidence: 99%

Redefining ARDS: a paradigm shift

Villar,

Szakmany,

Grasselli

et al. 2023

Crit Care

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Although the defining elements of “acute respiratory distress syndrome” (ARDS) have been known for over a century, the syndrome was first described in 1967. Since then, despite several revisions of its conceptual definition, it remains a matter of debate whether ARDS is a discrete nosological entity. After almost 60 years, it is appropriate to examine how critical care has modeled this fascinating syndrome and affected patient’s outcome. Given that the diagnostic criteria of ARDS (e.g., increased pulmonary vascular permeability and diffuse alveolar damage) are difficult to ascertain in clinical practice, we believe that a step forward would be to standardize the assessment of pulmonary and extrapulmonary involvement in ARDS to ensure that each patient can receive the most appropriate and effective treatment. The selection of treatments based on arbitrary ranges of PaO2/FiO2 lacks sufficient sensitivity to individualize patient care.

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Section: Future Directionsmentioning

confidence: 99%

Redefining ARDS: a paradigm shift

Villar,

Szakmany,

Grasselli

et al. 2023

Crit Care

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“…37 Mode of ventilation impacts asynchrony, with greater levels of mechanical assistance resulting in greater levels of asynchrony. 38 However, until recently, little data on the presence of asynchrony during IMV has been available. Robinson et al 41 demonstrated that subjects receiving IMV compared with other modes of conventional ventilation had a higher asynchrony index.…”

Section: Asynchronymentioning

confidence: 99%

“…[35][36][37][38][39][40] The presence of an asynchrony index (all asynchronous breaths divided by total breaths, triggered, and missed triggered breaths times 100) Ͼ10% has been shown to be associated with an increased length of mechanical ventilation, 35,36 ICU stay, 35,36 and mortality. 37 Mode of ventilation impacts asynchrony, with greater levels of mechanical assistance resulting in greater levels of asynchrony.…”

Section: Asynchronymentioning

confidence: 99%

Should Intermittent Mandatory Ventilation Be Abolished?

Kacmarek

Branson

2016

Respiratory Care

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Intermittent mandatory ventilation (IMV) was introduced nearly 50 years ago. Despite the initial fanfare and early adoption by many, the role of IMV continues to be questioned. The use of small tidal volumes complicates the application of IMV, and issues with work of breathing, weaning and lack of clear advantages have many calling for a moratorium on its use. Spontaneous breathing, however, has a number of salutatory effects on gas exchange, the distribution of ventilation, and hemodynamics. These issues will be explored in light of a growing body of evidence. Key words: Mechanical ventilation, intermittent mandatory ventilation, synchronized intermittent mandatory ventilation, asynchrony and work of breathing. [Respir Care 2016;61(6):854 -866.

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