A Rational Framework for Selecting Modes of Ventilation...[corrected][published erratum appears in RESPIR CARE 2013 Apr; 58(4): e51]
Mechanical ventilation is a life-saving intervention for respiratory failure and thus has become the cornerstone of the practice of critical care medicine. A mechanical ventilation mode describes the predetermined pattern of patient-ventilator interaction. In recent years there has been a dizzying p...
| Publicado en: | Respiratory Care Vol. 58; no. 2; pp. 348 - 367 |
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| Autores principales: | , , |
| Formato: | review tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Feb2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104304433&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104304433 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2013 vid: 58 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 104304433 85161627 10.4187/respcare.01839 NLM22710796 104304433 ppf: 348 ppct: 19 formats: fmt: @attributes: type: P tig: atl: A Rational Framework for Selecting Modes of Ventilation...[corrected][published erratum appears in RESPIR CARE 2013 Apr; 58(4): e51] aug: au: Mireles-Cabodevila, Eduardo Hatipoğlu, Umur Chatburn, Robert L. affil: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio sug: subj: Conceptual Framework Nomenclature Respiration, Artificial Classification Respiration, Artificial Methods Goals and Objectives Positive End-Expiratory Pressure Respiration, Artificial Equipment and Supplies ab: Mechanical ventilation is a life-saving intervention for respiratory failure and thus has become the cornerstone of the practice of critical care medicine. A mechanical ventilation mode describes the predetermined pattern of patient-ventilator interaction. In recent years there has been a dizzying proliferation of mechanical ventilation modes, driven by technological advances and market pressures, rather than clinical data. The comparison of these modes is hampered by the sheer number of combinations that need to be tested against one another, as well as the lack of a coherent, logical nomenclature that accurately describes a mode. In this paper we propose a logical nomenclature for mechanical ventilation modes, akin to biological taxonomy. Accordingly, the control variable, breath sequence, and targeting schemes for the primary and secondary breaths represent the order, family, genus, and species, respectively, for the described mode. To distinguish unique operational algorithms, a fifth level of distinction, termed variety, is utilized. We posit that such coherent ordering would facilitate comparison and understanding of modes. Next we suggest that the clinical goals of mechanical ventilation may be simplified into 3 broad categories: provision of safe gas exchange; provision of comfort; and promotion of liberation from mechanical ventilation. Safety is achieved via optimization of ventilation-perfusion matching and pressure-volume relationship of the lungs. Comfort is provided by fostering patient-ventilator synchrony. Liberation is promoted by optimization of the weaning experience. Then we follow a paradigm that matches the technological capacity of a particular mode to achieving a specific clinical goal. Finally, we provide the reader with a comparison of existing modes based on these principles. The status quo in mechanical ventilation mode nomenclature impedes communication and comparison of existing mechanical ventilation modes. The proposed model, utilizing a systematic nomenclature, provides a useful framework to address this unmet need. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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