Recent advances in mechanical ventilation - 21/08/11

Doi : 10.1016/j.amjmed.2004.12.005

Carolyn S. Calfee, MD ^a,^b,^⁎ , Michael A. Matthay, MD ^a,^b,^c
^a Cardiovascular Research Institute, San Francisco, California
^b Department of Medicine, University of California at San Francisco, San Francisco, California.
^c Department of Anesthesia, University of California at San Francisco, San Francisco, California.

Requests for reprints should be addressed to Carolyn S. Calfee, MD, University of California, San Francisco, Pulmonary Division, 505 Parnassus Avenue, San Francisco, California 94143-0111.

Abstract

Important advances have been made over the past decade towards understanding the optimal approach to ventilating patients with acute respiratory failure. Evidence now supports the use of noninvasive positive pressure ventilation in selected patients with hypercapnic respiratory failure and chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and for facilitating the discontinuation of ventilatory support in patients with chronic pulmonary disease. The concept of a lung protective ventilatory strategy has revolutionized the management of the acute respiratory distress syndrome. The process of liberation from mechanical ventilation is becoming more standardized, with evidence supporting daily trials of spontaneous breathing in all suitable mechanically ventilated patients. This article critically reviews the most important recent advances in mechanical ventilation and suggests future directions for further research in the field.

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Keywords : Mechanical ventilation, Noninvasive ventilation, Acute respiratory distress syndrome, Weaning