Don’t bother for a definition, it’s a made up hybrid word, may be a neologisms in the making The mechanical ventilation literature is jammed with those 2 acronyms VALI (Ventilator Associated Lung Injury) & VILI (Ventilator Induced Lung Injury) Is there a difference between them ? Are they synonyms ? If they are the same then why use different terms for the same meaning ? and if they are different, how to differentiate between them ? is it “You Say Tomato, I say Tomato” To add to the confusion, some authorities decided to create the term VAE (Ventilator Associated Events), a garbage term t ..read more

Before we dig in this tough topic, let’s agree or disagree that that there is nothing called optimal or best PEEP. Regardless of the PEEP level used, there will be overdistention in some areas, some under distention and collapse in other areas of the lungs. Here are some points to keep in mind when we talk PEEP The normal and the diseased lungs are markedly heterogenic with each lobule or even each of the approximately 500 million alveoli have their own mechanics The pleural pressures are not uniform and thus the trans-alveolar pressures will vary depending on the location of the alveoli Not ..read more

No doubt, HFOT has set foot as an important therapy in the field of respiratory failure and became an important tool in the armamentarium of therapies available to hopefully avoid invasive mechanical ventilation.   The mechanisms of its action and physiologic beneficial effects have been described in multiple reviews and studies.  Isn’t that enough? No, let’s be greedy and demand more. More of what?  Monitoring: The field of respiratory failure relies heavily on monitoring which helps tailor the therapy to the patient’s needs. Yes, we can monitor the patient’s clinical co ..read more

Over the last couple of decades, our understanding of lung injury and the support of the injured lung has evolved significantly. The lungs are an expansive organ with relatively fewer cells than other organs but have great ability to heal and regenerate the injured epithelial, endothelial and supporting matrix. However, the healing process could be different in different pathologies, different acuities, different ages. The ultimate repair of the injured lungs is through regeneration (making new cells), however through many different inflammatory and immune pathways sometimes repair (scarring ..read more

This is a continuation of the last blog: Mechanical Power Over the last two decades we were stuck on targeting a certain value of tidal volume or an inspiratory pressure (tidal, driving pressure) in a hope to reduce VILI and mortality. Have we been wrong? Maybe yes, maybe it was just a step in the right direction. We now know that it is much more than that, and the interaction between the tidal volume (strain), pressure (stress) in interaction with flow rates, inspiratory time, respiratory rate, PEEP levels all summed up in the mechanical power are all indicted contributors. Before we repeat ..read more

Over the last decade, our understanding of VILI has grown exponentially and in the last couple years, the concept of mechanical power has gained popularity. Finally, it seems like we are moving from the very simplistic 6ml/kg/IBW, and the debate of whether the volumes or the pressures are the responsible for the injury (both). The mechanical power (the energy delivered from the ventilator per minute) incorporates all the components delivered from the ventilator (tidal volume, flow, inspiratory pressure, inspiratory time, PEEP, Respiratory rate) and it is a good comprehensive concept that invol ..read more

A question I always ask myself, why are we treating our patients like cars? Need to fill gas/oil tanks/tires with certain volumes and up to certain pressures. Is the human lung the same as a car part? If you agree that our lungs are different, then please ask yourself why are we giving certain volume (6 ml/kg) every breath, and to a certain pressure (plateau < 30 cmH2O), and applying some tables (PEEP-FiO2) to our patients. Just to be clear and before you trash this blog, I’m not advocating giving high tidal volumes, pressures to a sick lung. We are talking about “Individualized Ventilatio ..read more

Sign up for a free membership to get notified of new educational materials every month Membership Year In Review 2022 Year-in-Review-2022Download Year In Review 2021 Year-in-Review-2021Download The post Year in Review / Journal Club appeared first on Society of Mechanical Ventilation ..read more

Those are traumas that happen after placing the patient on the ventilator and the only way to avoid them is to avoid mechanical ventilation which of course can’t always be done. Those can cause worsening hypoxemia that can prolong mechanical ventilation, lead to multi-system organ dysfunction, and increase mortality. So the best strategy is to try to avoid them, rapidly diagnose them, and correct what we can. Our understanding of VILI have spiked over the last two decade. Since the positive results of the low vs high tidal volume trial in ARDS in the beginning of the century, most clinicians ..read more

In 2000, I was an internal medicine resident highly fascinated with yet poorly educated about the field of critical care medicine specifically the science of mechanical ventilation. When the ARMA trial of low tidal volume 6 vs 12 ml/kg IBW came out that year, I thought why 12? Did we even use 12 ml/kg even then? The joke between us at the time was, any patient goes on the ventilator, the settings are AC (I never use that horrible term unless I am talking about air conditioning), tidal volume 500, respiratory rate of 15 and PEEP 5 regardless. So, for an average patient with IBW 70 kg, that is ..read more