Category Archives: Academic Half Day

Mechanical Ventilation in Severe Asthma

The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe air-flow obstruction – Am Rev Respir Dis 1987

• Initial case series mentioned by Dr. Corbridge that described the relationship between minute ventilation, tidal volume, and inspiratory time on pulmonary hyperinflation in states of severe airflow obstruction

Mechanical ventilation for severe asthma – CHEST 2015

• Helpful review of how to manage the ventilator in severe asthma

Management of life-threatening asthma – CHEST 2022

• New CHEST review which provides more details on pharmacotherapies

Advanced Topics in ARDS and Ventilator Management

Acute Respiratory Distress Syndrome – Nat Rev Dis Primers 2019

• Nice review which summarizes a lot of what we know about ARDS pathobiology

Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy – Am J Respir Crit Care Med 2013

• Important study which found that < 50% of autopsy specimens from patients who met Berlin Criteria for ARDS had diffuse alveolar damage on pathology. Pneumonia was the most common alternative finding

New Insights into Clinical and Mechanistic Heterogeneity of the Acute Respiratory Distress Syndrome: Summary of the Aspen Lung Conference 2021 – Am J Respir Cell Mol Bio 2022

• Summary of discussions from Aspen Lung Conference. Provides a nice review of ARDS phenotyping including hypo and hyperinflammatory  phenotypes and implications for clinical trial design

The “baby lung” became an adult – Intensive Care Med 2016

• Easy to ready summary of “baby lung” concept in ARDS

Driving pressure and survival in the acute respiratory distress syndrome – N Engl J Med 2015

• Re-analysis of ARDS clinical trials which found that driving pressure was strongly associated with survival and that interventions which lowered delta P were associated with improved outcomes

Fifty Years of Research in ARDS. Spontaneous Breathing during Mechanical Ventilation. Risks, Mechanisms, and Management – Am J Respir Crit Care Med 2017 

• Nice summary of potential risks and benefits of spontaneous breathing during ARDS. Discusses transpulmonary pressure and pendelluft

Setting PEEP in ARDS

Fifty Years of Research in ARDS. Setting Positive End-Expiratory Pressure in Acute Respiratory Distress Syndrome – Am J Respir Crit Care Med 2017

• Part of 50 years of research in ARDS series (worth reading entire series). Review several approaches to setting PEEP including driving pressure, PV curves, and esophageal pressure monitoring

Liberation from Mechanical ventilation

Summary of ACCP/ATS Liberation from IMV guidelines on this blog 

Two foundational vent liberation trials to know:

A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group – N Engl J Med 1995

• Landmark weaning trial which found T-piece was superior to weaning by pressure support or IMV

Comparison of three methods of gradual withdrawal from ventilator support during weaning from mechanical ventilation – Am J Respir Crit Care Med 1994

• Using the specific weaning protocols in the trial, a progressive reduction in pressure support was superior to weaning by T-piece or SIMV

Journal Club

Early Active Mobilization during Mechanical Ventilation in the ICU – N Engl J Med 2022

• In mechanically ventilated patients, an intervention to achieve the highest possible level of mobilization that was deemed safe during daily therapy did not improve outcomes and was associated with more adverse events compared to usual care

Anaglesia and Sedation in the ICU

Ventilatory Dyssynchrony

Patient-ventilator Interactions: Implications or Clinical Management – AJRCCM 2013

• Evergreen review of trigger, flow, and cycle dyssynchronies including recognition and management

Alveolar Gas Equation

Teaching an intuitive derivation of the clinical alveolar equations: mass balance as a fundamental physiological principle – Adv Physiol Educ 2020

• In-depth derivation of alveolar gas equation for those interested in a deep dive

Bias in Pulse Oximetry

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study – BMJ 2022

• Recently published large retrospective study that found occult hypoxemia (SaO2 <88% with SpO2 ≥92%) more common in Black vs White patient

Non-invasive Ventilation in the ICU

Philips Respironics V60 User Manual 

• Critically important to know how to use the devices available to you
• Page 4-7 reviews trigger, target, and cycle for the different modes available on the V60

ATS/ERS Guidelines on use of NIV for Acute Respiratory Failure – ERJ 2017

• Consensus guidelines on use of NIV in respiratory failure. A nice summary of the literature on the use of NIV in the pre-intubation and post-extubation setting

Liberation from Mechanical Ventilation in Critically Ill Adults: An Official ATS/ACCP Clinical Practice Guideline – AJRCCM 2017

• Summary of 3 important guidelines from the ATS/ACCP on evidence-based liberation from mechanical ventilation in critically ill adults. References to the parent documents are provided in this summary

Journal Club: PROSEVA

Prone positioning in severe acute respiratory distress syndrome – NEJM, 2013

• Landmark RCT which found prone positioning for 16 hrs/day associated with a significant mortality benefit for patients with severe ARDS

Prone position-induced improvement in gas exchange does not predict improved survival in the acute respiratory distress syndrome – AJRCCM 2014

• Retrospective analysis of PROSEVA data which found that did not find an association between the improvement in gas exchange and survival – suggesting perhaps that proning mechanism of benefit is largely through limiting VILI

Evidence-based ARDS Care

An OfficialAmerican Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome – AJRCCM 2017

• Evidence-based multi-society guidelines on mechanical ventilation in ARDS. Only LTVV + Pplt < 30 cmH20 and prone positioning for > 12hrs/day in severe ARDS receive strong recommendations FOR

Formal guidelines: management of acute respiratory distress syndrome – Annals Intensive Care 2019

• More recent guidelines from Société de Réanimation de Langue Française. Their approach: