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Open Access 01-12-2020 | Narrative Review

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

Authors: Ewan C. Goligher, Annemijn H. Jonkman, Jose Dianti, Katerina Vaporidi, Jeremy R. Beitler, Bhakti K. Patel, Takeshi Yoshida, Samir Jaber, Martin Dres, Tommaso Mauri, Giacomo Bellani, Alexandre Demoule, Laurent Brochard, Leo Heunks

Published in: Intensive Care Medicine | Issue 12/2020

Abstract

Mechanical ventilation may have adverse effects on both the lung and the diaphragm. Injury to the lung is mediated by excessive mechanical stress and strain, whereas the diaphragm develops atrophy as a consequence of low respiratory effort and injury in case of excessive effort. The lung and diaphragm-protective mechanical ventilation approach aims to protect both organs simultaneously whenever possible. This review summarizes practical strategies for achieving lung and diaphragm-protective targets at the bedside, focusing on inspiratory and expiratory ventilator settings, monitoring of inspiratory effort or respiratory drive, management of dyssynchrony, and sedation considerations. A number of potential future adjunctive strategies including extracorporeal CO₂ removal, partial neuromuscular blockade, and neuromuscular stimulation are also discussed. While clinical trials to confirm the benefit of these approaches are awaited, clinicians should become familiar with assessing and managing patients’ respiratory effort, based on existing physiological principles. To protect the lung and the diaphragm, ventilation and sedation might be applied to avoid excessively weak or very strong respiratory efforts and patient-ventilator dysynchrony.

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Title: Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort
Authors: Ewan C. Goligher
Annemijn H. Jonkman
Jose Dianti
Katerina Vaporidi
Jeremy R. Beitler
Bhakti K. Patel
Takeshi Yoshida
Samir Jaber
Martin Dres
Tommaso Mauri
Giacomo Bellani
Alexandre Demoule
Laurent Brochard
Leo Heunks
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06288-9

At a glance: The STEP trials

Springer Medicine

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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