The physiological underpinnings of life-saving respiratory support
3
Issued Date
2022-10-01
Resource Type
ISSN
03424642
eISSN
14321238
Scopus ID
2-s2.0-85131712307
Pubmed ID
35690953
Journal Title
Intensive Care Medicine
Volume
48
Issue
10
Start Page
1274
End Page
1286
Rights Holder(s)
SCOPUS
Bibliographic Citation
Intensive Care Medicine Vol.48 No.10 (2022) , 1274-1286
Suggested Citation
Telias I., Brochard L.J., Gattarello S., Wunsch H., Junhasavasdikul D., Bosma K.J., Camporota L., Brodie D., Marini J.J., Slutsky A.S., Gattinoni L. The physiological underpinnings of life-saving respiratory support. Intensive Care Medicine Vol.48 No.10 (2022) , 1274-1286. 1286. doi:10.1007/s00134-022-06749-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85514
Title
The physiological underpinnings of life-saving respiratory support
Author's Affiliation
Keenan Research Centre for Biomedical Science
University of Minnesota Twin Cities
Sunnybrook Health Sciences Centre
Columbia University Irving Medical Center
IRCCS Ospedale San Raffaele
Universitätsmedizin Göttingen
University of Toronto
Faculty of Medicine Ramathibodi Hospital, Mahidol University
University Health Network University of Toronto
Vagelos College of Physicians and Surgeons
Western University
Guy's and St Thomas' NHS Foundation Trust
University of Minnesota Twin Cities
Sunnybrook Health Sciences Centre
Columbia University Irving Medical Center
IRCCS Ospedale San Raffaele
Universitätsmedizin Göttingen
University of Toronto
Faculty of Medicine Ramathibodi Hospital, Mahidol University
University Health Network University of Toronto
Vagelos College of Physicians and Surgeons
Western University
Guy's and St Thomas' NHS Foundation Trust
Other Contributor(s)
Abstract
Treatment of respiratory failure has improved dramatically since the polio epidemic in the 1950s with the use of invasive techniques for respiratory support: mechanical ventilation and extracorporeal respiratory support. However, respiratory support is only a supportive therapy, designed to “buy time” while the disease causing respiratory failure abates. It ensures viable gas exchange and prevents cardiorespiratory collapse in the context of excessive loads. Because the use of invasive modalities of respiratory support is also associated with substantial harm, it remains the responsibility of the clinician to minimize such hazards. Direct iatrogenic consequences of mechanical ventilation include the risk to the lung (ventilator-induced lung injury) and the diaphragm (ventilator-induced diaphragm dysfunction and other forms of myotrauma). Adverse consequences on hemodynamics can also be significant. Indirect consequences (e.g., immobilization, sleep disruption) can have devastating long-term effects. Increasing awareness and understanding of these mechanisms of injury has led to a change in the philosophy of care with a shift from aiming to normalize gases toward minimizing harm. Lung (and more recently also diaphragm) protective ventilation strategies include the use of extracorporeal respiratory support when the risk of ventilation becomes excessive. This review provides an overview of the historical background of respiratory support, pathophysiology of respiratory failure and rationale for respiratory support, iatrogenic consequences from mechanical ventilation, specifics of the implementation of mechanical ventilation, and role of extracorporeal respiratory support. It highlights the need for appropriate monitoring to estimate risks and to individualize ventilation and sedation to provide safe respiratory support to each patient.