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Respiratory and Mechanical Ventilation Management: Avoidance of Complications

  • Joan-Daniel Martí
  • Roberto Martinez-Alejos
Chapter

Abstract

Invasive mechanical ventilation (IMV) is a live-saving strategy often implemented in critically ill patients to overcome respiratory failure from either an acute, exacerbated or planned (e.g. surgery) clinical situation. However, several respiratory adverse effects may result from the use of mechanical ventilation, increasing morbidity and healthcare costs in these patients. Indeed, mucus retention is highly prevalent in the critically ill, independent of a pre-existent respiratory disease, with associated risk for atelectasis or respiratory infections. Moreover, respiratory muscle weakness is also recognized as a common adverse effect derived from IMV, which may result in a prolonged need for ventilation or intensive care unit length of stay. The knowledge of pathophysiological consequences derived from IMV and adequate respiratory management of critically ill patients is mandatory to ensure the quality of daily care in these patients, whilst also maximizing the potential for a successful ICU discharge. Thus, the purpose of this chapter is to describe the basics of pulmonary complications resulting from intubation and the use of mechanical ventilation in critically ill adults, presenting the most commonly implemented strategies for its management.

Keywords

Critical care Mechanical ventilation Mucus retention Airway clearance Endotracheal suctioning Humidification Chest physiotherapy Respiratory muscle training 

References

  1. 1.
    Konrad F, Schreiber T, Brecht-Kraus D, et al. Mucociliary transport in ICU patients. Chest. 1994;105:237–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Shah C, Kollef MH. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med. 2004;32:120–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Shapiro M, Wilson RK, Casar G, Bloom K, Teague RB. Work of breathing through different sized endotracheal tubes. Crit Care Med. 1986;14:1028–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Sackner MA, Hirsch J, Epstein S. Effect of cuffed endotracheal tubes on tracheal mucous velocity. Chest. 1975;68:774–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Gal TJ. Effects of endotracheal intubation on normal cough performance. Anesthesiology. 1980;52:324–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Kilgour E, Rankin N, Ryan S, Pack R. Mucociliary function deteriorates in the clinical range of inspired air temperature and humidity. Intensive Care Med. 2004;30(7):1491–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Cole AM, Dewan P, Ganz T. Innate antimicrobial activity of nasal secretions. Infect Immun. 1999;67:3267–75.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Dullenkopf A, Gerber A, Weiss M. Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med. 2003;29:1849–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Torres A, Serra-Batlles J, Ros E, Piera C, de la Puig BJ, Cobos A, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992;116:540–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:1851–8.PubMedCrossRefGoogle Scholar
  11. 11.
    American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.CrossRefGoogle Scholar
  12. 12.
    Li Bassi G, Zanella A, Cressoni M, Stylianou M, Kolobow T. Following tracheal intubation, mucus flow is reversed in the semirecumbent position: possible role in the pathogenesis of ventilator-associated pneumonia. Crit Care Med. 2008;36:518–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10:931–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016;150:1129–40.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;35:2007–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Supinski GS, Morris PE, Dhar S, Callahan LA. Diaphragm dysfunction in critical illness. Chest. 2018;153:1040–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. J Physiother. 2017;63:4–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015;61:125–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Marques Tonella R, Roceto Ratti LDS, LEB D, Junior CF, Da Silva PL, ARDS H, et al. Inspiratory muscle training in the intensive care unit: a new perspective. J Clin Med Res. 2017;9:929–34.CrossRefGoogle Scholar
  20. 20.
    Bisset BM, Leditschke IA, Neeman T, Boots R, Paratz J. Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial. Thorax. 2016;71:812–9.CrossRefGoogle Scholar
  21. 21.
    Martin AD, Smith BK, Davenport PD, Harman E, Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011;15:R84.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care. 2010;55:758.Google Scholar
  23. 23.
    Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning? Chest. 2000;118:1095–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Caruso P, Denari S, Ruiz SA, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med. 2009;37:32–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Frost SA, Azeem A, Alexandrou E, Tam V, Murphy JK, Hunt L, et al. Subglottic secretion drainage for preventing ventilator associated pneumonia: a meta-analysis. Aust Crit Care. 2013;26:180–8.PubMedCrossRefGoogle Scholar
  26. 26.
    AARC, Restrepo RD, Walsh BK. Humidification during invasive and noninvasive mechanical ventilation. Respir Care. 2012;57:782–8.CrossRefGoogle Scholar
  27. 27.
    Kelly M, Gillies D, Todd DA, Lockwood C. Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database Syst Rev. 2010;(4):CD004711.Google Scholar
  28. 28.
    Branson RD. Secretion management in the mechanically ventilated patient. Respir Care. 2007;52:1328–42.PubMedGoogle Scholar
  29. 29.
    Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118:1801–13.PubMedCrossRefGoogle Scholar
  30. 30.
    Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144:825–47.PubMedCrossRefGoogle Scholar
  31. 31.
    Benjamin RG, Chapman GA, Kim CS, Sackner MA. Removal of bronchial secretions by two-phase gas-liquid transport. Chest. 1989;95:658–63.PubMedCrossRefGoogle Scholar
  32. 32.
    Kim CS, Rodriguez CR, Eldridge MA, Sackner MA. Criteria for mucus transport in the airways by two-phase gas-liquid flow mechanism. J Appl Physiol. 1986;60:901–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Kim CS, Greene MA, Sankaran S, Sackner MA. Mucus transport in the airways by two-phase gas-liquid flow mechanism: continuous flow model. J Appl Physiol. 1986;60:908–17.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim CS, Iglesias AJ, Sackner MA. Mucus clearance by two-phase gas-liquid flow mechanism: asymmetric periodic flow model. J Appl Physiol. 1987;62:959–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Volpe MS, Adams AB, Amato MB, Marini JJ. Ventilation patterns influence airway secretion movement. Respir Care. 2008;53:1287–94.PubMedGoogle Scholar
  36. 36.
    Denehy L. The use of manual hyperinflation in airway clearance. Eur Respir J. 1999;14:958–65.PubMedCrossRefGoogle Scholar
  37. 37.
    Paulus F, Binnekade JM, Vroom MB, Schultz MJ. Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review. Crit Care. 2012;16:R145.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Borges LF, Saraiva MS, Saraiva MAS, Macagnan FE, Kessler A. Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis. Rev Bras Ter Intensiva. 2017;29:96–104.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Guimarães FS, Lopes AJ, Constantino SS, Lima JC, Canuto P, de Menezes SL. Expiratory rib cage compression in mechanically ventilated subjects: a randomized crossover trial [corrected]. Respir Care. 2014;59:678–85.PubMedCrossRefGoogle Scholar
  40. 40.
    Martí JD, Bassi GL, Rigol M, Saucedo L, Ranzani OT, Esperatti M, et al. Effects of manual rib cage compressions on expiratory flow and mucus clearance during mechanical ventilation. Crit Care Med. 2013;41:850–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Homnick DN. Mechanical insufflation-exsufflation for airway mucus clearance. Respir Care. 2007;52:1296–305.PubMedGoogle Scholar
  42. 42.
    Sánchez-García M, Santos P, Rodríguez-Trigo G, Martínez-Sagasti F, Fariña-González T, Del Pino-Ramírez Á, et al. Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway. Intensive Care Med Exp. 2018;6:8.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Ferreira de Camillis ML, Savi A, Goulart Rosa R, Figueiredo M, Wickert R, Borges LGA, et al. Effects of mechanical insufflation-exsufflation on airway mucus clearance among mechanically ventilated ICU subjects. Respir Care. 2018;63:1471–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Coutinho WM, Vieira PJC, Kutchak FM, Dias AS, Rieder MM, Forgiarini LA Jr. Comparison of mechanical insufflation-exsufflation and endotracheal suctioning in mechanically ventilated patients: effects on respiratory mechanics, hemodynamics, and volume of secretions. Indian J Crit Care Med. 2018;22:485–90.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Guerin C, Bourdin G, Leray V, Delannoy B, Bayle F, Germain M, Richard JC. Performance of the cough assist insufflation-exsufflation device in the presence of an endotracheal tube or tracheostomy tube: a bench study. Respir Care. 2011;56:1108–14.PubMedCrossRefGoogle Scholar
  46. 46.
    Volpe MS, Naves JM, Ribeiro GG, Ruas G, Amato MBP. Airway clearance with an optimized mechanical insufflation-exsufflation maneuver. Respir Care. 2018;63:1214–22.PubMedCrossRefGoogle Scholar
  47. 47.
    Levine S, Nguyen T, Taylor N, Friscia M, Budak MT, Rothenberg P, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2007;358:1327–35.CrossRefGoogle Scholar
  48. 48.
    Tobin MJ, Laghi F, Jubran A. Narrative review: ventilator-induced respiratory muscle weakness. Ann Intern Med. 2010;153:240–5.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Jaber S, Petrof BJ, Jung B, Chanques G, Berthet J, Rabel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011;183:364–71.PubMedCrossRefGoogle Scholar
  50. 50.
    Marin-Corral J, Dot I, Boguña M, Cecchini L, Zapatero A, Gracia MP, et al. Structural differences in the diaphragm of patients following controlled vs assisted and spontaneous mechanical ventilation. Intensive Care Med. 2019;45:488–500.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Joan-Daniel Martí
    • 1
  • Roberto Martinez-Alejos
    • 2
  1. 1.Cardiovascular Surgery ICUHospital ClinicBarcelonaSpain
  2. 2.Department of Critical Care Medicine and Anesthesiology Saint EloiMontpellier University Hospital and School of MedicineMontpellierFrance

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