Advertisement

Respiratory and Ventilatory Assessment

  • Alberto Lucchini
  • Christian De Felippis
  • Stefano Bambi
Chapter

Abstract

Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indexes can be determined, such as volume, compliance, resistance, and work of breathing.

Ventilation monitoring plays an important role in the current management of patients with acute respiratory failure, but sometimes there’s a lack of definitions regarding which “signals” and “derived variables” should be prioritized, as well as specifications about the timing and modes of application.

New techniques of respiratory monitoring have recently been made available for clinical use, but their use and arrangement are not always well defined.

We summarize the current modes of respiratory monitoring and their potential practical applications during invasive and noninvasive ventilation and during extracorporeal membrane oxygenation in patients affected by severe ARDS, needing rescue therapies to maintain blood oxygenation adequate.

Keywords

Acute respiratory distress syndrome Mechanical ventilation Noninvasive ventilation Patient-ventilator interaction Asynchronies Extracorporeal membrane oxygenation 

References

  1. 1.
    Nieman GF, Satalin J, Andrews P, Habashi NM, Gatto LA. Lung stress, strain, and energy load: engineering concepts to understand the mechanism of ventilator-induced lung injury (VILI). Intensive Care Med Exp. 2016;4:16.  https://doi.org/10.1186/s40635-016-0090-5. Epub 2016 Jun 18CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–33.  https://doi.org/10.1001/jama.2012.5669.CrossRefGoogle Scholar
  3. 3.
    Bein T, Grasso S, Moerer O, Quintel M, Guerin C, Deja M, et al. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia. Intensive Care Med. 2016;42:699–711.  https://doi.org/10.1007/s00134-016-4325-4.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Jubran A. Pulse oximetry. Crit Care. 2015;19:27.  https://doi.org/10.1186/s13054-015-0984-8.CrossRefGoogle Scholar
  5. 5.
    Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Med Devices (Auckl). 2014;7:231–9.  https://doi.org/10.2147/MDER.S47319.CrossRefGoogle Scholar
  6. 6.
    Walsh BK, Crotwell DN, Restrepo RD. Capnography/capnometry during mechanical ventilation: 2011. Respir Care. 2011;56:503–9.  https://doi.org/10.4187/respcare.01175.CrossRefPubMedGoogle Scholar
  7. 7.
    Thompson JE, Jaffe MB. Capnographic waveforms in the mechanically ventilated patient. Respir Care. 2005;50:100–8.PubMedGoogle Scholar
  8. 8.
    Kodali BS, Urman RD. Capnography during cardiopulmonary resuscitation: current evidence and future directions. J Emerg Trauma Shock. 2014;7:332–40.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Jordan J, Rose L, Dainty KN, Noyes J, Blackwood B. Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis. Cochrane Database Syst Rev. 2016;10:CD011812.  https://doi.org/10.1002/14651858.CD011812.pub2. CrossRefPubMedGoogle Scholar
  10. 10.
    Brochard L, Martin GS, Blanch L, Pelosi P, Belda FJ, Jubran A, et al. Clinical review: respiratory monitoring in the ICU—a consensus of 16. Crit Care. 2012;16:219.  https://doi.org/10.1186/cc11146.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mehta S, Cook DJ, Skrobik Y, Muscedere J, Martin CM, Stewart TE, et al. A ventilator strategy combining low tidal volume ventilation, recruitment maneuvers, and high positive end-expiratory pressure does not increase sedative, opioid, or neuromuscular blocker use in adults with acute respiratory distress syndrome and may improve patient comfort. Ann Intensive Care. 2014;4:33–7.  https://doi.org/10.1186/s13613-014-0033-9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Sole ML, Bennett M, Ashworth S. Clinical indicators for endotracheal suctioning in adult patients receiving mechanical ventilation. Am J Crit Care. 2015;24:318–24.  https://doi.org/10.4037/ajcc2015794.CrossRefPubMedGoogle Scholar
  13. 13.
    AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. American Association for Respiratory Care. Respir Care. 2010;55:758–6.Google Scholar
  14. 14.
    Hough CL, Kallet RH, Ranieri VM, Rubenfeld GD, Luce JM, Hudson LD. Intrinsic positive end-expiratory pressure in Acute Respiratory Distress Syndrome (ARDS) Network subjects. Crit Care Med. 2005;33(3):527.CrossRefPubMedGoogle Scholar
  15. 15.
    Vitacca M, Lanini B, Nava S, Barbano L, Portal R, Clini E, et al. Inspiratory muscle workload due to dynamic intrinsic PEEP in stable COPD patients: effects of two different settings of non-invasive pressure-support ventilation. Monaldi Arch Chest Dis. 2004;6:81–5.  https://doi.org/10.4081/monaldi.2004.704.CrossRefGoogle Scholar
  16. 16.
    Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, et al. Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med. 2016;42:1360–73.  https://doi.org/10.1007/s00134-016-4400-x.CrossRefPubMedGoogle Scholar
  17. 17.
    Moerer O, Barwing J, Quintel M. Neurally adjusted ventilatory assist (NAVA). A new mode of assisted mechanical ventilation. Anaesthesist. 2008;57:998–1005.  https://doi.org/10.1007/s00101-008-1412-0. CrossRefPubMedGoogle Scholar
  18. 18.
    Navalesi P, Colombo D, Della Corte F. NAVA ventilation. Minerva Anestesiol. 2010;76:346–52.PubMedGoogle Scholar
  19. 19.
    Piquilloud L, Vignaux L, Bialais E, Roeseler J, Sottiaux T, Laterre PF, et al. Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med. 2011;37:263–71.  https://doi.org/10.1007/s00134-010-2052-9.CrossRefPubMedGoogle Scholar
  20. 20.
    Petrof BJ, Hussain SN. Ventilator-induced diaphragmatic dysfunction: what have we learned? Curr Opin Crit Care. 2016;22:67–72.  https://doi.org/10.1097/MCC.0000000000000272.CrossRefPubMedGoogle Scholar
  21. 21.
    Rose L, Schultz MJ, Cardwell CR, Jouvet P, McAuley DF, Blackwood B. Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a Cochrane systematic review and meta-analysis. Crit Care. 2015;19:4.  https://doi.org/10.1186/s13054-015-0755-6.CrossRefGoogle Scholar
  22. 22.
    Vagheggini G, Mazzoleni S, Vlad Panait E, Navalesi P, Ambrosino N. Physiologic response to various levels of pressure support and NAVA in prolonged weaning. Respir Med. 2013;107:1748–54.  https://doi.org/10.1016/j.rmed.2013.08.013.CrossRefPubMedGoogle Scholar
  23. 23.
    Bellani G, Patroniti N, Weismann D, Galbiati L, Curto F, et al. Measurement of pressure-time product during spontaneous assisted breathing by rapid interrupter technique. Anesthesiology. 2007;106:484–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Blanch L, Villagra A, Sales B, Montanya J, Lucangelo U, Luján M, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41:633–41.  https://doi.org/10.1007/s00134-015-3692-6.CrossRefPubMedGoogle Scholar
  25. 25.
    Delisle S, Ouellet P, Bellemare P, Tétrault JP, Arsenault P. Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes. Ann Intensive Care. 2011;1:42–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Murias G, Lucangelo U, Blanch L. Patient-ventilator asynchrony. Curr Opin Crit Care. 2016;22:53–9.  https://doi.org/10.1097/MCC.0000000000000270.CrossRefPubMedGoogle Scholar
  27. 27.
    Cavaliere F, Conti G, Costa R, Spinazzola G, Proietti R, Sciuto A, et al. Exposure to noise during continuous positive airway pressure: influence of interfaces and delivery systems. Acta Anaesthesiol Scand. 2008;52:52–6.  https://doi.org/10.1111/j.1399-6576.2007.01474.x.CrossRefPubMedGoogle Scholar
  28. 28.
    Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2016;315:2435–4.  https://doi.org/10.1001/jama.2016.6338.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Bellani G, Patroniti N, Greco M, Foti G, Pesenti A. The use of helmets to deliver non-invasive continuous positive airway pressure in hypoxemic acute respiratory failure. Minerva Anestesiol. 2008;74:651–6.PubMedGoogle Scholar
  30. 30.
    Patroniti N, Foti G, Manfio A, Coppo A, Bellani G, Pesenti A. Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study. Intensive Care Med. 2003;29:1680–7.  https://doi.org/10.1007/s00134-003-1931-8.CrossRefPubMedGoogle Scholar
  31. 31.
    Ferrario D, Lucchini A. Helmet delivered CPAP for in-patients. Minerva Anestesiol. 2002;68:481–4.PubMedGoogle Scholar
  32. 32.
    Lucchini A, Valsecchi D, Elli S, Doni V, Corsaro P, Tundo P, et al. The comfort of patients ventilated with the helmet bundle. Assist Inferm Ric. 2010;29(4):174–83.PubMedGoogle Scholar
  33. 33.
    Milan M, Zanella A, Isgrò S, Deab SA, Magni F, Pesenti A, et al. Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply. Intensive Care Med. 2011;37:1031–5.  https://doi.org/10.1007/s00134-011-2207-3.CrossRefPubMedGoogle Scholar
  34. 34.
    Trevisanuto D, Camiletti L, Udilano A, Doglioni N, Zanardo V. Noise levels during neonatal helmet CPAP. Arch Dis Child Fetal Neonatal Ed. 2008;93:F396–7.  https://doi.org/10.1136/adc.2008.140715.CrossRefPubMedGoogle Scholar
  35. 35.
    American Association for Respiratory Care, Restrepo RD, Walsh BK. Humidification during invasive and noninvasive mechanical ventilation: 2012. Respir Care. 2012;57:782–8.  https://doi.org/10.4187/respcare.01766.CrossRefGoogle Scholar
  36. 36.
    American National Standards Institute; American Society of Anesthesiologists. Standard for humidifiers and nebulizers for medical use. ANSI. 1979;Z79:9.Google Scholar
  37. 37.
    Chiumello D, Chierichetti M, Tallarini F, Cozzi P, Cressoni M, Polli F, et al. Effect of a heated humidifier during continuous positive airway pressure delivered by a helmet. Crit Care. 2008;12:R55.  https://doi.org/10.1186/cc6875.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Nava S, Ceriana P. Patient-ventilator interaction during noninvasive positive pressure ventilation. Respir Care Clin N Am. 2005;11:281–9.  https://doi.org/10.1016/j.rcc.2005.02.003.CrossRefPubMedGoogle Scholar
  39. 39.
    Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, et al. Subject-ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med. 2008;34:1615–23.  https://doi.org/10.1007/s00134-008-1163-z.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Lemyze M, Mallat J, Nigeon O, Barrailler S, Pepy F, Gasan G, et al. Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure. Crit Care Med. 2013;41:481–8.  https://doi.org/10.1097/CCM.0b013e31826ab4af.CrossRefPubMedGoogle Scholar
  41. 41.
    Bambi S. Noninvasive positive pressure ventilation: an ABC approach for advanced nursing in emergency departments and acute care settings. Dimens Crit Care Nurs. 2009;28:253–63.  https://doi.org/10.1097/DCC.0b013e3181b3ffdc. CrossRefPubMedGoogle Scholar
  42. 42.
    Bambi S, Peris A, Esquinas AM. Pressure ulcers caused by masks during noninvasive ventilation. Am J Crit Care. 2016;25:6.  https://doi.org/10.4037/ajcc2016906.CrossRefPubMedGoogle Scholar
  43. 43.
    Nava S, Navalesi P, Gregoretti C. Interfaces and humidification for noninvasive mechanical ventilation. Respir Care. 2009;54:71–84.PubMedGoogle Scholar
  44. 44.
    Pisani L, Carlucci A, Nava S. Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency. Minerva Anestesiol. 2012;78:1154–61.PubMedGoogle Scholar
  45. 45.
    Di Marco F, Centanni S, Bellone A, Messinesi G, Pesci A, Scala R, et al. Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial. Crit Care. 2011;15:R283.  https://doi.org/10.1186/cc10567.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800.  https://doi.org/10.1001/jama.2016.0291.CrossRefPubMedGoogle Scholar
  47. 47.
    Luciani GB, Hoxha S, Torre S, Rungatscher A, Menon T, Barozzi L, et al. Improved outcome of cardiac extracorporeal membrane oxygenation in infants and children using magnetic levitation centrifugal pumps. Artif Organs. 2016;40:27–33.  https://doi.org/10.1111/aor.12647.CrossRefPubMedGoogle Scholar
  48. 48.
    Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63.  https://doi.org/10.1016/S0140-6736(09)61069-2.CrossRefPubMedGoogle Scholar
  49. 49.
    Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011;37:1447–5.  https://doi.org/10.1007/s00134-011-2301-6.CrossRefPubMedGoogle Scholar
  50. 50.
    Gattinoni L, Carlesso E, Langer T. Clinical review: extracorporeal membrane oxygenation. Crit Care. 2011;15:243.  https://doi.org/10.1186/cc10490.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Pesenti A, Zanella A, Patroniti N. Extracorporeal gas exchange. Curr Opin Crit Care. 2009;15:52–8.  https://doi.org/10.1097/MCC.0b013e3283220e1f.CrossRefPubMedGoogle Scholar
  52. 52.
    Avalli L, Sangalli F, Migliari M, Maggioni E, Gallieri S, Segramora V, et al. Early vascular complications after percutaneous cannulation for extracorporeal membrane oxygenation for cardiac assist. Minerva Anestesiol. 2016;82:36–4.PubMedGoogle Scholar
  53. 53.
    Chauhan S, Subin S. Extracorporeal membrane oxygenation—an anaesthesiologist’s perspective—part II: clinical and technical consideration. Ann Card Anaesth. 2012;15:69–82.  https://doi.org/10.4103/0971-9784.91485.CrossRefPubMedGoogle Scholar
  54. 54.
    Posluszny J, Rycus PT, Bartlett RH, Engoren M, Haft JW, Lynch WR, et al. Outcome of adult respiratory failure patients receiving prolonged (≥14 days) ECMO. Ann Surg. 2016;263:573–8.  https://doi.org/10.1097/SLA.0000000000001176.CrossRefPubMedGoogle Scholar
  55. 55.
    Lubnow M, Philipp A, Foltan M, Bull Enger T, Lunz D, Bein T, et al. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange—retrospective analysis of 265 cases. PLoS One. 2014;9:e112316.  https://doi.org/10.1371/journal.pone.0112316. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alberto Lucchini
    • 1
  • Christian De Felippis
    • 2
  • Stefano Bambi
    • 3
  1. 1.General Intensive Care UnitSan Gerardo Hospital, ASST Monza, University of Milano-BicoccaMilanItaly
  2. 2.Adult Intensive Care Unit, Glenfield HospitalUniversity Hospital of Leicester-NHS TrustLeicesterUK
  3. 3.Emergency & Trauma ICU, University Hospital CareggiFlorenceItaly

Personalised recommendations