![]() ![]() In the intensive care unit (ICU), even though two meta-analyses suggest that patients with uninjured lungs could benefit from ventilation with low V T ( 10, 11), a prospective study reported no association between V T and outcomes ( 12), which may be attributed to the fact that V T in this study was much lower than in the aforementioned meta-analyses ( 10, 11). In the emergency department, mechanically ventilated patients with injured and uninjured lungs could also benefit from the use of low V Ts ( 9). This could be attributed to the difficulty in controlling V T during PCV, thus highlighting the importance of V T. The frequency of PPCs was higher in PCV than in VCV. Additionally, pressure-controlled ventilation (PCV) has been compared to volume-controlled ventilation (VCV), focusing on PPCs this comparison is important to distinguish the potential role of strict control of V T during VCV. In patients under general anesthesia, no association has been observed between V T and postoperative pulmonary complications (PPCs) ( 8). In both uninjured and injured lungs, the use of low V T has been preferred over high V T. Inputs: ventilator parameters set by the operator Tidal volume (V T) Moreover, new ventilator-derived parameters, such as mechanical energy, mechanical power, and intensity, will be discussed in light of recent evidence ( 5- 7). In this review, we will discuss the ventilator parameters adjusted by the operator (inputs) and ventilator parameters obtained after interaction with respiratory system structures during mechanical ventilation (outputs). During assisted mechanical ventilation, in addition to these parameters, the pressure generated 100 ms after onset of inspiratory effort (P 0.1) and pressure-time product per minute (PTP/min) should also be evaluated. ![]() Regardless of ventilator mode, the following ventilator-derived parameters should be measured in order to mitigate harmful effects ( 2, 4): intrinsic PEEP (PEEPi), peak (Ppeak) and plateau (Pplat) pressures, driving pressure (ΔP), and transpulmonary pressure (P L). Once the inputs-tidal volume (V T), positive end-expiratory pressure (PEEP), respiratory rate (RR), and inspiratory airflow (V’)-have been adjusted, the information obtained from the mechanical ventilator (the outputs or ventilator-derived parameters) can be examined. The basis of this process relies on the interaction between physical forces acting on lung structures during mechanical ventilation adjusted by the operator and the lung and chest wall mechanics of the patient ( 3). The benefits and harms of mechanical ventilation depend not only on the adjustment of ventilator parameters, but also on the interpretation of ventilator-derived parameters, which should be used to guide ventilatory strategies. ![]() Mechanical ventilation is a life-support system used to maintain adequate lung function in patients who are critically ill or undergoing general anesthesia ( 1, 2) however, it may cause lung damage. Keywords: Mechanical ventilation tidal volume positive end-expiratory pressure (PEEP) respiratory rate inspiratory flow plateau pressure driving pressure transpulmonary pressure mechanical energy mechanical power Additionally, more clinical research to evaluate the safe thresholds of each parameter in injured and uninjured lungs is required. The aforementioned parameters should be seen as a set of outputs, all of which need to be strictly monitored at bedside in order to develop a personalized, case-by-case approach to mechanical ventilation. During assisted mechanical ventilation, in addition to these parameters, the pressure generated 100 ms after onset of inspiratory effort (P 0.1) and the pressure-time product per minute (PTP/min) should also be evaluated. Once the inputs-tidal volume (V T), positive end-expiratory pressure (PEEP), respiratory rate (RR), and inspiratory airflow (V’)-have been adjusted, the following outputs should be measured: intrinsic PEEP, peak (Ppeak) and plateau (Pplat) pressures, driving pressure (ΔP), transpulmonary pressure (P L), mechanical energy, mechanical power, and intensity. The benefits and harms of mechanical ventilation depend not only on the operator’s setting of the machine (input), but also on their interpretation of ventilator-derived parameters (outputs), which should guide ventilator strategies. Policy of Dealing with Allegations of Research MisconductĪbstract: Mechanical ventilation is a life-support system used to maintain adequate lung function in patients who are critically ill or undergoing general anesthesia.Policy of Screening for Plagiarism Process. ![]()
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