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Ventilation in Critical Care Medicine
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Ventilation in Critical Care Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (20 November 2024) | Viewed by 4600

Special Issue Editor

Dr. Gianluca Zani

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Guest Editor
Anesthesia and Intensive Care Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
Interests: ventilation; acute respiratory failure; ICU; anesthesia

Special Issue Information

Dear Colleagues,

Mechanical ventilation is a common and often life-saving intervention in critically ill patients, and it can be carried out in many different ways. For example, the decision to perform invasive or non-invasive ventilation, with which the device and location (ICU, operation theater or NORA), how to set the tidal volume and PEEP, the utility of the prone position and weaning strategies are still debated topics. The avoidance of ventilation-induced lung damage through a protective ventilation approach is currently a major focus of clinical interest. However, despite multiple studies having been produced, the number of issues for which we are in the dark still outnumbers those for which we are certain. The COVID-19 pandemic has highlighted the fragility of us all, emphasizing the role of a suitable ventilation strategy related to perfusion and also the importance of both clinical and physiological studies. Ventilation is moving towards goal-directed therapy, the result of replicable measurements to verify the effectiveness of the treatment and possibly make changes in real time.

This Special Issue aims to provide new information on pathological mechanisms, examination and treatment methods for critically ill patients to personalize ventilation. We invite the submission of original research papers as well as contemporary review articles that reflect the latest progress in and potential of this research field.

Dr. Gianluca Zani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • invasive ventilation
  • non-invasive ventilation
  • acute respiratory failure
  • best PEEP
  • respiratory weaning
  • respiratory mechanics
  • ventilation and perfusion
  • personalized ventilation

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Published Papers (4 papers)

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13 pages, 2142 KiB  
Article
Skeletal Muscle Mass Loss Leads to Prolonged Mechanical Ventilation and Higher Tracheotomy Rates in Critically Ill Patients
by Gabriel M. Allgayer, Bernhard Ulm, Andreas P. Sauter, Stefan J. Schaller, Manfred Blobner and Kristina E. Fuest
J. Clin. Med. 2024, 13(24), 7772; https://doi.org/10.3390/jcm13247772 - 19 Dec 2024
Viewed by 502
Abstract
Background: Skeletal muscle mass depletion adversely affects critically ill patient outcomes. Standardized methods for assessing muscle mass in this population are limited, particularly regarding changes during ICU stays and their implications for risk stratification. Methods: In this secondary analysis of our [...] Read more.
Background: Skeletal muscle mass depletion adversely affects critically ill patient outcomes. Standardized methods for assessing muscle mass in this population are limited, particularly regarding changes during ICU stays and their implications for risk stratification. Methods: In this secondary analysis of our prospective data registry of surgical ICU patients, we used a single slice extracted from a computed tomography scan to determine the patient’s direction of absolute change in skeletal muscle mass between two different time points (−14 d to +0 d and +5 d to +21 d) during his or her critical illness. Results: In total, 98 surgical patients were included in the final analysis. A decrease in a patient’s skeletal muscle mass is associated with prolonged mechanical ventilation compared to patients whose skeletal muscle mass remained the same or increased (415 vs. 42 h, p = 0.003). Patients losing skeletal muscle mass also needed to be ventilated more frequently (88.3% vs. 60.5%, p = 0.002), had a higher rate of tracheotomy (50.0% vs. 23.7%, p = 0.011), and had an increased ICU length of stay (22 vs. 13 days, p = 0.045). Conclusions: A decreased skeletal muscle index in early critical illness negatively impacts ventilation parameters, highlighting the importance of monitoring and managing muscle mass changes to optimize outcomes in ICU patients. Full article
(This article belongs to the Special Issue Ventilation in Critical Care Medicine)
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Other

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13 pages, 1115 KiB  
Systematic Review
Heart Rate Variability During Weaning from Invasive Mechanical Ventilation: A Systematic Review
by Giovanni Giordano, Francesco Alessandri, Antonella Tosi, Veronica Zullino, Leonardo Califano, Luigi Petramala, Gioacchino Galardo and Francesco Pugliese
J. Clin. Med. 2024, 13(24), 7634; https://doi.org/10.3390/jcm13247634 - 15 Dec 2024
Viewed by 580
Abstract
Background: The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation [...] Read more.
Background: The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). Methods: The protocol of this systematic review was registered with PROSPERO (CRD42024485800). We searched PubMed and Scopus databases from inception till March 2023 to identify randomized controlled trials and observational studies investigating HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation. Our primary outcome was to investigate HRV changes occurring during the weaning from IMV. Results: Seven studies (n = 342 patients) were included in this review. All studies reported significant changes in at least one HRV parameter. The indices Low Frequency (LF), High Frequency (HF), and LF/HF ratio seem to be the most promising in predicting the outcome of weaning with reliability. Some HRV indices showed modification in response to different ventilator settings or modalities. Conclusions: Available data report HRV modifications during the process of weaning and suggest a promising role of some HRV indices in predicting weaning outcomes in critically ill patients. Point-of-care HRV monitoring systems might help to early detect patients at risk of weaning failure. Full article
(This article belongs to the Special Issue Ventilation in Critical Care Medicine)
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13 pages, 1070 KiB  
Systematic Review
The Value of Ischemic Cardiac Biomarkers to Predict Spontaneous Breathing Trial or Extubation Failure: A Systematic Review
by Carline N. L. Groenland, Maud A. Blijleven, Imane Ramzi, Eric A. Dubois, Leo Heunks, Henrik Endeman, Evert-Jan Wils and Vivan J. M. Baggen
J. Clin. Med. 2024, 13(11), 3242; https://doi.org/10.3390/jcm13113242 - 30 May 2024
Viewed by 1107
Abstract
Background: It is unclear whether other cardiac biomarkers than NT-proBNP can be useful in the risk stratification of patients weaning from mechanical ventilation. The aim of this study is to summarize the role of ischemic cardiac biomarkers in predicting spontaneous breathing trial (SBT) [...] Read more.
Background: It is unclear whether other cardiac biomarkers than NT-proBNP can be useful in the risk stratification of patients weaning from mechanical ventilation. The aim of this study is to summarize the role of ischemic cardiac biomarkers in predicting spontaneous breathing trial (SBT) or extubation failure. Methods: We systematically searched Embase, MEDLINE, Web of Science, and Cochrane Central for studies published before January 2024 that reported the association between ischemic cardiac biomarkers and SBT or extubation failure. Data were extracted using a standardized form and methodological assessment was performed using the QUIPS tool. Results: Seven observational studies investigating four ischemic cardiac biomarkers (Troponin-T, Troponin-I, CK-MB, Myoglobin) were included. One study reported a higher peak Troponin-I in patients with extubation failure compared to extubation success (50 ng/L [IQR, 20–215] versus 30 ng/L [IQR, 10–86], p = 0.01). A second study found that Troponin-I measured before the SBT was higher in patients with SBT failure in comparison to patients with SBT success (100 ± 80 ng/L versus 70 ± 130 ng/L, p = 0.03). A third study reported a higher CK-MB measured at the end of the SBT in patients with weaning failure (SBT or extubation failure) in comparison to weaning success (8.77 ± 20.5 ng/mL versus 1.52 ± 1.42 ng/mL, p = 0.047). Troponin-T and Myoglobin as well as Troponin-I and CK-MB measured at other time points were not found to be related to SBT or extubation failure. However, most studies were underpowered and with high risk of bias. Conclusions: The association with SBT or extubation failure is limited for Troponin-I and CK-MB and appears absent for Troponin-T and Myoglobin, but available studies are hampered by significant methodological drawbacks. To more definitively determine the role of ischemic cardiac biomarkers, future studies should prioritize larger sample sizes, including patients at risk of cardiac disease, using stringent SBTs and structured timing of laboratory measurements before and after SBT. Full article
(This article belongs to the Special Issue Ventilation in Critical Care Medicine)
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9 pages, 7878 KiB  
Case Report
Ventilation Management in a Patient with Ventilation–Perfusion Mismatch in the Early Phase of Lung Injury and during the Recovery
by Ana Cicvarić, Josipa Glavaš Tahtler, Tajana Turk, Sanda Škrinjarić-Cincar, Despoina Koulenti, Nenad Nešković, Mia Edl and Slavica Kvolik
J. Clin. Med. 2024, 13(3), 871; https://doi.org/10.3390/jcm13030871 - 2 Feb 2024
Viewed by 1878
Abstract
Chest trauma is one of the most serious and difficult injuries, with various complications that can lead to ventilation–perfusion (V/Q) mismatch and systemic hypoxia. We are presenting a case of a 53-year-old male with no chronic therapy who was admitted to the Intensive [...] Read more.
Chest trauma is one of the most serious and difficult injuries, with various complications that can lead to ventilation–perfusion (V/Q) mismatch and systemic hypoxia. We are presenting a case of a 53-year-old male with no chronic therapy who was admitted to the Intensive Care Unit due to severe respiratory failure after chest trauma. He developed a right-sided pneumothorax, and then a thoracic drain was placed. On admission, the patient was hemodynamically unstable and tachypneic. He was intubated and mechanically ventilated, febrile (38.9 °C) and unconscious. A lung CT showed massive non-ventilated areas, predominantly in the right lung, guiding repeated therapeutic and diagnostic bronchoalveolar lavages. He was ventilated with PEEP of 10 cmH2O with a FiO2 of 0.6–0.8. Empirical broad-spectrum antimicrobial therapy was immediately initiated. Both high FiO2 and moderate PEEP were maintained and adjusted according to the current blood gas values and oxygen saturation. He was weaned from mechanical ventilation, and non-invasive oxygenation was continued. After Stenotrophomonas maltophilia was identified and treated with sulfamethoxazole/trimethoprim, a regression of lung infiltrates was observed. In conclusion, both ventilatory and antibiotic therapy were needed to improve the oxygenation and outcome of the patient with S. maltophilia pneumonia and V/Q mismatch. Full article
(This article belongs to the Special Issue Ventilation in Critical Care Medicine)
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