New Trends in Mechanical Ventilation

Dear Colleagues,

Mechanical ventilation has undergone significant advancements in both anesthesia and intensive care, evolving towards less invasive techniques such as pressure support ventilation, CPAP, and the use of less aggressive artificial airways like laryngeal masks and helmets. However, challenges remain, particularly in patients who are difficult to ventilate, such as those with morbid obesity undergoing prolonged laparoscopic procedures in the Trendelenburg position, or ARDS patients in the ICU. These situations often result in low total lung compliance, complicating intraoperative oxygenation even with high airway pressures and 100% inspiratory oxygen. Despite efforts to mitigate these challenges with strategies like high PEEP and lung recruitment, postoperative complications such as atelectasis remain prevalent, often requiring extended oxygen therapy, CPAP, and physiotherapy for recovery.

New ventilation modes like variable ventilation and constant flow ventilation appear to offer some benefit in reducing atelectasis.

Another ongoing concern is the need for endotracheal tubes (ETTs) in patients who are difficult to ventilate and the prevention of aspiration in those at higher risk. The shift towards less invasive artificial airways was driven by the reduction in minor complications like hoarseness. However, research into developing better-sealing ETTs with lower cuff pressures for difficult-to-ventilate patients may promote their resurgence as a safer option for all patients requiring mechanical ventilation. Additionally, eliminating air leaks may reduce environmental concerns when using inhalation anesthesia.

These issues, alongside the physiological effects of mechanical ventilation on pleural pressure, highlight the complexity of positive pressure ventilation and the need to re-explore negative pressure ventilation (NPV). NPV mimics spontaneous breathing without increasing pleural pressure and avoids atelectasis more effectively. While its current ideal use is in supporting non-intubated patients at home, with adapted technology, it could be reintroduced for more severe cases in the ICU and possibly in the OR.

Given these emerging challenges and the need for improved approaches, we invite contributions to our Special Issue focused on "New Trends in Mechanical Ventilation" to explore and address these critical topics.

Prof. Dr. Jan P. Mulier
Guest Editor

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• positive pressure ventilation
• negative pressure ventilation
• constant flow ventilation
• PEEP
• lung recruitment
• obesity
• laparoscopy
• ARDS
• atelectasis
• total lung compliance