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Enhancing Mechanical Ventilation and Lung Monitoring in Intensive Care Units: Strategies for Optimization

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

Deadline for manuscript submissions: closed (30 October 2024) | Viewed by 5205

Special Issue Editors

Dr. Gaetano Scaramuzzo

E-Mail
Guest Editor
Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
Interests: mechanical ventilation; lung monitoring; acute respiratory failure; intensive care
Special Issues, Collections and Topics in MDPI journals
Dr. Savino Spadaro

E-Mail Website
Guest Editor
Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
Interests: mechanical ventilation; lung monitoring; acute respiratory failure; intensive care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the last few years, many new ventilatory strategies have been suggested for patients undergoing mechanical ventilation in ICUs. Moreover, new diagnostic, non-invasive tools have been developed, such as ultrasound or electrical impedance tomography. These have facilitated a better understanding of respiratory failure and provided opportunities to improve the clinical management of ICU-housed, ventilated patients.

In this Special Issue we would like to collect papers focusing on novel ways of implementing mechanical ventilation in ICUs, not only focusing on the ventilatory aspect (i.e., new ventilatory modes), but evaluating all the crucial procedures performed on ventilated patients (e.g., respiratory monitoring, sedation, secretion removal, VILI and P-SILI reduction, muscle monitoring, and respiratory physiotherapy).

Therefore, we invite you to submit original papers, commentaries, and meta-analyses in order to contribute to improve the management of ICU-housed, ventilated patients.

Dr. Gaetano Scaramuzzo
Dr. Savino Spadaro
Guest Editors

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

  • acute respiratory failure
  • lung monitoring
  • electrical impedance tomography
  • mechanical ventilation

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Published Papers (4 papers)

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Research

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12 pages, 1139 KiB  
Article
Oscillometry Longitudinal Data on COVID-19 Acute Respiratory Distress Syndrome Treated with Non-Invasive Respiratory Support
by Chiara Torregiani, Elisa Baratella, Antonio Segalotti, Barbara Ruaro, Francesco Salton, Paola Confalonieri, Stefano Tavano, Giulia Lapadula, Chiara Bozzi, Marco Confalonieri, Raffaele L. Dellaca’ and Chiara Veneroni
J. Clin. Med. 2024, 13(7), 1868; https://doi.org/10.3390/jcm13071868 - 24 Mar 2024
Cited by 1 | Viewed by 952
Abstract
Background: Oscillometry allows for the non-invasive measurements of lung mechanics. In COVID-19 ARDS patients treated with Non-Invasive Oxygen Support (NI-OS), we aimed to (1) observe lung mechanics at the patients’ admission and their subsequent changes, (2) compare lung mechanics with clinical and [...] Read more.
Background: Oscillometry allows for the non-invasive measurements of lung mechanics. In COVID-19 ARDS patients treated with Non-Invasive Oxygen Support (NI-OS), we aimed to (1) observe lung mechanics at the patients’ admission and their subsequent changes, (2) compare lung mechanics with clinical and imaging data, and (3) evaluate whether lung mechanics helps to predict clinical outcomes. Methods: We retrospectively analyzed the data from 37 consecutive patients with moderate–severe COVID-19 ARDS. Oscillometry was performed on their 1st, 4th, and 7th day of hospitalization. Resistance (R5), reactance (X5), within-breath reactance changes (ΔX5), and the frequency dependence of the resistance (R5–R19) were considered. Twenty-seven patients underwent computed tomographic pulmonary angiography (CTPA): collapsed, poorly aerated, and normally inflated areas were quantified. Adverse outcomes were defined as intubation or death. Results: Thirty-two patients were included in this study. At the first measurement, only 44% of them had an abnormal R5 or X5. In total, 23 patients had measurements performed on their 3rd day and 7 on their 7th day of hospitalization. In general, their R5, R5–R19, and ΔX decreased with time, while their X5 increased. Collapsed areas on the CTPA correlated with the X5 z-score (ρ = −0.38; p = 0.046), while poorly aerated areas did not. Seven patients had adverse outcomes but did not present different oscillometry parameters on their 1st day of hospitalization. Conclusions: Our study confirms the feasibility of oscillometry in critically ill patients with COVID-19 pneumonia undergoing NI-OS. The X5 z-scores indicates collapsed but not poorly aerated lung areas in COVID-19 pneumonia. Our data, which show a severe impairment of gas exchange despite normal reactance in most patients with COVID-19 ARDS, support the hypothesis of a composite COVID-19 ARDS physiopathology. Full article
(This article belongs to the Special Issue Enhancing Mechanical Ventilation and Lung Monitoring in Intensive Care Units: Strategies for Optimization)
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Review

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10 pages, 590 KiB  
Review
High-Flow Nasal Oxygen in Patients with Acute Hypercapnic Respiratory Failure: A Narrative Review of the Physiological Rationale and Clinical Evidence
by Gabriele Pintaudi, Salvatore Lucio Cutuli, Tommaso Rosà, Teresa Michi, Alessandro Cardu, Filippo Bongiovanni, Massimo Antonelli and Domenico Luca Grieco
J. Clin. Med. 2024, 13(21), 6350; https://doi.org/10.3390/jcm13216350 - 23 Oct 2024
Viewed by 871
Abstract
Acute hypercapnic respiratory failure is a life-threatening condition caused by alveolar hypoventilation. It is mostly caused by an acute exacerbation of chronic obstructive pulmonary disease or conditions yielding muscle dysfunction. Noninvasive ventilation through a facemask is the cornerstone first-line strategy to support hypercapnic [...] Read more.
Acute hypercapnic respiratory failure is a life-threatening condition caused by alveolar hypoventilation. It is mostly caused by an acute exacerbation of chronic obstructive pulmonary disease or conditions yielding muscle dysfunction. Noninvasive ventilation through a facemask is the cornerstone first-line strategy to support hypercapnic patients with acidemia, and current guidelines strongly recommend this intervention to improve survival and long-term clinical outcomes. Because of its benefits related to carbon dioxide washout from the upper airways and the enhanced comfort, high-flow nasal oxygen has been proposed as a respiratory support strategy in patients with hypercapnic respiratory failure, both as an alternative to and in combination with noninvasive ventilation. When compared to noninvasive ventilation as a first-line intervention, high-flow nasal oxygen shows a higher rate of failure. Hence, if not contraindicated, the use of noninvasive ventilation should be preferred. After the resolution of acidemia with noninvasive ventilation, high-flow nasal oxygen showed promising physiological effects compared to conventional oxygen. During weaning from mechanical ventilation in patients with or at risk of developing hypercapnia, high-flow nasal oxygen showed encouraging results, especially when applied alternating with sessions of noninvasive ventilation. Optimal settings of high-flow nasal oxygen in hypercapnic patients include the use of a smaller-size cannula, flows ranging between 30 and 40 L/min, and FiO2 adjusted to obtain SpO2 between 88% and 92%. Specific interfaces, such as asymmetric cannulas, may further enhance the benefits of a high flow in terms of carbon dioxide clearance. In this narrative review, we provide an updated overview of the physiological rationale and clinical evidence concerning the use of high-flow nasal oxygen in patients with acute hypercapnic respiratory failure. Full article
(This article belongs to the Special Issue Enhancing Mechanical Ventilation and Lung Monitoring in Intensive Care Units: Strategies for Optimization)
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16 pages, 1119 KiB  
Review
Diagnostic Accuracy of Lung Ultrasound in Neonatal Diseases: A Systematized Review
by Stefano Nobile, Lucia Sette, Claudia Esposito, Francesca Riitano, Chiara Di Sipio Morgia, Annamaria Sbordone, Giovanni Vento and Alessandro Perri
J. Clin. Med. 2024, 13(11), 3107; https://doi.org/10.3390/jcm13113107 - 25 May 2024
Viewed by 1192
Abstract
Background: Respiratory problems are frequent in newborns, and are mainly studied with chest X-rays, whereas CT scans are usually needed for the evaluation of rare malformations and diseases. Lung ultrasound (LUS] has been proposed as an alternative method of diagnosing a variety of [...] Read more.
Background: Respiratory problems are frequent in newborns, and are mainly studied with chest X-rays, whereas CT scans are usually needed for the evaluation of rare malformations and diseases. Lung ultrasound (LUS] has been proposed as an alternative method of diagnosing a variety of respiratory conditions. In recent years, there has been a rapid increase in LUS studies, thanks to the ability of LUS to rapidly exclude complications and significantly reduce radiation exposure in this fragile population. We aimed to summarize the current knowledge about LUS. Methods: A literature search was conducted on the Medline and Cochrane databases using appropriate terms. The inclusion criteria were: English language and human species. Exclusion criteria were: non-English language, animal species, case reports, case series, non-systematic reviews, and editorials. Results: The search returned 360 results. No Cochrane reviews were found. Titles and abstracts were screened, and 37 were finally considered. Studies concerning the use of lung ultrasound for the following conditions were presented: neonatal respiratory distress syndrome, transient tachypnea of the newborn, pneumothorax, pulmonary hemorrhage, pneumonia, bronchopulmonary dysplasia, and prediction of extubation success. Conclusions: We discussed the utility of LUS for the diagnosis and treatment of neonatal diseases according to the most recent literature. Full article
(This article belongs to the Special Issue Enhancing Mechanical Ventilation and Lung Monitoring in Intensive Care Units: Strategies for Optimization)
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Other

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14 pages, 401 KiB  
Systematic Review
High-Flow Nasal Cannula System in Respiratory Failure Associated with Interstitial Lung Diseases: A Systematic Review and Narrative Synthesis
by Raffaella Pagliaro, Luigi Aronne, Ramona Fomez, Vincenzo Ferri, Antonia Montella, Stefano Sanduzzi Zamparelli, Andrea Bianco and Fabio Perrotta
J. Clin. Med. 2024, 13(10), 2956; https://doi.org/10.3390/jcm13102956 - 17 May 2024
Cited by 1 | Viewed by 1683
Abstract
Background: High-flow nasal cannula (HFNC) therapy has emerged as a promising treatment modality for interstitial lung disease (ILD)-related respiratory failure. This systematic review aims to evaluate the efficacy and safety of HFNC therapy in patients with ILDs. Methods: A comprehensive literature search [...] Read more.
Background: High-flow nasal cannula (HFNC) therapy has emerged as a promising treatment modality for interstitial lung disease (ILD)-related respiratory failure. This systematic review aims to evaluate the efficacy and safety of HFNC therapy in patients with ILDs. Methods: A comprehensive literature search was conducted using major electronic databases to identify relevant studies investigating the use of HFNC therapy in ILD patients with respiratory failure. Outcome measures of interest included improvements in oxygenation, dyspnea relief, respiratory rate control, hospital length of stay, and mortality. Results: Twelve studies were analyzed with an overall population of 715 patients included. Idiopathic Pulmonary Fibrosis (IPF) was the most prevalent type of ILD. Evaluated clinical settings were acute (7 studies), chronic (2 studies), and end-stage (3 studies) ILDs. The HFNC as a support for acute respiratory failure seems not inferior to non-invasive ventilation while offering better comfort and patient’s perception. Poor data are available about use in chronic/long-term or rehabilitative settings. In end of life/palliative care, an HFNC might improve quality of life. Despite the promising results, further research is warranted to establish optimal HFNC protocols, identify patient subgroups most likely to benefit, and explore long-term outcomes. Conclusions: Overall, the HFNC appears to be a valuable therapeutic option for managing respiratory failure in ILD patients, offering potential improvements in oxygenation and symptom relief. Full article
(This article belongs to the Special Issue Enhancing Mechanical Ventilation and Lung Monitoring in Intensive Care Units: Strategies for Optimization)
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