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An alternative approach to achieve more protective ventilation is high-frequency oscillatory ventilation (HFOV) [9].
ECMO is used to treat patients who develop refractory hypoxemia and to provide a more protective ventilation.
Due to the introduction of surfactant treatment for RDS, more protective ventilation strategies, and the use of antenatal glucocorticoids, BPD is now mostly seen among very immature infants, which are of a much younger GA then 30 years ago.
In particular, there are indices that a more protective ventilation (not only higher PEEP as per protocol) was applied in the PAL group since at baseline controls had slightly higher tidal volumes and lower PEEP levels.
Hypercapnia was also managed in moderate ARDS patients using ECCO2R to facilitate more protective ventilation strategies by enabling reduction of tidal volumes to ≤ 4 mL/kg without complications [20, 21].
The changes in PaCO2 observed for strategies 1 and 2 are accompanied by large increases in the P/F ratio (due to alveolar recruitment arising from increases in P alv)—only strategy 3 showed a consistent reduction in P alv as RR increased, i.e. only strategy 3 implemented a more protective ventilation strategy.
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This may be due to the wide range of aetiologies of acute respiratory failure in the paediatric intensive care unit, together with a gradual trend toward the use of more protective conventional ventilation strategies that emphasize lung recruitment and minimize tidal volumes.
The clinical importance of these findings is not clear, and further study is needed to see whether these findings are replicated when more lung-protective ventilation is applied.
A more compelling potential application of these devices that could be explored in future studies lies in enhancing CO2 removal and thereby facilitating more lung-protective ventilation in patients with severe ARDS.
It is encouraging that NIV-NAVA has effectively maintained a state in which pulmonary gas exchange was seemingly more protective than conventional invasive ventilation.
However, ECCO2R could facilitate implementation of ventilation strategies more protective than those recommended today, so as to limit lung injury further in mechanical ventilation.
More suggestions(15)
more elaborate ventilation
more tidal ventilation
more uneven ventilation
more successful ventilation
more heterogeneous ventilation
more protective plan
more protective zoning
more prolonged ventilation
more aggressive ventilation
more synchronous ventilation
more protective clothing
more detailed ventilation
more spontaneous ventilation
more physiological ventilation
more homogenous ventilation
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