- Author
-
A. Serpa Neto
- Title
- Lung-protective ventilation in intensive care unit and operation room
- Subtitle
- Tidal volume size, level of positive end-expiratory pressure and driving pressure
- Supervisors
-
M.J. Schultz
P. Pelosi - Co-supervisors
-
M. Gama de Abreu
S.N.T. Hemmes - Award date
- 15 September 2017
- Number of pages
- 550
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Several investigations have shown independent associations between three ventilator settings – tidal volume size, positive end–expiratory pressure (PEEP) and driving pressure – and outcomes in patients with the acute respiratory distress syndrome (ARDS). There is an increasing notion that similar associations may exist between these ventilation parameters and outcomes in intensive care unit (ICU) patients without ARDS. Even in surgery patients, who usually receive mechanical ventilation for shorter periods of time than ICU patients, outcomes could depend on these three settings.
The main aim of this thesis was to investigate associations between tidal volume size, PEEP and driving pressures, and outcomes in ICU patients without ARDS, patients receiving intraoperative ventilation, and patients receiving extracorporeal support as a rescue therapy for ARDS. We hypothesized that tidal volumes, PEEP and driving pressure are independently associated with outcomes in these groups of patients.
The main findings are that three potentially modifiable ventilator settings – tidal volume, PEEP and driving pressure – have independent associations with diverse outcomes in ICU patients without ARDS, in surgery patients receiving intraoperative ventilation, and in ARDS patients under extracorporeal support. All these findings strongly support the idea that strategies aiming at optimization of these three settings could improve outcomes of patients receiving mechanical ventilatory support.
We further suggest that one way to monitor the risk of damage caused by mechanical ventilation is to monitor the amount of energy transferred during mechanical ventilation. Finally, driving pressure itself is an important driver of the energy delivered by the ventilator to lung in each breath. - Persistent Identifier
- https://hdl.handle.net/11245.1/35660734-9d32-4127-8608-68207d9d5d28
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: A meta-analysis
Chapter 3: Dissipated energy is a key mediator of VILI: Rationale for using low driving pressures
Chapter 4: Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis
Chapter 5: Optimizing the settings on the ventilator settings: High PEEP for all?
Chapter 6: Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: A meta-analysis of individual patient data
Chapter 7: Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications
Chapter 8: Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: A systematic translational review and meta-analysis
Chapter 9: Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome: a systematic review and individual patient data analysis
Chapter 10: Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis
Chapter 11: Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study
Chapter 12: Potentially modifiable factors contributing to outcome in patients without ARDS under invasive mechanical ventilatory support: a secondary analysis of PRoVENT
Chapter 13: Extracorporeal life support: a ‘breath-taking’ technology
Chapter 14: Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: A pooled individual patient data analysis
15: Impact of ventilator settings in patients with ARDS undergoing extracorporeal carbon dioxide removal: A pooled individual patient data analysis
Chapter 16: Summary & general discussion
Chapter 17: Nederlandse samenvatting
Appendices
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