Mechanical Ventilation/Ventricular Assist Devices, An Issue of Critical Care Clinics, Volume 34-3

This issue of Critical Care Clinics focuses on Mechanical Ventilation and Ventricular Assist Devices, with topics including: Targeted management approach to cardiogenic shock; Prevention and treatment of right heart failure during left ventricular assist device support therapy; Complications of durable left ventricular assist device support therapy; Patient and device management on left ventricular assist device support therapy; Challenges and future directions in left ventricular assist device support therapy; Monitoring global and regional mechanics; Asynchrony consequences and management; Determinants and prevention of ventilator-induced lung injury; Extracorporeal gas exchange; Non-invasive options; Mobilization and VIDD avoidance; Initiating and discontinuing invasive support; and Automation of ventilation.

· Section I: Mechanical Ventilation

· Preface

· Critical Care Airway Management

· Key points

· Introduction

· Complications of urgent endotracheal intubation

· Identification of the difficult airway in urgent endotracheal intubation

· Rapid sequence intubation versus graded sedation intubation for urgent endotracheal intubation

· Direct laryngoscopy versus video laryngoscopy for urgent endotracheal intubation

· Preoxygenation techniques for urgent endotracheal intubation

· Gastric ultrasonography

· Improving the safety of urgent endotracheal intubation

· Summary

· Asynchrony Consequences and Management

· Key points

· Introduction: what is dyssynchrony and why does it matter?

· Dyssynchrony: definitions and mechanistic classification

· Association with poor outcome

· Management

· Summary

· Determinants and Prevention of Ventilator-Induced Lung Injury

· Key points

· Introduction

· Definition of ventilator-induced lung injury

· The nature of ventilator-induced lung injury

· The assessment of ventilator-induced lung injury

· Ventilator-induced lung injury in clinical practice

· How best to prevent ventilator-induced lung injury

· Avoiding Respiratory and Peripheral Muscle Injury During Mechanical Ventilation: Diaphragm-Protective Ventilation and Early Mobilization

· Key points

· Introduction

· Definition and epidemiology

· Clinical significance: impact on outcomes

· Mechanisms of muscle injury and weakness during critical illness

· Prevention and treatment

· Summary

· Automation of Mechanical Ventilation

· Key points

· Introduction

· Definitions

· Proposed advantages

· Automated control of mechanical ventilation

· Adaptive support ventilation

· Summary

· Noninvasive Options

· Key points

· Introduction

· Noninvasive ventilation and continuous positive airway pressure

· Noninvasive ventilation and high-flow nasal cannula oxygenation

· Interfaces of noninvasive ventilation

· Carbon dioxide rebreathing during noninvasive ventilation

· Asynchrony during noninvasive ventilation

· Main indications for noninvasive ventilation

· Other applications of noninvasive ventilation

· Practical advice

· Intensity of inspiratory efforts and lung stretching during noninvasive ventilation

· Summary

· Extracorporeal Gas Exchange

· Key points

· Introduction

· Evidence and indications for mid- to high-flow extracorporeal gas exchange

· Evidence and indications for low flow extracorporeal gas exchange

· Low-flow extracorporeal gas exchange to avoid intubation in acute respiratory failure

· Low-flow extracorporeal gas exchange to facilitate lung-protective ventilation

· Low-flow extracorporeal gas exchange to facilitate weaning

· Actual status and outlook

· Section II: Ventricular Assist Devices

· Preface

· A Targeted Management Approach to Cardiogenic Shock

· Key points

· Introduction

· Etiology

· Pathophysiology

· Evaluation of a patient in cardiogenic shock

· Risk stratification and clinical outcomes

· Treatment

· Summary

· Prevention and Treatment of Right Ventricular Failure During Left Ventricular Assist Device Therapy

· Key points

· Introduction

· Definition of right ventricular failure

· Mechanisms of right ventricular failure

· Prevention of right ventricular failure

· Treatment of right ventricular failure

· Summary

· Device Management and Flow Optimization on Left Ventricular Assist Device Support

· Key points

· Introduction

· Principles of left ventricular assist device function and normal left ventricular assist device physiology

· Power, flow, and pulsatility

· Decreased left ventricular assist device flow

· Increased left ventricular assist device flow

· Ramp study for assessment of device function and speed optimization

· Evidence-based heart failure therapy

· Summary

· Complications of Durable Left Ventricular Assist Device Therapy

· Key points

· Introduction

· Complications related to pump-patient interface

· Complications related to the patient

· Summary

· Challenges and Future Directions in Left Ventricular Assist Device Therapy

· Key points

· Introduction

· Focus on evolving indications

· Focus on patient-centered care and quality of life

· Focus on myocardial recovery and role of concomitant medical therapy

· Focus on risk stratification

· Focus on pulsatility and flow

· Focus on cost-effectiveness of durable left ventricular assist devices

· Focus on minimally invasive implantation techniques

· Focus on durable biventricular support

· Focus on fully implantable systems