Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation
Abstract Background Mechanical ventilation is an essential therapy to support critically ill respiratory failure patients. Current standards of care consist of generalised approaches, such as the use of positive end expiratory pressure to inspired oxygen fraction (PEEP–FiO2) tables, which fail to ac...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | BioMedical Engineering OnLine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12938-018-0599-9 |
| _version_ | 1818321327336980480 |
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| author | Vincent J. Major Yeong Shiong Chiew Geoffrey M. Shaw J. Geoffrey Chase |
| author_facet | Vincent J. Major Yeong Shiong Chiew Geoffrey M. Shaw J. Geoffrey Chase |
| author_sort | Vincent J. Major |
| collection | DOAJ |
| description | Abstract Background Mechanical ventilation is an essential therapy to support critically ill respiratory failure patients. Current standards of care consist of generalised approaches, such as the use of positive end expiratory pressure to inspired oxygen fraction (PEEP–FiO2) tables, which fail to account for the inter- and intra-patient variability between and within patients. The benefits of higher or lower tidal volume, PEEP, and other settings are highly debated and no consensus has been reached. Moreover, clinicians implicitly account for patient-specific factors such as disease condition and progression as they manually titrate ventilator settings. Hence, care is highly variable and potentially often non-optimal. These conditions create a situation that could benefit greatly from an engineered approach. The overall goal is a review of ventilation that is accessible to both clinicians and engineers, to bridge the divide between the two fields and enable collaboration to improve patient care and outcomes. This review does not take the form of a typical systematic review. Instead, it defines the standard terminology and introduces key clinical and biomedical measurements before introducing the key clinical studies and their influence in clinical practice which in turn flows into the needs and requirements around how biomedical engineering research can play a role in improving care. Given the significant clinical research to date and its impact on this complex area of care, this review thus provides a tutorial introduction around the review of the state of the art relevant to a biomedical engineering perspective. Discussion This review presents the significant clinical aspects and variables of ventilation management, the potential risks associated with suboptimal ventilation management, and a review of the major recent attempts to improve ventilation in the context of these variables. The unique aspect of this review is a focus on these key elements relevant to engineering new approaches. In particular, the need for ventilation strategies which consider, and directly account for, the significant differences in patient condition, disease etiology, and progression within patients is demonstrated with the subsequent requirement for optimal ventilation strategies to titrate for patient- and time-specific conditions. Conclusion Engineered, protective lung strategies that can directly account for and manage inter- and intra-patient variability thus offer great potential to improve both individual care, as well as cohort clinical outcomes. |
| first_indexed | 2024-12-13T10:39:08Z |
| format | Article |
| id | doaj.art-931ee4b756804f28b1ec6af3269a5d86 |
| institution | Directory Open Access Journal |
| issn | 1475-925X |
| language | English |
| last_indexed | 2024-12-13T10:39:08Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BioMedical Engineering OnLine |
| spelling | doaj.art-931ee4b756804f28b1ec6af3269a5d862022-12-21T23:50:36ZengBMCBioMedical Engineering OnLine1475-925X2018-11-0117113110.1186/s12938-018-0599-9Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilationVincent J. Major0Yeong Shiong Chiew1Geoffrey M. Shaw2J. Geoffrey Chase3Department of Population Health, NYU Langone HealthSchool of Engineering, Monash University MalaysiaDepartment of Intensive Care, Christchurch HospitalCentre for Bioengineering, University of CanterburyAbstract Background Mechanical ventilation is an essential therapy to support critically ill respiratory failure patients. Current standards of care consist of generalised approaches, such as the use of positive end expiratory pressure to inspired oxygen fraction (PEEP–FiO2) tables, which fail to account for the inter- and intra-patient variability between and within patients. The benefits of higher or lower tidal volume, PEEP, and other settings are highly debated and no consensus has been reached. Moreover, clinicians implicitly account for patient-specific factors such as disease condition and progression as they manually titrate ventilator settings. Hence, care is highly variable and potentially often non-optimal. These conditions create a situation that could benefit greatly from an engineered approach. The overall goal is a review of ventilation that is accessible to both clinicians and engineers, to bridge the divide between the two fields and enable collaboration to improve patient care and outcomes. This review does not take the form of a typical systematic review. Instead, it defines the standard terminology and introduces key clinical and biomedical measurements before introducing the key clinical studies and their influence in clinical practice which in turn flows into the needs and requirements around how biomedical engineering research can play a role in improving care. Given the significant clinical research to date and its impact on this complex area of care, this review thus provides a tutorial introduction around the review of the state of the art relevant to a biomedical engineering perspective. Discussion This review presents the significant clinical aspects and variables of ventilation management, the potential risks associated with suboptimal ventilation management, and a review of the major recent attempts to improve ventilation in the context of these variables. The unique aspect of this review is a focus on these key elements relevant to engineering new approaches. In particular, the need for ventilation strategies which consider, and directly account for, the significant differences in patient condition, disease etiology, and progression within patients is demonstrated with the subsequent requirement for optimal ventilation strategies to titrate for patient- and time-specific conditions. Conclusion Engineered, protective lung strategies that can directly account for and manage inter- and intra-patient variability thus offer great potential to improve both individual care, as well as cohort clinical outcomes.http://link.springer.com/article/10.1186/s12938-018-0599-9Mechanical ventilationIntensive careRespiratory failureModel-based treatmentPatient-specific ventilationProtective lung strategies |
| spellingShingle | Vincent J. Major Yeong Shiong Chiew Geoffrey M. Shaw J. Geoffrey Chase Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation BioMedical Engineering OnLine Mechanical ventilation Intensive care Respiratory failure Model-based treatment Patient-specific ventilation Protective lung strategies |
| title | Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation |
| title_full | Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation |
| title_fullStr | Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation |
| title_full_unstemmed | Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation |
| title_short | Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation |
| title_sort | biomedical engineer s guide to the clinical aspects of intensive care mechanical ventilation |
| topic | Mechanical ventilation Intensive care Respiratory failure Model-based treatment Patient-specific ventilation Protective lung strategies |
| url | http://link.springer.com/article/10.1186/s12938-018-0599-9 |
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