Journal of Neurocritical Care (대한신경집중치료학회지)

The Korean Neurocritical Care Society (대한신경집중치료학회)
권호 표지
DOI QR코드

DOI QR Code

Monitoring and Interpretation of Mechanical Ventilator Waveform in the Neuro-Intensive Care Unit

신경계 중환자실에서 기계호흡 그래프 파형 감시와 분석

  • Park, Jin (Department of Critical Care Medicine, Ewha Womans University Mokdong Hospital)
  • 박진 (이대목동병원 응급중환자진료과)
  • Received : 2018.11.16
  • Accepted : 2018.12.06
  • Published : 2018.12.30
⟨ Previous Next ⟩

Abstract

Management of mechanical ventilation is essential for patients with neuro-critical illnesses who may also have impairment of airways, lungs, respiratory muscles, and respiratory drive. However, balancing the approach to mechanical ventilation in the intensive care unit (ICU) with the need to prevent additional lung and brain injury, is challenging to intensivists. Lung protective ventilation strategies should be modified and applied to neuro-critically ill patients to maintain normocapnia and proper positive end expiratory pressure in the setting of neurological closed monitoring. Understanding the various parameters and graphic waveforms of the mechanical ventilator can provide information about the respiratory target, including appropriate tidal volume, airway pressure, and synchrony between patient and ventilator, especially in patients with neurological dysfunction due to irregularity of spontaneous respiration. Several types of asynchrony occur during mechanical ventilation, including trigger, flow, and termination asynchrony. This review aims to present the basic interpretation of mechanical ventilator waveforms and utilization of waveforms in various clinical situations in the neuro-ICU.

Keywords

References

  1. Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, et al. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma 2003;55:106-11. https://doi.org/10.1097/01.TA.0000071620.27375.BE
  2. Bratton SL, Davis RL. Acute lung injury in isolated traumatic brain injury. Neurosurgery 1997;40:707-12. https://doi.org/10.1097/00006123-199704000-00009
  3. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Loraenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54. https://doi.org/10.1056/NEJM199802053380602
  4. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8. https://doi.org/10.1056/NEJM200005043421801
  5. Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010;14:R1. https://doi.org/10.1186/cc8230
  6. Wolthuis EK, Choi G, Dessing MC, Bresser P, Lutter R, Dzoljic M, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology 2008;108:46-54. https://doi.org/10.1097/01.anes.0000296068.80921.10
  7. Pinheiro de Oliveira R, Hetzel MP, dos Anjos Silva M, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care 2010;14:R39. https://doi.org/10.1186/cc8919
  8. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive endexpiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36. https://doi.org/10.1056/NEJMoa032193
  9. Frost EA. Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients. J Neurosurg 1977;47:195-200. https://doi.org/10.3171/jns.1977.47.2.0195
  10. McGuire G, Crossley D, Richards J, Wong D. Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Crit Care Med 1997;25:1059-62. https://doi.org/10.1097/00003246-199706000-00025
  11. Caricato A, Conti G, Della Corte F, Mancino A, Santilli F, Sandroni C, et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma 2005;58:571-6. https://doi.org/10.1097/01.TA.0000152806.19198.DB
  12. The Korean Academy of Tuberculosis and Respiratory Diseases, Korean Society of Critical Care Medicine. Clinical practice guideline of acute respiratory distress syndrome. Seoul: MEDrang 2016.
  13. Jung JH. Brain and lung: lung injury in patients with brain injury. J Neurocrit Care 2017;10:1-6. https://doi.org/10.18700/jnc.170009
  14. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372:747-55. https://doi.org/10.1056/NEJMsa1410639
  15. Mascia L, Grasso S, Fiore T, Bruno F, Berardino M, Ducati A. Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure. Intensive Care Med 2005;31:373-9. https://doi.org/10.1007/s00134-004-2491-2
  16. Branson RD, Blakeman TC, Robinson BR. Asynchrony and dyspnea. Respir Care 2013;58:973-89. https://doi.org/10.4187/respcare.02507
  17. Nguyen TN, Badjatia N, Malhotra A, Gibbons FK, Qureshi MM, Greenberg SA. Factors predicting extubation success in patients with Guillain-Barre syndrome. Neurocrit Care 2006;5:230-4. https://doi.org/10.1385/NCC:5:3:230
  18. Wu JY, Kuo PH, Fan PC, Wu HD, Shih FY, Yang PC. The role of non-invasive ventilation and factors predicting extubation outcome in myasthenic crisis. Neurocrit Care 2009;10:35-42. https://doi.org/10.1007/s12028-008-9139-y
  19. Williamson CA, Sheehan KM, Tipirneni R, Roark CD, Pandey AS, Thompson BG, et al. The association between spontaneous hyperventilation, delayed cerebral ischemia, and poor neurological outcome in patients with subarachnoid hemorrhage. Neurocrit Care 2015;23:330-8. https://doi.org/10.1007/s12028-015-0138-5
  20. Carrera E, Schmidt JM, Fernandez L, Kurtz P, Merkow M, Stuart M, et al. Spontaneous hyperventilation and brain tissue hypoxia in patients with severe brain injury. J Neurol Neurosurg Psychiatry 2010;81:793-7. https://doi.org/10.1136/jnnp.2009.174425