The Science Journal of the American Association for Respiratory Care

Conference Proceedings

March 2002 / Volume 47 / Number 3 / Page 319

Ventilatory Adjuncts

Robert M Kacmarek PhD RRT FAARC

Introduction
Tracheal Pressure Triggering
Automatic Tube Compensation
High Frequency Oscillation
Tracheal Gas Insufflation
Partial Liquid Ventilation
Prone Positioning
Summary
A number of adjuncts to mechanical ventilation have been the focus of recent research. Automatic tube compensation (the regulation of airway pressure by estimation of tracheal pressure) appears to be an ideal approach to unloading the resistive effort imposed by the endotracheal tube. Randomized controlled trials have recently been performed with high frequency oscillation (HFO), partial liquid ventilation (PLV), and prone positioning. Unfortunately, all of those trials were negative; however, it appears the only technique that will be abandoned for the near future is PLV. The HFO trial trended toward benefit with HFO, and one must question the protocol used in the prone positioning trial. With both HFO and prone positioning we will have to wait for additional randomized clinical trials before the status of those techniques can be determined. No randomized trials of tracheal gas insufflation have been performed. Of major concern with tracheal gas insufflation is the lack of a commercial product.
Key mechanical ventilation, tracheal pressure triggering, automatic tube compensation, high frequency oscillatory ventilation, tracheal gas insufflation, partial liquid ventilation, prone positioning.
[Respir Care 2002;47(2):319–330]

Introduction

Over the last 10 to 15 years a great deal of research interest has focused on alternative approaches to establishing adequate gas exchange or the use of adjuncts to mechanical ventilation. The list of potential topics under this heading is large and includes tracheal pressure-triggering, automatic tube compensation (ATC), high-frequency oscillation (HFO), partial liquid ventilation (PLV), tracheal gas insufflation (TGI), and prone positioning. This review focuses on the current status of each of those adjuncts and comments on the current clinical usefulness of each.

The entire text of this article is available in the printed version of the March 2002 RESPIRATORY CARE.

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