1
|
Rubulotta F, Blanch Torra L, Naidoo KD, Aboumarie HS, Mathivha LR, Asiri AY, Sarlabous Uranga L, Soussi S. Mechanical Ventilation, Past, Present, and Future. Anesth Analg 2024; 138:308-325. [PMID: 38215710 DOI: 10.1213/ane.0000000000006701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Mechanical ventilation (MV) has played a crucial role in the medical field, particularly in anesthesia and in critical care medicine (CCM) settings. MV has evolved significantly since its inception over 70 years ago and the future promises even more advanced technology. In the past, ventilation was provided manually, intermittently, and it was primarily used for resuscitation or as a last resort for patients with severe respiratory or cardiovascular failure. The earliest MV machines for prolonged ventilatory support and oxygenation were large and cumbersome. They required a significant amount of skills and expertise to operate. These early devices had limited capabilities, battery, power, safety features, alarms, and therefore these often caused harm to patients. Moreover, the physiology of MV was modified when mechanical ventilators moved from negative pressure to positive pressure mechanisms. Monitoring systems were also very limited and therefore the risks related to MV support were difficult to quantify, predict and timely detect for individual patients who were necessarily young with few comorbidities. Technology and devices designed to use tracheostomies versus endotracheal intubation evolved in the last century too and these are currently much more reliable. In the present, positive pressure MV is more sophisticated and widely used for extensive period of time. Modern ventilators use mostly positive pressure systems and are much smaller, more portable than their predecessors, and they are much easier to operate. They can also be programmed to provide different levels of support based on evolving physiological concepts allowing lung-protective ventilation. Monitoring systems are more sophisticated and knowledge related to the physiology of MV is improved. Patients are also more complex and elderly compared to the past. MV experts are informed about risks related to prolonged or aggressive ventilation modalities and settings. One of the most significant advances in MV has been protective lung ventilation, diaphragm protective ventilation including noninvasive ventilation (NIV). Health care professionals are familiar with the use of MV and in many countries, respiratory therapists have been trained for the exclusive purpose of providing safe and professional respiratory support to critically ill patients. Analgo-sedation drugs and techniques are improved, and more sedative drugs are available and this has an impact on recovery, weaning, and overall patients' outcome. Looking toward the future, MV is likely to continue to evolve and improve alongside monitoring techniques and sedatives. There is increasing precision in monitoring global "patient-ventilator" interactions: structure and analysis (asynchrony, desynchrony, etc). One area of development is the use of artificial intelligence (AI) in ventilator technology. AI can be used to monitor patients in real-time, and it can predict when a patient is likely to experience respiratory distress. This allows medical professionals to intervene before a crisis occurs, improving patient outcomes and reducing the need for emergency intervention. This specific area of development is intended as "personalized ventilation." It involves tailoring the ventilator settings to the individual patient, based on their physiology and the specific condition they are being treated for. This approach has the potential to improve patient outcomes by optimizing ventilation and reducing the risk of harm. In conclusion, MV has come a long way since its inception, and it continues to play a critical role in anesthesia and in CCM settings. Advances in technology have made MV safer, more effective, affordable, and more widely available. As technology continues to improve, more advanced and personalized MV will become available, leading to better patients' outcomes and quality of life for those in need.
Collapse
Affiliation(s)
- Francesca Rubulotta
- From the Department of Critical Care Medicine, McGill University, Montreal, Quebec, Canada
| | - Lluis Blanch Torra
- Department of Critical Care, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Kuban D Naidoo
- Division of Critical Care, University of Witwatersrand, Johannesburg, South Africa
| | - Hatem Soliman Aboumarie
- Department of Anaesthetics, Critical Care and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield Hospitals, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, United Kingdom
| | - Lufuno R Mathivha
- Department of Anaesthetics, Critical Care and Mechanical Circulatory Support, The Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand
| | - Abdulrahman Y Asiri
- Department of Internal Medicine and Critical Care, King Khalid University Medical City, Abha, Saudi Arabia
- Department of Critical Care Medicine, McGill University
| | - Leonardo Sarlabous Uranga
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Sabri Soussi
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto
- UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Institut national de la santé et de la recherche médicale (INSERM), Université de Paris Cité, France
| |
Collapse
|
2
|
Wisse J, Jonkman AH. Body position to optimize mechanics in ARDS: to which degree does the angle matter? Intensive Care Med Exp 2023; 11:79. [PMID: 37966548 PMCID: PMC10651604 DOI: 10.1186/s40635-023-00560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Jantine Wisse
- Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annemijn H Jonkman
- Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
3
|
Barbour RL, Graber HL. Hemoglobin signal network mapping reveals novel indicators for precision medicine. Sci Rep 2023; 13:18257. [PMID: 37880310 PMCID: PMC10600136 DOI: 10.1038/s41598-023-43694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
Precision medicine currently relies on a mix of deep phenotyping strategies to guide more individualized healthcare. Despite being widely available and information-rich, physiological time-series measures are often overlooked as a resource to extend insights gained from such measures. Here we have explored resting-state hemoglobin measures applied to intact whole breasts for two subject groups - women with confirmed breast cancer and control subjects - with the goal of achieving a more detailed assessment of the cancer phenotype from a non-invasive measure. Invoked is a novel ordinal partition network method applied to multivariate measures that generates a Markov chain, thereby providing access to quantitative descriptions of short-term dynamics in the form of several classes of adjacency matrices. Exploration of these and their associated co-dependent behaviors unexpectedly reveals features of structured dynamics, some of which are shown to exhibit enzyme-like behaviors and sensitivity to recognized molecular markers of disease. Thus, findings obtained strongly indicate that despite the use of a macroscale sensing method, features more typical of molecular-cellular processes can be identified. Discussed are factors unique to our approach that favor a deeper depiction of tissue phenotypes, its extension to other forms of physiological time-series measures, and its expected utility to advance goals of precision medicine.
Collapse
Affiliation(s)
- Randall L Barbour
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Harry L Graber
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
- Photon Migration Technologies Corp, 15 Cherry Lane, Glen Head, NY, 11545, USA
| |
Collapse
|
4
|
Sanchez-Pinto LN, Bhavani SV, Atreya MR, Sinha P. Leveraging Data Science and Novel Technologies to Develop and Implement Precision Medicine Strategies in Critical Care. Crit Care Clin 2023; 39:627-646. [PMID: 37704331 DOI: 10.1016/j.ccc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Precision medicine aims to identify treatments that are most likely to result in favorable outcomes for subgroups of patients with similar clinical and biological characteristics. The gaps for the development and implementation of precision medicine strategies in the critical care setting are many, but the advent of data science and multi-omics approaches, combined with the rich data ecosystem in the intensive care unit, offer unprecedented opportunities to realize the promise of precision critical care. In this article, the authors review the data-driven and technology-based approaches being leveraged to discover and implement precision medicine strategies in the critical care setting.
Collapse
Affiliation(s)
- Lazaro N Sanchez-Pinto
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | | | - Mihir R Atreya
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Pratik Sinha
- Division of Clinical and Translational Research, Department of Anesthesia, Washington University School of Medicine, 1 Barnes Jewish Hospital Plaza, St. Louis, MO 63110, USA; Division of Critical Care, Department of Anesthesia, Washington University School of Medicine, 1 Barnes Jewish Hospital Plaza, St. Louis, MO 63110, USA
| |
Collapse
|
5
|
Hochberg CH, Sahetya SK. Laying the Groundwork for Physiology-Guided Precision Medicine in the Critically Ill. NEJM Evid 2023; 2:EVIDe2300051. [PMID: 38320026 DOI: 10.1056/evide2300051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Canonical critical care syndromes such as sepsis and acute respiratory distress syndrome (ARDS) include patients with markedly heterogeneous biology.1 This, paired with decades of randomized controlled trials (RCTs) that were traditionally viewed as "negative," has stalled progress in improving patient outcomes.2 However, emerging awareness of sub-phenotypes based on differences in biomarker profiles and resulting heterogeneous treatment effects have led to calls for precision medicine in which therapies are targeted to those most likely to benefit.3.
Collapse
Affiliation(s)
- Chad H Hochberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore
| | - Sarina K Sahetya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore
| |
Collapse
|
6
|
Merdji H, Curtiaud A, Aheto A, Studer A, Harjola VP, Monnier A, Duarte K, Girerd N, Kibler M, Ait-Oufella H, Helms J, Mebazaa A, Levy B, Kimmoun A, Meziani F. Performance of Early Capillary Refill Time Measurement on Outcomes in Cardiogenic Shock: An Observational, Prospective Multicentric Study. Am J Respir Crit Care Med 2022. [DOI: 10.1164/rccm.202204-0687oc 10.1164/rccm.202204-0687oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Hamid Merdji
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Strasbourg, France
| | - Anais Curtiaud
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Antoine Aheto
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Antoine Studer
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Alexandra Monnier
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Kevin Duarte
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433; Medical Intensive Care Unit Brabois, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433; Medical Intensive Care Unit Brabois, France
| | - Marion Kibler
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Julie Helms
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Strasbourg, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology, Burn and Critical Care, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Conditions, Fédération Hospitalo-Universitaire Promice, University of Paris, Paris, France
| | - Bruno Levy
- INSERM U1116, Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux, Centre Hospitalier Régional Universitaire de Nancy, France; and
| | - Antoine Kimmoun
- INSERM U1116, Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux, Centre Hospitalier Régional Universitaire de Nancy, France; and
| | - Ferhat Meziani
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Strasbourg, France
- Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis French Clinical Research Infrastructure Network, France
| |
Collapse
|
7
|
Ruscic K, Hanidziar D, Shaw K, Wiener-Kronish J, Shelton KT. Systems Anesthesiology: Integrating Insights From Diverse Disciplines to Improve Perioperative Care. Anesth Analg 2022; 135:673-677. [PMID: 36108178 PMCID: PMC9494922 DOI: 10.1213/ane.0000000000006166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Katarina Ruscic
- Division of Critical Care, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dusan Hanidziar
- Division of Critical Care, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kendrick Shaw
- Division of Critical Care, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jeanine Wiener-Kronish
- Division of Critical Care, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kenneth T Shelton
- Division of Critical Care, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|