Individualized or precision medicine uses individual patient characteristics to guide and tailor medical treatment. Applying a lung-protective ventilation strategy, which is adjusted to the individual physiology and based on constant adjustment of ventilator settings to meet changing patient needs, may reduce the potential risks of VILI better than conventional therapy.
- An evaluation of respiratory mechanics at the bedside allows clinicians to individualize the best available evidence to the patient’s unique lung mechanics.
- An individualized approach that includes scaling VT according to the size of the aerated portion of the lung (the “baby” lung) rather than predicted “healthy” lung size, may promote lung protection. A possible way to tailor tidal volume is to use the compliance of the respiratory system (CRS). Lung compliance, as a good index of normally aerated lung tissue, can give an estimation of the size of the “baby” lung. Driving pressure (ΔP), as the ratio between tidal volume and static compliance, essentially estimates the mechanical distortion provided to the baby lung.
- ASV and INTELLiVENT-ASV adjust tidal volume and driving pressure according to static compliance. When static compliance decreases, tidal volume decreases accordingly and driving pressure is maintained within safe limits.
- A recruitment strategy (recruitment manoeuvre and high level of PEEP) may improve outcomes only when applied in patients with good potential for recruitment. An assessment of the patient’s individual therapeutic response helps to identify patients who are likely to benefit from the recruitment manoeuvre and higher PEEP. The P/V Tool Pro represents a simple bedside tool for assessing lung recruitability and carrying out recruitment manoeuvres.
- Transpulmonary pressure (PL), calculated as the difference between the airway pressure (Paw) and the oesophageal pressure (Peso), separates the pressure delivered to the lung from the one acting on chest wall and abdomen. As PL better indicates the risk of stress applied to the lung, it can represent the safest way to titrate mechanical ventilation and recruitment manoeuvre applied.
|09:30 - 10:15||Lung mechanics at the bedside||09:30 - 10:15||Lung mechanics at the bedside|
|10:30 - 11:15||Tidal volume and driving pressure adaptation breath-by-breath||10:30 - 11:15||Tidal volume and driving pressure adaptation breath-by-breath|
|11:30 - 12:15||Open lung strategy 2.0||11:30 - 12:15||Open lung strategy 2.0|
|13:15 - 14:00||Lung mechanics at the bedside||13:15 - 14:00||Lung mechanics at the bedside|
|14:30 - 15:15||Tidal volume and driving pressure adaptation breath-by-breath||14:30 - 15:15||Tidal volume and driving pressure adaptation breath-by-breath|
|15:30 - 16:15||Open lung strategy 2.0||15:30 - 16:15||Open lung strategy 2.0|