Anest. intenziv. Med. 2023;34(5):253-259 | DOI: 10.36290/aim.2023.061

Year 2023 in review - Respiratory failure and lung function replacementReview Article

Máca J., Sklienka P.

Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Ostrava a Lékařská fakulta, Ostravská univerzita, Ostrava

Ústav fyziologie a patofyziologie, Lékařská fakulta, Ostravská univerzita, Ostrava

Only a few original papers on respiratory issues have been published so far in 2023. The vast majority are systematic reviews and meta-analyses of already published studies. In March 2023, the European Society for Intensive Care Medicine (ESICM) issued recommendations for the management of acute respiratory distress syndrome (ARDS). In the first part of this text, a very basic summary of recommendations according to individual domains is described. Extracorporeal membrane oxygenation (ECMO) is an intervention that has received much attention in recent years, mainly due to the COVID-19 pandemic. The last randomized trial (EOLIA trial) did not confirm a mortality benefit [1]. However, the subsequent Bayesian analysis of the data of this study brought a posterior probability of a mortality benefit of ECMO support compared to conventional therapy in a selected subgroup of patients with early use of ECMO in patients with severe ARDS [2]. In the second part of the article, we summarize publications related to the effect of ECMO support on several specific groups of diseases. These are patients with polytrauma, life-threatening bronchial asthma, burn trauma, and kidney transplant patients. The third part of the article deals with various aspects of anticoagulant therapy used in ECMO support, including its monitoring and comparison of the effect of heparin and bivalirudin. The fourth part describes a publication evaluating the effectiveness of extracorporeal CO2 removal (ECCO2R) from the point of view of enabling ultraprotective mechanical ventilation in patients with moderate to severe ARDS. The fifth part deals with the relationship of selected pathophysiological aspects to clinical practice and results. It is an investigation of exhaled air analysis for determining the clinical outcome of patients with ventilator-associated pneumonia (VAP). Furthermore, there is also a description of the relationship between dead space ventilation and the prognosis of patients with ARDS. The sixth part deals with the optimization of artificial lung ventilation settings based on the use of transpulmonary pressure measurement. The next part of the article, the seventh, deals with a meta-analysis of the comparison of the effectiveness of non-invasive forms of mechanical ventilation and other methods, such as high-flow oxygen therapy and conventional oxygen therapy. The penultimate section relates to the effect of various forms of nebulization therapy, such as the use of heparin in patients with COVID-19 pneumonia, and in the general population of patients on mechanical ventilation, and the use of volatile anesthetics in patients with refractory bronchospasm. In the last section, the text deals with various aspects of interventions in patients with severe respiratory failure who remain conscious. This invloves the effect of the so-called awake prone position and awake extracorporeal oxygenation support.

Keywords: respiratory medicine, intensive care medicine, guidelines, mechanical ventilation, extracorporeal membrane oxygenation, high-flow oxygen therapy, prone position.

Received: November 18, 2023; Revised: November 18, 2023; Accepted: November 23, 2023; Published: December 20, 2023  Show citation