SCCM Resource Library-The Really Injured Lungs: Management of Acute Respiratory Failure in the Injured Patient

Video Transcription

Video Summary

Good afternoon, today we'll be talking about the management of acute respiratory failure in injured patients. The lecture covers the history of prone ventilation, absolute and relative contraindications to pronation, the effects of prone ventilation on functional residual capacity, perfusion, and ventilation, and the PROSIVA trial. The speaker discusses the importance of treating the underlying disease causing the acute respiratory distress syndrome (ARDS) and providing lung protective ventilation with low tidal volume and adequate PEEP, as well as avoiding positive fluid balance. However, in severe cases that don't respond to standard therapy, rescue therapies like ECMO and pronation may be necessary. The history of prone ventilation dates back to the 1970s, and it has been found to improve perfusion and lung recruitment in moderate to severe ARDS cases. Prone ventilation should be initiated within 48 hours and maintained for 12 to 16 hours. However, there are relative contraindications that need to be considered, such as multiple trauma, severe facial fractures, head injuries with increased ICP, and cardiovascular instability. The effect of prone ventilation on functional residual capacity is that it increases it due to the caudal movement of the diaphragm. The effect on perfusion is that it improves regional ventilation by eliminating compression of the lungs by the heart. The effect on ventilation has been shown to improve gas exchange and decrease CO2 levels. The speaker also discusses the PROSERVA trial, which showed improved mortality with early and long-prone sessions in severe ARDS patients. The mechanics of pronation are also explained, and the importance of a team approach and proper patient positioning are emphasized. The use of neuromuscular blocking agents is not recommended in most cases, and the speaker emphasizes the importance of engaging both the brain and the skeletal muscles for successful mobilization. Finally, the speaker recommends starting with easier cases and gradually progressing to more complex situations. In conclusion, pronation and patient mobilization can improve outcomes in acute respiratory failure, and a team approach and careful patient selection are key to success.

Asset Subtitle

Pulmonary, Patient and Family Support, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Apply advanced ventilatory modes to the trauma and burn injury patient with severe respiratory failure
Determine when to use prone positioning and/or extracorporeal membrane oxygenation (ECMO) in the patient with severe lung injury
Discover optimal techniques and challenges of placing patients in the prone position, including those on continuous renal replacement therapy and ECMO
Recognize which patients with severe lung injury may participate in physical therapy and discuss the benefits of physical therapy

Turn Them Upside Down: Not Always Easy Peasy
Samantha Gambles Farr

Can They Move if They Can't Breathe?
Heidi J. Engel

Current Treatment of Inhalational Injury
Laura S. Johnson

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Knowledge Area Patient and Family Support

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Respiratory Failure

Tag Rehabilitation Medicine

Year 2021

Keywords

acute respiratory failure

prone ventilation

ARDS

lung protective ventilation

ECMO

pronation

functional residual capacity

perfusion

ventilation

patient mobilization

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