Mechanical ventilation strategies in infective airway diseases

Introduction: Mechanical ventilation (MV) strategies in Infective Airway Diseases (IAD) are an important area of concern for an intensivist or clinician. Objective: To evaluate MV strategies in IAD based on literature survey. Method: Literature survey on ‘Mechanical Ventilation’ and ‘Infective Airway Disease’ was undertaken using PubMed & MEDLINE search. Methodological filters were applied to limit retrieval to evidence based clinical data. Incomplete methodology, results in abstract form, duplicate publications were excluded. Data extraction forms were piloted and used to obtain uniform quality of data. Data presented as recommendations (Grade A & B) using a narrative approach. Results and Conclusion: Bibliographic ‘human’ databases accessed in full-text revealed 36 citations; of which 27 full-text articles with clinical data were included and summarized: A minimum amount of positive end-expiratory pressure (PEEP); guided by guided by FiO2 requirement should be set to prevent lung collapse at end-expiration. Role of noninvasive positive-pressure ventilation (NIPPV) in sepsis related acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) is still undefined. Small tidal volume ventilation, limitation of end-inspiratory plateau pressure is beneficial and may be facilitated by permissive hypercapnia. Prone positioning should be considered in the severest of ARDS patients. The ideal fluid management strategy in ARDS is unknown. Daily spontaneous breathing trials may reduce the duration of MV. The role of High-Frequency Oscillatory Ventilation (HFOV) and Airway Pressure Release Ventilation (APRV) in infective ARDS is uncertain.