The last decade has generated a growing fund of knowledge on how
ventilator management can greatly impact patient outcome. The concepts
developed by ARDS Network have been broadly accepted and placed into
clinical practice, not only at university centers, but has filtered down to community
hospitals. We are educating our students, residents, and fellows not
only on the clinical aspects of ventilation but also in the growing fund of knowledge of the basic science of mechanical ventilation and how it may
generate not only physiologic responses in the lung but may also be part
of a greater systemic inflammatory response.
It is not only our goal in the issue to review the basic aspects of mechanical
ventilation, such as modes of mechanical ventilation, ventilatory monitoring,
and weaning from ventilation, but we wish to also develop discussion
on some of the common controversies such as alveolar recruitment and
stabilization. This issue also addresses some of the cutting edge concepts
of mechanical ventilation such as therapist-driven protocols to standardize
our care within specific disease groups. More and more, we use the education
and expertise of respiratory therapists to provide a comprehensive team
approach in patient management. Introduction of computer-based closed
loop ventilation will also surely change the face of critical care practice as
we allow technology to aid us in the 24/7 environment of the modern ICU.
We have also started to address three major complex patient disease
groups in this issue: massive chest trauma, the complex environment of
the neurologic ICU, and the fast-track world of the cardiovascular patient.
Aspects of each of these may have implications in the care of other less specialty-
based patients. No issue of a monograph on mechanical ventilation
can be complete without focusing on a major question in our society, that
of end of life. We are hopeful that this issue will be useful and spur
broad-based discussion on how to wean mechanical life support during that
highly emotionally charged period.
The full scope of the science and technology of mechanical ventilation
has grown to such an extent that no single issue of the Clinics can fully address
the topic, but we are hopeful that this issue acts as a base for further
reading and research.