« La ventilation mécanique : de la physiologie à la pratique » : quelle sonde, quel circuit, quel ventilateur ?

The use of cylindrical endotracheal tube cuff made of polyvinyl chloride should be combined with cuff pressure monitoring and adjustment between 20 and 30 cmH2O every 4-6 hours, which can be continuously achieved by using automated device. Aspirating subglottic secretions above the cuff also needs to be implemented routinely, although optimal modalities remain to be defined. Bedside implementation of bundles combining these endotracheal tube-related elements should lead to significant reduction in healthcare-acquired pneumonia. Double strands breathing circuits incorporating a heat-moisture exchanger filtre combined with an annulated tubing fit the vast majority of the patients. Heating humidifiers should be used for those situations at high risk for endotracheal tube obstruction. The significant heterogeneity of the performance of the commercialised filtres renders crucial to verify whether the characteristics meet the targeted criteria. Choosing an ICU ventilator essentially relies on the targeted respiratory conditions, the types of patients, the ventilatory modes, and the monitoring modalities that are commonly used by the practitioners in charge of the patients. While ICU ventilators demonstrate versatile features, they poorly perform regarding asynchrony management. However, they remain the most indicated device to respond to the technical needs that ICU patients require under invasive mechanical ventilation. The high heterogeneity of their technical performance implies that careful examination of their capacity to deliver the expected ventilatory parameters and the optimal pressurisation, has to be verified. This will warrant the best standard of care of ICU-mechanically ventilated patients.