Advanced Respiratory Therapies: Inhaled Therapies, Heliox, ECMO and ECCO2-R, and Non-conventional Ventilatory Modes

Abstract Summary This chapter discusses diverse and some esoteric aspects of respiratory critical care support, yet important to certain patient groups. Section 22.1 covers the indications, delivery, and practical aspects of inhaled therapies used for therapeutics such as bronchodilators, mucolytics, and antibiotics. The differences between circuits, non-invasive versus invasive mechanical ventilation, and particle delivery technologies are addressed. In Section 22.2, heliox, a gaseous mixture of helium and oxygen, is evaluated from a theoretical basis and in its implementation as a therapy for acute respiratory failure. It can reduce airway resistance and work of breathing. Heliox may be suitable for certain situations where upper airway flow is compromised despite conventional therapies. Clinical outcome studies in asthma, chronic obstructive pulmonary disease (COPD), and airways stenoses are described. Section 22.3 covers extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal for respiratory failure. From their history, through technical and practical aspects of set-up, clinical indications, evidence, and future developments, this provides a comprehensive succinct understanding of its role in contemporary respiratory critical care. Finally, Section 22.4 describes non-conventional modes of ventilation, which aim to address the limitations of conventional modes, specifically monotonous respiratory patterns or non-ideal triggering. Airway pressure release ventilation, variable ventilation, high-frequency oscillatory ventilation, proportional assist ventilation, neurally adjusted ventilatory assist, and flow-controlled ventilation are discussed. The theoretical benefits of these types of ventilation, and patient cohorts to select for further clinical studies, allow a glimpse into further advances likely to emerge.