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New Trends in Mechanical Ventilation
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New Trends in Mechanical Ventilation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (28 November 2025) | Viewed by 11392

Special Issue Editor

Prof. Dr. Jan P. Mulier

E-Mail Website
Guest Editor
Department of Anaesthesiology, Intensive Care and Reanimation, AZ Sint Jan Brugge, 8000 Bruges, Belgium
Interests: ventilation during laparoscopy and obesity; opioid-free anesthesia; personalized anesthesia to prevent sympathetic and inflammatory reactions

Special Issue Information

Dear Colleagues,

Mechanical ventilation has undergone significant advancements in both anesthesia and intensive care, evolving towards less invasive techniques such as pressure support ventilation, CPAP, and the use of less aggressive artificial airways like laryngeal masks and helmets. However, challenges remain, particularly in patients who are difficult to ventilate, such as those with morbid obesity undergoing prolonged laparoscopic procedures in the Trendelenburg position, or ARDS patients in the ICU. These situations often result in low total lung compliance, complicating intraoperative oxygenation even with high airway pressures and 100% inspiratory oxygen. Despite efforts to mitigate these challenges with strategies like high PEEP and lung recruitment, postoperative complications such as atelectasis remain prevalent, often requiring extended oxygen therapy, CPAP, and physiotherapy for recovery.

New ventilation modes like variable ventilation and constant flow ventilation appear to offer some benefit in reducing atelectasis.

Another ongoing concern is the need for endotracheal tubes (ETTs) in patients who are difficult to ventilate and the prevention of aspiration in those at higher risk. The shift towards less invasive artificial airways was driven by the reduction in minor complications like hoarseness. However, research into developing better-sealing ETTs with lower cuff pressures for difficult-to-ventilate patients may promote their resurgence as a safer option for all patients requiring mechanical ventilation. Additionally, eliminating air leaks may reduce environmental concerns when using inhalation anesthesia.

These issues, alongside the physiological effects of mechanical ventilation on pleural pressure, highlight the complexity of positive pressure ventilation and the need to re-explore negative pressure ventilation (NPV). NPV mimics spontaneous breathing without increasing pleural pressure and avoids atelectasis more effectively. While its current ideal use is in supporting non-intubated patients at home, with adapted technology, it could be reintroduced for more severe cases in the ICU and possibly in the OR.

Given these emerging challenges and the need for improved approaches, we invite contributions to our Special Issue focused on "New Trends in Mechanical Ventilation" to explore and address these critical topics.

Prof. Dr. Jan P. Mulier
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • positive pressure ventilation
  • negative pressure ventilation
  • constant flow ventilation
  • PEEP
  • lung recruitment
  • obesity
  • laparoscopy
  • ARDS
  • atelectasis
  • total lung compliance

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Published Papers (4 papers)

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Research

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15 pages, 1193 KB  
Article
Rethinking Mechanical Ventilation: Can Ventilation Mode Influence Long-Term Cognitive Outcomes in ICU Patients with COVID-19?
by Clementina M. van Rijn, Marta Godoy-González, Sol Fernández-Gonzalo, Pierre Souren, Malcolm G. Coulthard, David J. Howard and Marijtje L. A. Jongsma
J. Clin. Med. 2026, 15(2), 898; https://doi.org/10.3390/jcm15020898 - 22 Jan 2026
Viewed by 538
Abstract
Background: Long-term cognitive impairment is common among ICU patients who required invasive mechanical ventilation (IMV). Its etiology is likely multifactorial. This preregistered study examined the association between the duration of IMV and cognitive function post-ICU, as well as the moderating effects of age [...] Read more.
Background: Long-term cognitive impairment is common among ICU patients who required invasive mechanical ventilation (IMV). Its etiology is likely multifactorial. This preregistered study examined the association between the duration of IMV and cognitive function post-ICU, as well as the moderating effects of age and cognitive reserve. Methods: A secondary analysis was conducted using data from a published study of COVID-19 ICU survivors. One year after discharge, participants underwent a neuropsychological assessment. Linear regression models were used to evaluate associations between the variables. Results: Among patients who received IMV via endotracheal intubation, ventilation duration was not significantly associated with cognitive performance. In contrast, among tracheostomized patients, longer IMV duration was associated with better cognitive outcomes (Cohen’s f2 = 0.21). Age had a small negative main effect; in combination with IMV duration, f2 increased to 0.31. Cognitive reserve showed a strong positive association with cognitive outcome; in combination with IMV duration, f2 increased to 0.67. The interaction terms were negligible in both cases. Conclusions: We hypothesize that, compared to endotracheal intubation, IMV via tracheostoma may not only reduce the need for sedation, but also provide a more efficient respiratory support, therefore contributing to positive cognitive outcomes. However, IMV via tracheostomy still represents a form of positive pressure ventilation (PPV), which carries risks, such as ventilator-induced lung injury and reduced cardiac output and brain perfusion. These concerns about PPV, combined with our findings, indicate that alternative, non-invasive modes, such as negative pressure ventilation (NPV), warrant evaluation in future trials. Full article
(This article belongs to the Special Issue New Trends in Mechanical Ventilation)
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11 pages, 574 KB  
Article
Late-Preterm and Early-Term Respiratory Morbidity in Infants Born Primarily via Elective Caesarean Section
by Anthoula Arvaniti, Eleni Papachatzi, Emmanuella Magriplis, Nikolaos Antonakopoulos, Leonidas Antonakis, Gabriel Dimitriou and Theodore Dassios
J. Clin. Med. 2026, 15(1), 126; https://doi.org/10.3390/jcm15010126 - 24 Dec 2025
Viewed by 1128
Abstract
Background/Objectives: Although morbidity and mortality are more pronounced in extremely and very preterm infants, there is also considerable morbidity in preterm infants of more advanced gestations. Delivery via cesarean section is associated with a higher risk of perinatal complications even when performed electively. [...] Read more.
Background/Objectives: Although morbidity and mortality are more pronounced in extremely and very preterm infants, there is also considerable morbidity in preterm infants of more advanced gestations. Delivery via cesarean section is associated with a higher risk of perinatal complications even when performed electively. Our aim was to examine the possible contribution of prenatal and perinatal factors to the risk for respiratory morbidity in a population of late-preterm and early-term infants delivered with a high rate of elective cesarean section. Methods: In a retrospective cohort study, all late-preterm and early-term infants (34 to 38 completed weeks of gestation) that were admitted with respiratory distress to the Neonatal Intensive Care Unit of the University Hospital of Patras over a recent period of two years were included in the study. Results: In the study period, 489 infants of all gestations were admitted to the neonatal unit, of whom 221 were born between 34 and 38 + 6 gestational weeks. Ventilated infants had a significantly lower incidence of antenatal corticosteroids (41%) compared to non-ventilated infants (51%, p = 0.036) and a higher duration of parenteral nutrition [4 (1–6) days] compared to non-ventilated infants [2 (1–3) days, p < 0.001]. The incidence of late-onset sepsis was higher in the ventilated infants (26%) compared to the non-ventilated ones (8%, p < 0.001). Conclusions: Late preterm and early term infants who were invasively ventilated had less often received antenatal corticosteroids and had a higher incidence of late-onset sepsis compared to those who were not ventilated. Full article
(This article belongs to the Special Issue New Trends in Mechanical Ventilation)
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9 pages, 475 KB  
Article
Cell-Free Circulating Mitochondrial DNA Levels Following High-Frequency Jet Ventilation—A Post Hoc Analysis
by Marita Windpassinger, Michal Prusak, Kurt Ruetzler, Olga Plattner, Isabella Stanisz and Patrick Haider
J. Clin. Med. 2025, 14(18), 6528; https://doi.org/10.3390/jcm14186528 - 17 Sep 2025
Viewed by 932
Abstract
Background: Mitochondrial DNA (mtDNA), normally enclosed within mitochondria, can be released into circulation in response to cellular stress, hypoxia, or inflammation. Its detection in plasma has been proposed as a marker of cellular injury, particularly in the context of mechanical ventilation. High-frequency [...] Read more.
Background: Mitochondrial DNA (mtDNA), normally enclosed within mitochondria, can be released into circulation in response to cellular stress, hypoxia, or inflammation. Its detection in plasma has been proposed as a marker of cellular injury, particularly in the context of mechanical ventilation. High-frequency jet ventilation is a specialized approach of open-airway ventilation, delivering small tidal volumes through jet gas streams, applied with high pressure and oxygen fraction. It remains unclear whether this mode of ventilation contributes to mitochondrial stress. We therefore hypothesized that circulating mtDNA levels would increase after jet ventilation due to the combined effects of high oxygen exposure and mechanical strain. Furthermore, we explored whether the magnitude of mtDNA change correlates with the duration of ventilation and arterial oxygenation levels. Methods: Plasma levels of cell-free circulating mitochondrial DNA were measured in 30 patients before and following jet ventilation in laryngotracheal surgery. Post hoc analysis of a primary monocentric, randomized cross-over study was conducted to investigate ventilation distribution in high-frequency jet ventilation techniques. Results: Mitochondrial DNA levels significantly decreased after jet ventilation (median T0: 13.57; T1: 6.78; p = 0.0087). No significant associations were found between mtDNA change and jet ventilation duration, type of surgery, or ASA classification. Despite variable air entrainment in the open-jet ventilation system, the arterial partial pressure of oxygen increased significantly during the procedure. Conclusions: Jet ventilation was associated with a significant decrease in circulating mtDNA levels. This contrasts with our initial hypothesis of mtDNA elevation under ventilation-induced stress. These findings suggest that jet ventilation may exert less mitochondrial damage than previously expected. Full article
(This article belongs to the Special Issue New Trends in Mechanical Ventilation)
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Review

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15 pages, 1622 KB  
Review
Artificial Intelligence in the Management of Patients with Respiratory Failure Requiring Mechanical Ventilation: A Scoping Review
by Dmitriy Viderman, Ainur Ayazbay, Bakhtiyar Kalzhan, Symbat Bayakhmetova, Meiram Tungushpayev and Yerkin Abdildin
J. Clin. Med. 2024, 13(24), 7535; https://doi.org/10.3390/jcm13247535 - 11 Dec 2024
Cited by 12 | Viewed by 7977
Abstract
Background: Mechanical ventilation (MV) is one of the most frequently used organ replacement modalities in the intensive care unit (ICU). Artificial intelligence (AI) presents substantial potential in optimizing mechanical ventilation management. The utility of AI in MV lies in its ability to harness [...] Read more.
Background: Mechanical ventilation (MV) is one of the most frequently used organ replacement modalities in the intensive care unit (ICU). Artificial intelligence (AI) presents substantial potential in optimizing mechanical ventilation management. The utility of AI in MV lies in its ability to harness extensive data from electronic monitoring systems, facilitating personalized care tailored to individual patient needs. This scoping review aimed to consolidate and evaluate the existing evidence for the application of AI in managing respiratory failure among patients necessitating MV. Methods: The literature search was conducted in PubMed, Scopus, and the Cochrane Library. Studies investigating the utilization of AI in patients undergoing MV, including observational and randomized controlled trials, were selected. Results: Overall, 152 articles were screened, and 37 were included in the analysis. We categorized the goals of AI in the included studies into the following groups: (1) prediction of requirement in MV; (2) prediction of outcomes in MV; (3) prediction of weaning from MV; (4) prediction of hypoxemia after extubation; (5) prediction models for MV–associated severe acute kidney injury; (6) identification of long-term outcomes after prolonged MV; (7) prediction of survival. Conclusions: AI has been studied in a wide variety of patients with respiratory failure requiring MV. Common applications of AI in MV included the assessment of the performance of ML for mortality prediction in patients with respiratory failure, prediction and identification of the most appropriate time for extubation, detection of patient-ventilator asynchrony, ineffective expiration, and the prediction of the severity of the respiratory failure. Full article
(This article belongs to the Special Issue New Trends in Mechanical Ventilation)
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