mechanical ventilation
Summary
Mechanical ventilation is artificial respiratory support that assists or replaces spontaneous breathing using positive pressure to deliver oxygen and remove carbon dioxide. It's indicated for respiratory failure, airway protection, or during anesthesia. Key modes include volume-controlled, pressure-controlled, and assist-control ventilation.
Detail
Mechanical ventilation provides life-support by delivering predetermined tidal volumes or pressures to maintain adequate oxygenation and ventilation. The ventilator creates positive pressure that forces air into the lungs, reversing normal physiology where breathing is driven by negative intrathoracic pressure. Common indications include acute respiratory distress syndrome (ARDS), pneumonia, chronic obstructive pulmonary disease (COPD) exacerbations, neuromuscular weakness, and perioperative support. Ventilator settings include FiO2 (fraction of inspired oxygen), PEEP (positive end-expiratory pressure), respiratory rate, and tidal volume. Complications include ventilator-associated pneumonia (VAP), barotrauma/volutrauma, oxygen toxicity, and ventilator-induced lung injury (VILI). Weaning protocols assess readiness for extubation through spontaneous breathing trials. Liberation strategies focus on minimizing sedation and daily assessments to prevent prolonged mechanical ventilation and associated morbidity.
Sources
- Harrison's Principles of Internal Medicine
- Marino's The ICU Book
- West's Respiratory Physiology
- ARDS Network Protocol Studies
- American College of Chest Physicians Guidelines
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