Positive pressure mechanical ventilation was first introduced during the polio epidemic in the 1950s (1,2), but its usefulness in managing other causes of respiratory failure quickly became apparent. Today, positive pressure mechanical ventilators represent an essential component of patient management. Increased experience has propelled our understanding of pulmonary physiology and respiratory mechanics. As a result, new modes of ventilation such as pressure support ventilation (PSV), pressure control ventilation (PCV), and proportional assist ventilation (PAV) have proliferated. Each of these modes reflects an attempt by ventilator designers to meet the following goals: 1) provide adequate oxygenation and ventilation, 2) minimize parenchymal injury, 3) rehabilitate fatigued respiratory muscles, and 4) promote successful weaning. Unfortunately, the perfect mode of ventilation that accomplishes these goals in all situations has not been developed. In this chapter, the indications for mechanical ventilation and the functional characteristics of common ventilatory modes along with their relative advantages and disadvantages are discussed. In addition, the expanding role of noninvasive positive pressure ventilation and interventions to successfully wean the patient from mechanical ventilation are reviewed.
KeywordsMechanical Ventilation Continuous Positive Airway Pressure Airway Pressure Respiratory Muscle Pressure Support
Unable to display preview. Download preview PDF.
- 2.Silver MR. BIPAP: Useful new modality or confusing acronym? Crit Care Med 1998; 26: 1473 1474.Google Scholar
- 4.Sladen RN. Current concepts of mechanical ventilation. TARS Review Course Lectures 1999; 8692.Google Scholar
- 7.Bonmarchand G, Chevron V, Chopin C, Jusserand D, Girault C, Moritz F, Leroy J, Pasquis P. Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patents with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med 1996; 22: 1147–1154.PubMedCrossRefGoogle Scholar
- 18.Younes M. Proportional assist ventilation, a new approach to ventilatory support theory. Am RevGoogle Scholar
- Respir Dis 1992,145:114–20.Google Scholar
- 28.Goodwin SR. Aspiration syndromes, in Critical Care, ed. by Civetta JM, Taylor RW and Kirby RR, Lippincott-Raven Publishers, Philadelphia 1997; 1861–1875.Google Scholar
- 35.Amato MBP, Barbas CSV, Medeiros DM, Magaldi RB, Schettino G, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CRR. Effect of a protective ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338: 347–354.PubMedCrossRefGoogle Scholar
- 38.Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdû I, Macias S, Allegue JM, Blanco J, Carriedo D, Leon M, de la Cal MA, Taboada F, de Velasco JG, Goldwasser RS. Extubation outcome after spontaneous breathing trials with t-tube or pressure support ventilation. Am J Resp Crit Care Med 1997; 156: 459–465.PubMedCrossRefGoogle Scholar
- 40.Butler R, Keenan SP, Inman KJ, Sibbald WJ, Block G. Is there a preferred technique for weaning the difficult-to-wean patient? A systematic review of the literature. Crit Care Med 1999; 27: 2331 2336.Google Scholar
- 42.Kirton OC, DeHaven B, Hudson-Civetta J, Morgan JP, Windsor J, Civetta JM. Re-engineering ventilatory support to decrease days and improve resource utilization. Ann Surg 1996; 224: 396404.Google Scholar