Skip to main content

Conventional Mechanical Ventilation in Acute Respiratory Failure

  • Chapter
  • First Online:
Personalized Mechanical Ventilation
  • 831 Accesses

Abstract

Mechanical ventilation is a life-sustaining measure to support alveolar ventilation and gas exchange. Ventilatory support is initiated based on clinical signs and symptoms and used to lengthen the time for management of the physiologic effects of respiratory failure and/or shock. Understanding trigger, target, and cycle phase variables can help direct the selection of an appropriate ventilator mode. Basic ventilator settings including tidal volume, respiratory rate, fractional concentration of inspired oxygen, positive end-expiratory pressure, inspiratory flow, and trigger sensitivity are discussed below in detail.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cairo JM. Pilbeam’s mechanical ventilation physiological and clinical applications. 6th ed. Elsevier; 2016.

    Google Scholar 

  2. Slutsky AS. Mechanical ventilation. American College of Chest Physicians’ consensus conference. Chest. 1993;104(6):1833–59.

    Article  CAS  Google Scholar 

  3. Field S, Kelly SM, Macklem PT. The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis. 1982;126(1):9–13.

    CAS  Google Scholar 

  4. John B, West AML. West’s respiratory physiology. 10th ed. Alphen aan den Rijn: Wolters Kluwer; 2016.

    Google Scholar 

  5. Tobin MJ. Mechanical ventilation. N Engl J Med. 1994;330(15):1056–61.

    Article  CAS  Google Scholar 

  6. Poor H. Basics of mechanical ventilation. Springer; 2018.

    Google Scholar 

  7. Tobin MJ. Principles and practice of mechanical ventilation. 3rd ed. New York: McGraw-Hill Medical; 2013.

    Google Scholar 

  8. Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med. 2019;199(11):1368–76.

    Article  Google Scholar 

  9. Mosier JM, Sakles JC, Whitmore SP, Hypes CD, Hallett DK, Hawbaker KE, et al. Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications. Ann Intensive Care. 2015;5:4.

    Article  Google Scholar 

  10. Carrillo A, Gonzalez-Diaz G, Ferrer M, Martinez-Quintana ME, Lopez-Martinez A, Llamas N, et al. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012;38(3):458–66.

    Article  Google Scholar 

  11. Demoule A, Girou E, Richard JC, Taille S, Brochard L. Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med. 2006;32(11):1756–65.

    Article  Google Scholar 

  12. Kang BJ, Koh Y, Lim CM, Huh JW, Baek S, Han M, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41(4):623–32.

    Article  Google Scholar 

  13. MacIntyre N. Design features of modern mechanical ventilators. Clin Chest Med. 2016;37(4):607–13.

    Article  Google Scholar 

  14. Branson RD, Johannigman JA. What is the evidence base for the newer ventilation modes? Respir Care. 2004;49(7):742–60.

    Google Scholar 

  15. Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care. 2002;47(4):416–24; discussion 24–6.

    Google Scholar 

  16. Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358(13):1327–35.

    Article  CAS  Google Scholar 

  17. Goligher EC, Dres M, Patel BK, Sahetya SK, Beitler JR, Telias I, et al. Lung- and diaphragm-protective ventilation. Am J Respir Crit Care Med. 2020;202(7):950–61.

    Article  Google Scholar 

  18. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126–36.

    Article  CAS  Google Scholar 

  19. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8.

    Article  Google Scholar 

  20. Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988;137(5):1159–64.

    Article  CAS  Google Scholar 

  21. International consensus conferences in intensive care medicine: ventilator-associated lung injury in ARDS. This official conference report was cosponsored by the American Thoracic Society, the European Society of Intensive Care Medicine, and the Societé de Réanimation de Langue Française, and was approved by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 1999;160(6):2118–24.

    Google Scholar 

  22. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(9):1253–63.

    Article  Google Scholar 

  23. Simonis FD, Serpa Neto A, Binnekade JM, Braber A, Bruin KCM, Determann RM, et al. Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS: a randomized clinical trial. JAMA. 2018;320(18):1872–80.

    Article  Google Scholar 

  24. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651–9.

    Article  CAS  Google Scholar 

  25. Neto AS, Simonis FD, Barbas CS, Biehl M, Determann RM, Elmer J, et al. Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome: a systematic review and individual patient data analysis. Crit Care Med. 2015;43(10):2155–63.

    Article  Google Scholar 

  26. Siemieniuk RAC, Chu DK, Kim LH, Güell-Rous MR, Alhazzani W, Soccal PM, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169.

    Article  Google Scholar 

  27. Mackle D, Bellomo R, Bailey M, Beasley R, Deane A, Eastwood G, et al. Conservative oxygen therapy during mechanical ventilation in the ICU. N Engl J Med. 2020;382(11):989–98.

    Article  Google Scholar 

  28. Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018;391(10131):1693–705.

    Article  Google Scholar 

  29. Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, de Jonge E. Association between arterial Hyperoxia and outcome in subsets of critical illness: a systematic review, meta-analysis, and meta-regression of cohort studies. Crit Care Med. 2015;43(7):1508–19.

    Article  Google Scholar 

  30. Girardis M, Busani S, Damiani E, Donati A, Rinaldi L, Marudi A, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA. 2016;316(15):1583–9.

    Article  CAS  Google Scholar 

  31. Schjørring OL, Klitgaard TL, Perner A, Wetterslev J, Lange T, Siegemund M, et al. Lower or higher oxygenation targets for acute hypoxemic respiratory failure. N Engl J Med. 2021;384:1301–11.

    Article  Google Scholar 

  32. Barrot L, Asfar P, Mauny F, Winiszewski H, Montini F, Badie J, et al. Liberal or conservative oxygen therapy for acute respiratory distress syndrome. N Engl J Med. 2020;382(11):999–1008.

    Article  CAS  Google Scholar 

  33. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462.

    Article  Google Scholar 

  34. Mélot C. Contribution of multiple inert gas elimination technique to pulmonary medicine. 5. Ventilation-perfusion relationships in acute respiratory failure. Thorax. 1994;49(12):1251–8.

    Article  Google Scholar 

  35. Caironi P, Cressoni M, Chiumello D, Ranieri M, Quintel M, Russo SG, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2010;181(6):578–86.

    Article  Google Scholar 

  36. Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359(20):2095–104.

    Article  CAS  Google Scholar 

  37. Beitler JR, Sarge T, Banner-Goodspeed VM, Gong MN, Cook D, Novack V, et al. Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-Fio2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2019;321(9):846–57.

    Article  Google Scholar 

  38. Hata JS, Togashi K, Kumar AB, Hodges LD, Kaiser EF, Tessmann PB, et al. The effect of the pressure-volume curve for positive end-expiratory pressure titration on clinical outcomes in acute respiratory distress syndrome: a systematic review. J Intensive Care Med. 2014;29(6):348–56.

    Article  Google Scholar 

  39. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351(4):327–36.

    Article  Google Scholar 

  40. Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):646–55.

    Article  CAS  Google Scholar 

  41. Rodriguez PO, Bonelli I, Setten M, Attie S, Madorno M, Maskin LP, et al. Transpulmonary pressure and gas exchange during decremental PEEP titration in pulmonary ARDS patients. Respir Care. 2013;58(5):754–63.

    Google Scholar 

  42. Pintado MC, de Pablo R, Trascasa M, Milicua JM, Rogero S, Daguerre M, et al. Individualized PEEP setting in subjects with ARDS: a randomized controlled pilot study. Respir Care. 2013;58(9):1416–23.

    Article  Google Scholar 

  43. Sahetya SK, Goligher EC, Brower RG. Fifty years of research in ARDS. Setting positive end-expiratory pressure in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(11):1429–38.

    Article  Google Scholar 

  44. Steingrub JS, Tidswell M, Higgins TL. Hemodynamic consequences of heart-lung interactions. J Intensive Care Med. 2003;18(2):92–9.

    Article  Google Scholar 

  45. Mitchell JR, Whitelaw WA, Sas R, Smith ER, Tyberg JV, Belenkie I. RV filling modulates LV function by direct ventricular interaction during mechanical ventilation. Am J Physiol Heart Circ Physiol. 2005;289(2):H549–57.

    Article  CAS  Google Scholar 

  46. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;157(1):294–323.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bonnie R. Wang .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wang, B.R., Hyzy, R.C. (2022). Conventional Mechanical Ventilation in Acute Respiratory Failure. In: Hidalgo, J., Hyzy, R.C., Mohamed Reda Taha, A., Tolba, Y.Y.A. (eds) Personalized Mechanical Ventilation . Springer, Cham. https://doi.org/10.1007/978-3-031-14138-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-14138-6_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14137-9

  • Online ISBN: 978-3-031-14138-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics