MECHANICAL

VENTILATION TYPES

Mechanical

ventilationisamethodto
mechanicallyassistorreplacespontaneous
breathing.Thismayinvolveamachinecalleda
ventilatororthebreathingmaybeassistedbya
registerednurse,physician,physicianassistant,
respiratorytherapist,paramedic,orothersuitable
personcompressingabagorsetofbellows.
Mechanicalventilationistermed"invasive"ifit
involvesanyinstrumentpenetratingthroughthe
mouth(suchasanendotrachealtube)ortheskin
(suchasatracheostomytube).

Ventilatorscomeinmanydifferentstylesandmethodof
givingabreathtosustainlife.Therearemanualventilators
suchasbagvalvemasksandanesthesiabagsthatrequire
theuserstoholdtheventilatortothefaceortoan
artificialairwayandmaintainbreathswiththeirhands.
Mechanicalventilatorsareventilatorsnotrequiring
operatoreffortandaretypicallycomputer-controlledor
pneumatic-controlled.
Mechanical ventilators
Mechanicalventilatorstypicallyrequirepowerbyabattery
orawalloutlet(DCorAC)thoughsomeventilatorswork
onapneumaticsystemnotrequiringpower.
Transport ventilatorsTheseventilatorsaresmalland
morerugged,andcanbepoweredpneumaticallyorviaAC
orDCpowersources.

Types of ventilators

Intensive-care ventilatorsTheseventilatorsarelarger
andusuallyrunonACpower(thoughvirtuallyallcontaina
batterytofacilitateintra-facilitytransportandasaback-upin
theeventofapowerfailure).Thisstyleofventilatoroften
providesgreatercontrolofawidevarietyofventilation
parameters(suchasinspiratoryrisetime).ManyICU
ventilatorsalsoincorporategraphicstoprovidevisualfeedback
ofeachbreath.
Neonatal ventilatorsDesignedwiththepretermneonate
inmind,theseareaspecializedsubsetofICUventilatorsthat
aredesignedtodeliverthesmaller,moreprecisevolumesand
pressuresrequiredtoventilatethesepatients.
Positive airway pressure ventilators(PAP)These
ventilatorsarespecificallydesignedfornon-invasive
ventilation.Thisincludesventilatorsforuseathomefor
treatmentofchronicconditionssuchassleepapneaorCOPD.

Types of ventilators

SMARTBAGMOBag-Valve-Mask

Resuscitator

 Mechanicalventilationisindicatedwhenthepatient's

spontaneousventilationisinadequatetomaintainlife.It
isalsoindicatedasprophylaxisforimminentcollapseof
otherphysiologicfunctions,orineffectivegasexchange
inthelungs.Becausemechanicalventilationservesonly
toprovideassistanceforbreathinganddoesnotcurea
disease,thepatient'sunderlyingconditionshouldbe
correctableandshouldresolveovertime.Inaddition,
otherfactorsmustbetakenintoconsiderationbecause
mechanicalventilationisnotwithoutitscomplications

Medical uses

Respiratorytherapistexamininga

mechanicallyventilatedpatientonan
IntensiveCareUnit.

Commonmedicalindicationsforuseinclude:
Acutelunginjury(includingARDS,trauma)
Apneawithrespiratoryarrest,includingcasesfrom

intoxication
Acutesevereasthma,requiringintubation
Chronicobstructivepulmonarydisease(COPD)
Acuterespiratoryacidosiswithpartialpressureofcarbon
dioxide(pCO
2)>50mmHgandpH<7.25,whichmaybedueto
paralysisofthediaphragmduetoGuillain-Barrsyndrome,
myastheniagravis,motorneurondisease,spinalcordinjury,
ortheeffectofanaestheticandmusclerelaxantdrugs

INDICATION

Increasedworkofbreathingasevidencedby

significanttachypnea,retractions,andotherphysical
signsofrespiratorydistress
Hypoxemiawitharterialpartialpressureofoxygen(PaO
2)<55mmHgwithsupplementalfractionofinspired
oxygen(FiO
2)=1.0
Hypotensionincludingsepsis,shock,
congestiveheartfailure
Neurologicaldiseasessuchasmusculardystrophyand
amyotrophiclateralsclerosis

INDICATION

BarotraumaPulmonarybarotraumaisawell-known
complicationofpositive-pressuremechanicalventilation.This
includespneumothorax,subcutaneousemphysema,
pneumomediastinum,andpneumoperitoneum.
Ventilator-associated lung injury
Ventilator-associatedlunginjury(VALI)referstoacutelunginjury
thatoccursduringmechanicalventilation.Itisclinically
indistinguishablefromacutelunginjuryor
acuterespiratorydistresssyndrome(ALI/ARDS).
DiaphragmControlledmechanicalventilationmayleadtoa
rapidtypeofdisuseatrophyinvolvingthediaphragmaticmuscle
fibers,whichcandevelopwithinthefirstdayofmechanical
ventilation.Thiscauseofatrophyinthediaphragmisalsoacause
ofatrophyinallrespiratoryrelatedmusclesduringcontrolled
mechanicalventilation.
Motility of mucocilia in the airwaysPositivepressure
ventilationappearstoimpairmucociliarymotilityintheairways.
Bronchialmucustransportwasfrequentlyimpairedandassociated
withretentionofsecretionsandpneumonia.

Associated risk

Mechanicalventilationisoftenalife-saving

intervention,butcarriespotentialcomplications
includingpneumothorax,airwayinjury,alveolar
damage,andventilator-associatedpneumonia.
Othercomplicationsincludediaphragmatrophy,
decreasedcardiacoutput,andoxygentoxicity.
Oneoftheprimarycomplicationsthatpresentsin
patientsmechanicallyventilatedisacutelung
injury(ALI)/acuterespiratorydistresssyndrome
(ARDS).ALI/ARDSarerecognizedassignificant
contributorstopatientmorbidityandmortality.

Complications

Inmanyhealthcaresystems,prolongedventilation

aspartofintensivecareisalimitedresource(inthat
thereareonlysomanypatientsthatcanreceivecare
atanygivenmoment).Itisusedtosupportasingle
failingorgansystem(thelungs)andcannotreverse
anyunderlyingdiseaseprocess(suchasterminal
cancer).Forthisreason,therecanbe(occasionally
difficult)decisionstobemadeaboutwhetheritis
suitabletocommencesomeoneonmechanical
ventilation.Equallymanyethicalissuessurroundthe
decisiontodiscontinuemechanicalventilation.

COMPLICATIONS