Review Article

Invasive Mechanical Ventilation

Authors: James M. Walter, MD, Thomas C. Corbridge, MD, Benjamin D. Singer, MD

Abstract

Invasive mechanical ventilation is a potentially lifesaving intervention for acutely ill patients. The goal of this review is to provide a concise, clinically focused overview of basic invasive mechanical ventilation for the many clinicians who care for mechanically ventilated patients. Attention is given to how common ventilator modes differ in delivering a mechanical breath, evaluation of respiratory system mechanics, how to approach acute changes in airway pressure, and the diagnosis of auto-positive end-expiratory pressure. Waveform interpretation is emphasized throughout the review.

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References

1. Carson SS, Cox CE, Holmes GM, et al. The changing epidemiology of mechanical ventilation: a population-based study. J Intensive Care Med 2006;21:173-182.
 
2. Halpern NA, Goldman DA, Tan KS, et al. Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000-2010. Crit Care Med 2016;44:1490-1499.
 
3. Cox CE, Carson SS, Ely EW, et al. Effectiveness of medical resident education in mechanical ventilation. Am J Respir Crit Care Med 2003;167:32-38.
 
4. Wilcox SR, Strout TD, Schneider JI, et al. Academic emergency medicine physicians' knowledge of mechanical ventilation. West J Emerg Med 2016;17:271-279.
 
5. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. 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;342:1301-1308.
 
6. Cinnella G, Conti G, Lofaso F, et al. Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am J Respir Crit Care Med 1996;153:1025-1033.
 
7. Kapitan KS. Ventilatory failure. Can you sustain what you need? Ann Am Thorac Soc 2013;10:396-399.
 
8. Singer BD, Corbridge TC. Pressure modes of invasive mechanical ventilation. South Med J 2011;104:701-709.
 
9. Esteban A, Anzueto A, Alia I, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 2000;161:1450-1458.
 
10. Leatherman J. Mechanical ventilation for severe asthma. Chest 2015;147:1671-1680.
 
11. Shanholtz C, Brower R. Should inverse ratio ventilation be used in adult respiratory distress syndrome? Am J Respir Crit Care Med 1994;149:1354-1358.
 
12. Chacko B, Peter JV, Tharyan P, et al. Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev 2015;1:CD008807.
 
13. MacIntyre NR, McConnell R, Cheng KC, et al. Patient-ventilator flow dyssynchrony: flow-limited versus pressure-limited breaths. Crit Care Med 1997;25:1671-1677.
 
14. Kacmarek RM, Branson RD. Should intermittent mandatory ventilation be abolished? Respir Care 2016;61:854-866.
 
15. Marini JJ, Smith TC, Lamb VJ. External work output and force generation during synchronized intermittent mechanical ventilation. Effect of machine assistance on breathing effort. Am Rev Respir Dis 1988;138:1169-1179.
 
16. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903.
 
17. Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995;332:345-350.
 
18. 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;195:1429-1438.
 
19. Stansbury RC, Long JL, Petsonk EL. Respiratory mechanics in a patient requiring neuromuscular blockade. Ann Am Thorac Soc 2017;14:288-292.
 
20. Tobin MJ, Lodato RF. PEEP, auto-PEEP, and waterfalls. Chest 1989;96:449-451.
 
21. Marini JJ. Dynamic hyperinflation and auto-positive end-expiratory pressure: lessons learned over 30 years. Am J Respir Crit Care Med 2011;184:756-762.