Mechanical Ventilation

• Mechanical ventilation:
  • Is a procedure often performed in patients in respiratory failure:
    • Which is defined broadly as:
      • The inability to meet the body’s needs:
        • For oxygen delivery or
        • Carbon dioxide removal
  • Ventilators delivers air:
    • Usually with an elevated oxygen content:
      • To a patient’s lungs via an endotracheal tube:
        • To facilitate:
          • The exchange of oxygen and carbon dioxide
  • The indications for mechanical ventilation include:
    • Airway protection
    • Treatment of hypoxemic respiratory failure:
      • Low blood oxygen
    • Treatment of hypercapnic respiratory failure:
      • Elevated carbon dioxide in the blood
    • Treatment of a combined hypoxic and hypercapnic respiratory failure
    • On some occasions:
      • Patients are also intubated and placed on mechanical ventilation for:
        • Procedures
    • However:
      • Intubation and initiation of mechanical ventilation require a great degree of vigilance:
        • As committing to this therapy can affect the patient’s overall course of treatment
• Mechanical ventilation is managed by:
  • Respiratory Therapists (RTs)
  • Highly-trained medical professionals:
    • Who specialize in the care of respiratory illnesses
• In addition to managing ventilators:
  • RTs have expertise in other forms of oxygen administration and respiratory support, provide medications for respiratory disorders, and assess patients for extubation readiness
  • RTs are essential for the appropriate care of mechanically ventilated patients
  • Conversely:
    • Mechanical ventilation traditionally has not been taught as a core component of many medical and nursing practices:
      • Outside of Critical Care and Anesthesiology
  • As such, to collaborate effectively with RTs in the care of ventilated patients:
    • Additional education is warranted
  • Ventilator management can seem intimidating due to varied and confusing terminology (with many clinicians using synonyms for the same modes or settings), slight variation among brands of ventilators, unfamiliarity, or ceding management to others.
• For COVID-19 patients:
  • Ventilators are often crucial:
    • Given the nature of the illness
  • But note that intubation and initiation of mechanical ventilation require a great degree of vigilance
  • The data supporting the importance of good ventilator management continues to increase, and appreciating the fundamental principles of ventilation is essential for all clinicians involved in the care of these patients

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