Mechanical ventilation is the process of using devices to totally or partially provide O² and CO² transport between the environment and the pulmonary capillary bed.  The desired effect of mechanical ventilation is to maintain appropriate levels of PO² and PCO² in arterial blood while also unloading the ventilatory muscles.  Understanding the interactions of applied airway pressure and flow with respiratory system mechanics and patient effort is critical to proper management.  In recent years, a growing appreciation for ventilator-induced lung injury has prompted a reevaluation of the balance between providing adequate gas exchange and the “toxic” effects of high intrathoracic pressures and high inspired oxygen concentrations.  The concept of lung protective ventilatory strategies is now driving current approaches to mechanical ventilatory support.

Click here to view the entire chapter of Principles of Mechanical Ventilation. 
 

For more information on caring for the criticially ill and injured patients, the publication Adult Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.

Noninvasive Ventilation for Acute Respiratory Failure. 10th Critical Care Refresher Course. 2006

Noninvasive ventilation (NIV) is the form of positive pressure administered via various interfaces to the upper airway has assumed a prominent role in the management of acute respiratory failure.  Studies over the past decade have provided evidence to support use in patients with acute respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbations or associated with immunocompromised states and to facilitate weaning in intubated COPD patients.

Mechanical ventilation represents the backbone of modern intensive care.  Indications for mechanical ventilation are intuitive to most intensive care and emergency medicine practitioners, but can be stated explicitly due to their characteristics, which include the following: type I respiratory failure, type II respiratory failure, excessive work of breathing, obtundation or neuromuscular weakness, or post - surgery, anesthesia and/or resuscitation. 

For more information on caring for critically ill or injured patients, the publication Pediatric Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.

Weaning and Extubation.  Current Concepts in Pediatric Critical Care Course. 2006.

Invasive mechanical ventilation is life saving in infants and children with respiratory failure.  Mechanical ventilation is associated with complications that include airway injury, nosocomial infections of the airway and the lung and ventilator –induced lung injury. This transition involves the reduction of mechanical ventilator support while the patient assumes the responsibility for effective gas exchange.  Weaning from mechanical ventilation can be defined as the transition from ventilatory support to complete spontaneous breathing.  Weaning is defined as a success when a patient maintains effective gas exchange with complete spontaneous breathing without mechanical ventilation.      

For more information on caring for critically ill and injured patients, the publication Current Concepts in Pediatric Critical Care Course is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.

  SCCM Pod-26 PCCM: Assessing Sedation Levels of Mechanically Ventilated Pediatric Patients
Martha Curley, RN, PhD, discusses her article in the March 2006 issue of Pediatric Critical Care Medicine, titled "State Behavioral Scale: A Sedation Assessment Instrument for Infants and Young Children Supported on Mechanical Ventilation." Dr. Curley, director of nursing research in critical care and cardiovascular nursing research at The Children’s Hospital in Boston, Massachusetts, is a recognized expert in pediatric critical care nursing. She discusses the development and validation of the State Behavioral Scale, a tool used in the evaluation of the level of sedation in pediatric patients requiring mechanical ventilation. (Pediatric Care Medicine, Volume 7, Number 2 March 2006 pp 107-114)
 
  SCCM Pod-34 CCM: Lorazepam vs. Propofol
Shannon S. Carson, MD, assistant professor of medicine at the University of North Carolina at Chapel Hill and associate medical director of the medical and respiratory ICUs at the UNC Medical Center, as well as John P. Kress, MD, assistant professor of medicine at the University of Chicago, discuss their article from the May 2006 Critical Care Medicine, "A Randomized Trial of Intermittent Lorazepam vs. Propofol With Daily Interruption in Mechanically Ventilated Patients." (Crit Care Med Volume 34, Number 5, May 2006 pp 1326-1332)

  SCCM Pod-44 CCM: The Role of Weaning
Maged A. Tanios, MD, discusses his article, "A randomized, controlled trial of the role of weaning: Predictors in clinical decision making," from the October issue of Critical Care Medicine. Dr. Tanios is the director of the ICU at St. Mary Medical Center and assistant professor of medicine at the University of California, Los Angeles School of Medicine. (Crit. Care Med. 34(10):2530-2535, October 2006)