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Mechanical ventilation

The meaning of «mechanical ventilation»

Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for artificial ventilation where mechanical means are used to assist or replace spontaneous breathing.[1] This may involve a machine called a ventilator, or the breathing may be assisted manually by a suitably qualified professional, such as an anesthesiologist, Respiratory Therapist, Registered Nurse, paramedic or other first responder, by compressing a bag valve mask device.

Mechanical ventilation is termed "invasive" if it involves any instrument inside the trachea through the mouth, such as an endotracheal tube, or the skin, such as a tracheostomy tube. [2] Face or nasal masks are used for non-invasive ventilation in appropriately selected conscious patients.

The two main types of mechanical ventilation include positive pressure ventilation where air (or another gas mix) is pushed into the lungs through the airways, and negative pressure ventilation where air is usually, in essence, sucked into the lungs by stimulating movement of the chest. Apart from these two main types, there are many specific modes of mechanical ventilation, and their nomenclature has been revised over the decades as the technology has continually developed.

Mechanical ventilation is indicated when the patient's spontaneous breathing is inadequate to maintain life. It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs. Because mechanical ventilation serves only to provide assistance for breathing and does not cure a disease, the patient's underlying condition should be identified and treated in order to resolve over time. In addition, other factors must be taken into consideration because mechanical ventilation is not without its complications [3] One of the main reasons why a patient is admitted to an ICU is for delivery of mechanical ventilation. Monitoring a patient in mechanical ventilation has many clinical applications: Enhance understanding of pathophysiology, aid with diagnosis, guide patient management, avoid complications and assessment of trends.[4] In general, mechanical ventilation is initiated to protect the airway/reduce work of breathing and/or correct blood gases.

Common specific medical indications for use include:

Mechanical ventilation can be used as a short-term measure, for example during an operation or critical illness (often in the setting of an intensive-care unit). It may be used at home or in a nursing or rehabilitation institution if patients have chronic illnesses that require long-term ventilatory assistance.[citation needed]

Mechanical ventilation is often a life-saving intervention, but carries potential complications including pneumothorax, airway injury, alveolar damage, ventilator-associated pneumonia, and ventilator-associated tracheobronchitis.[7][8] Other complications include diaphragm atrophy, decreased cardiac output, and oxygen toxicity. One of the primary complications that presents in patients mechanically ventilated is acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). ALI/ARDS are recognized as significant contributors to patient morbidity and mortality.[9]

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