Mechanical Ventilation Indications,Advantages,Complications,Use

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PRACTICAL GUIDELINES FOR MECHANICAL VENTILATION

Indications For Mechanical Ventilation

Related topics

Summary and Introduction

Objectives Of Mechanical Ventilation

Mechanical Ventilatory Support

Ventilation Strategies

Special Modes Of Ventilation

Giuseppe A. Marraro, MD
Director
Department of Anesthesia and Intensive Care
Pediatric Intensive Care Unit
Fatebenefratelli and Ophthalmiatric Hospital
Milano, Italy

Correspondence:
Corso Porta Nuova 23 - I 20121, Milano, Italy. E-Mail gmarraro@picu.it

INDICATIONS FOR MECHANICAL
VENTILATION :

Mechanical ventilation constitutes the final step in a series of therapeutic man oeuvres of increasing complexity employed in the treatment of respiratory failure. Ventilatory support is indicated in infants and children who cannot breathe adequately without assistance and in those in whom unassisted ventilation will be dangerous or life-threatening.

Advantages:

Correct ventilation of both lungs and progressive improvement of lung pathology
Improvement of oxygenation and reduction of hypercapnia
Reduction of respiratory fatigue and oxygen consumption
Protection of airways and efficacious bronchosuctioning if tracheal intubation is performed.

Absolute indication for intubation and mechanical ventilation are:

emergency
apnea and severe irregularity of spontaneous breathing
severe respiratory failure
ineffectiveness of oxygen therapy by mask, CPAP or non- invasive ventilation

More frequent complications are (9-12) :

reduction of venous return and cardiac output as a consequence of politicization of inhalatory phase. This can be seen mainly in cases of hypovolemia
lung volume and FRC reduction
lung inhomogeneity due to over-expansion of better ventilated areas
small airway closure connected with impossibility to expel secretions and their migration to more declivous and dependent areas (Figure 3a and 3b)
secretion stiffening, loss of ciliary activity and mucus alteration if not well-warmed and humidified gases are used
lung trauma connected with high peak pressure (barotrauma), large volumes (volutrauma) and biological factors (biotrauma) e.g. inflammation
development of infection due to incorrect nursing, insufficient secretion clearance, atelectasis development, etc.
vocal chords and tracheal lesions which can evolve into stenosis if traumatic tracheal intubation is applied - hypoventilation and hypoxia due to technical problems

Figure 3A - CT scan before intubation and controlled ventilation.

Figure 3B - Same case as figure 3A. Atelectasis formation in dependent lung regions following 2 hours of mechanical ventilation.

Use of mechanical ventilation must take the following into account:

The underlying physiopathology varies with time and thus mode, settings and intensity of ventilatory support should be frequently re-assessed.
Mechanical ventilation is associated with a number of adverse consequences and side effects, and as such, measures to minimize such complications should be implemented immediately after its application.
Alveolar over-distension can cause alveolar damage or air leaks (baro- volutrauma). Hence, man oeuvres to prevent the development of excess alveolar (or transpulmonary) pressure should be instituted (protective lung strategies).
Dynamic hyperinflation (gas trapping, Auto-PEEP, intrinsic PEEP) often goes unnoticed and should be measured or estimated, especially in patients with airway obstruction. Management should be towards limiting the development of dynamic hyperinflation
and its adverse consequences.

Next : Mechanical Ventilatory Support

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