Mechanical Ventilation Physiological Clinical Objectives Applications

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PRACTICAL GUIDELINES FOR MECHANICAL VENTILATION

Objectives Of Mechanical Ventilation

Related topics

Summary and Introduction

Indications For 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

OBJECTIVES OF MECHANICAL
VENTILATION:

The fundamental objectives for ventilatory support in acutely ill patients may be viewed physiologically and clinically (1, 5-8):

Physiological objectives

To support or manipulate pulmonary gas exchange
- To normalize alveolar ventilation (PaO2, PaCO2 and pH)
- To achieve and maintain PaO2 > 60 mm Hg and peripheral Sat O2 > 90%.
To increase lung volume and maintain adequate functional residual capacity (FRC)
- To obtain lung expansion and to prevent or treat atelectasis
- To improve oxygenation and lung compliance
To reduce the work of breathing in presence of high airway resistance and/or reduced compliance, when spontaneous breathing becomes ineffective.

Clinical objectives

In presence of pathologic lung Lung pathology may be connected with difficult gas diffusion, particularly concerning alveolar oxygen levels (principally paO2), or with ineffective inhaling and/or exhaling condition, which affect the elimination of CO2 particularly, as well as the acquisition of O2.

Objectives:
- improve lung pathology
- reverse hypoxemia, hypercarbia and acute respiratory acidosis
- decrease systemic or myocardial oxygen consumption
- relieve respiratory distress and reverse ventilatory muscle fatigue
- stabilize chest wall in case of rib instability and/or loss of integrity
Ventilatory support in cases of lung pathology must:
- prevent appearance of complications connected with artificial supports
- avoid appearance of ventilation/perfusion (V/Q) mismatch
- prevent or reverse atelectasis-reducing alveolar collapse during expiratory phase and keep alveoli open for as long as possible during ventilation.
In healthy lung

Objectives:
- provide adequate gas exchange
- permit sedation and/or neuromuscular blockage (e.g. to control seizures or provide general anesthesia)
- prevent complications connected with ventilatory support
- avoid appearance of atelectasis and ventilation/perfusion (V/Q) mismatch.

Next : Indications For Mechanical Ventilation

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