Mechanical Ventilation

1. Ventilation Modes

2. Troubleshooting the Ventilator

3. Permissive Hypercapnia

4. Monitoring the Ventilated Patient

5. Lung Protective Ventilation

6. Assist-Control Ventilation

7. Synchronized Intermittent Mandatory Ventilation

8. Pressure Support Ventilation

9. Optimizing PEEP

10. Trigger & Flow

11. Patient-Ventilator Asynchrony

12. Airway Pressure Release Ventilation

13. High Frequency Oscillatory Ventilation

14. Liberation from Mechanical Ventilation

15. Prolonged Respiratory Failure

The Commandments of Mechanical Ventilation

I. Assess lung compliance daily with a plateau pressure

II. Intubating a critically ill patient is never a sign of weakness

III. Mechanical ventilation offers no curative properties in itself

IV. Be familiar with ventilation modes and recognize that none are perfect

V. Avoid tidal volumes greater than 4-8 mL per kg predicted body weight

VI. For atelectasis in the setting of hypoxemia, adjust PEEP before FiO2

VII. Don't pursue a normal ABG at the expense of ventilator induced lung injury

VIII. A patient in shock should be placed on assist control

IX. Suspect all patients esp. with obstructive lung disease to have auto-PEEP

X. Perform a daily SBT once the reason for intubation has resolved

Modified from Owens, William. The Ventilator Book. 3rd ed., First Draught Press, 2021.