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Mechanical ventilation From Wikipedia, the free encyclopedia Jump to: HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "mwhead#mw-head" navigation, HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_venti lation" \l "p-search#p-search" search In HYPERLINK "http://en.wikipedia.org/wiki/Architecture" \o "Architecture" archit ecture and HYPERLINK "http://en.wikipedia.org/wiki/HVAC" \o "HVAC" climate control, mechanical or forced ventilation is the use of powered equipment, e.g. HYPERLIN K "http://en.wikipedia.org/wiki/Fan_(mechanical)" \o "Fan (mechanical)" fans and b lowers, to move air see HYPERLINK "http://en.wikipedia.org/wiki/Ventilation_(archi tecture)" \o "Ventilation (architecture)" ventilation (architecture). Mechanical ventilationIntervention HYPERLINK "http://en.wikipedia.org/wiki/ICD-9-CM_V olume_3" \o "ICD-9-CM Volume 3" ICD-9: HYPERLINK "http://icd9cm.chrisendres.com/inde x.php?srchtype=procs&srchtext=93.90&Submit=Search&action=search" 93.90 HYPERLINK " http://icd9cm.chrisendres.com/index.php?srchtype=procs&srchtext=96.7&Submit=Sear ch&action=search" 96.7 HYPERLINK "http://en.wikipedia.org/wiki/Medical_Subject_Headin gs" \o "Medical Subject Headings" MeSH HYPERLINK "http://www.nlm.nih.gov/cgi/mesh/20 11/MB_cgi?field=uid&term=D012121" D012121 HYPERLINK "http://en.wikipedia.org/wiki/OPS -301" \o "OPS-301" OPS-301code: HYPERLINK "http://ops.icd-code.de/ops/code/8-71.html" 8-71In HYPERLINK "http://en.wikipedia.org/wiki/Medicine" \o "Medicine" medicine, mech anical ventilation is a method to mechanically assist or replace spontaneous HYP ERLINK "http://en.wikipedia.org/wiki/Respiration_(physiology)" \o "Respiration ( physiology)" breathing. This may involve a machine called a HYPERLINK "http://en.w ikipedia.org/wiki/Ventilator" \o "Ventilator" ventilator or the breathing may be a ssisted by a HYPERLINK "http://en.wikipedia.org/wiki/Physician" \o "Physician" ph ysician, HYPERLINK "http://en.wikipedia.org/wiki/Respiratory_therapist" \o "Respi ratory therapist" respiratory therapist or HYPERLINK "http://en.wikipedia.org/wiki /Nurse" \o "Nurse" other suitable person compressing a HYPERLINK "http://en.wikipe dia.org/wiki/Bag_valve_mask" \o "Bag valve mask" bag or set of bellows. Traditiona lly divided into HYPERLINK "http://en.wikipedia.org/wiki/Iron_lung" \o "Iron lun g" negative-pressure ventilation, where air is essentially sucked into the lungs, or HYPERLINK "http://en.wikipedia.org/wiki/Positive_pressure_ventilation" \o "Po sitive pressure ventilation" positive pressure ventilation, where air (or another gas mix) is pushed into the HYPERLINK "http://en.wikipedia.org/wiki/Vertebrate_t rachea" \o "Vertebrate trachea" trachea. There are two main divisions of mechanica l ventilation; Invasive ventilation, and non-invasive ventilation. HYPERLINK "htt p://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note-pmid22035827-0#c ite_note-pmid22035827-0" [1] There are two main HYPERLINK "http://en.wikipedia.org /wiki/Modes_of_mechanical_ventilation" \o "Modes of mechanical ventilation" modes of mechanical ventilation within the two divisions; positive pressure ventilatio n and negative pressure ventilation. Contents [ HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "#" hide] HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "History#Hist ory" 1 History HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Complication s#Complications" 2 Complications HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Application_ and_duration#Application_and_duration" 3 Application and duration HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Negative_pre ssure_machines#Negative_pressure_machines" 3.1 Negative pressure machines HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Positive_pre ssure_machines#Positive_pressure_machines" 3.2 Positive pressure machines

HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Indications_ for_use#Indications_for_use" 4 Indications for use HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Associated_r isk#Associated_risk" 5 Associated risk HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Types_of_ven tilators#Types_of_ventilators" 6 Types of ventilators HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Mechanical_v entilators#Mechanical_ventilators" 6.1 Mechanical ventilators HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Phases_of_br eath_delivery#Phases_of_breath_delivery" 7 Phases of breath delivery HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Breath_initi ation#Breath_initiation" 7.1 Breath initiation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Inspiration# Inspiration" 7.2 Inspiration HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Breath_termi nation#Breath_termination" 7.3 Breath termination HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Exhalation#E xhalation" 7.4 Exhalation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Modes_of_mec hanical_ventilation#Modes_of_mechanical_ventilation" 8 Modes of mechanical ventil ation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Volume_contr olled_continuous_mandatory_ventilation#Volume_controlled_continuous_mandatory_ve ntilation" 8.1 Volume controlled continuous mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Volume_contr olled_intermittent_mandatory_ventilation#Volume_controlled_intermittent_mandator y_ventilation" 8.2 Volume controlled intermittent mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Pressure_con trolled_continuous_mandatory_ventilation#Pressure_controlled_continuous_mandator y_ventilation" 8.3 Pressure controlled continuous mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Pressure_con trolled_intermittent_mandatory_ventilation#Pressure_controlled_intermittent_mand atory_ventilation" 8.4 Pressure controlled intermittent mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "High_frequen cy_ventilation#High_frequency_ventilation" 8.5 High frequency ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Continuous_s pontaneous_ventilation#Continuous_spontaneous_ventilation" 8.6 Continuous spontan eous ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Pressure_Sup port_Ventilation#Pressure_Support_Ventilation" 8.6.1 Pressure Support Ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Continuous_p ositive_airway_pressure#Continuous_positive_airway_pressure" 8.6.2 Continuous pos itive airway pressure HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Choosing_amo ngst_ventilator_modes#Choosing_amongst_ventilator_modes" 9 Choosing amongst venti lator modes HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Initial_vent ilator_settings#Initial_ventilator_settings" 10 Initial ventilator settings HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Tidal_volume .2C_rate.2C_and_pressures#Tidal_volume.2C_rate.2C_and_pressures" 10.1 Tidal volum e, rate, and pressures HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Sighs#Sighs" 10.2 Sighs HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Initial_FiO2 #Initial_FiO2" 10.3 Initial FiO2 HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Positive_end -expiratory_pressure#Positive_end-expiratory_pressure" 10.4 Positive end-expirato ry pressure HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Positioning# Positioning" 10.5 Positioning

HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Sedation_and _paralysis#Sedation_and_paralysis" 10.6 Sedation and paralysis HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Prophylaxis# Prophylaxis" 10.7 Prophylaxis HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Modification _of_settings#Modification_of_settings" 11 Modification of settings HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "When_to_with draw_mechanical_ventilation#When_to_withdraw_mechanical_ventilation" 11.1 When to withdraw mechanical ventilation HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Respiratory_ monitoring#Respiratory_monitoring" 12 Respiratory monitoring HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "Artificial_a irways_as_a_connection_to_the_ventilator#Artificial_airways_as_a_connection_to_t he_ventilator" 13 Artificial airways as a connection to the ventilator HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "References#R eferences" 14 References HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "External_lin ks#External_links" 15 External links[ HYPERLINK "http://en.wikipedia.org/w/index.php? title=Mechanical_ventilation&action=edit&section=1" \o "Edit section: History" ed it] History The Roman physician HYPERLINK "http://en.wikipedia.org/wiki/Galen" \o "Galen" Gal en may have been the first to describe mechanical ventilation: "If you take a dea d animal and blow air through its larynx [through a reed], you will fill its bro nchi and watch its lungs attain the greatest distention." HYPERLINK "http://en.wi kipedia.org/wiki/Mechanical_ventilation" \l "cite_note-tobin06-1#cite_note-tobin 06-1" [2] HYPERLINK "http://en.wikipedia.org/wiki/Vesalius" \o "Vesalius" Vesalius t oo describes ventilation by inserting a reed or cane into the HYPERLINK "http:// en.wikipedia.org/wiki/Vertebrate_trachea" \o "Vertebrate trachea" trachea of anima ls. HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note -RCP-2#cite_note-RCP-2" [3] In 1908 HYPERLINK "http://en.wikipedia.org/wiki/George _Poe" \o "George Poe" George Poe demonstrated his mechanical respirator by asphyxi ating dogs and seemingly bringing them back to life. HYPERLINK "http://en.wikiped ia.org/wiki/Mechanical_ventilation" \l "cite_note-smother-3#cite_note-smother-3" [4] [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=2" \o "Edit section: Complications" edit] Complications Mechanical ventilation is often a life-saving intervention, but carries many pot ential complications including HYPERLINK "http://en.wikipedia.org/wiki/Pneumotho rax" \o "Pneumothorax" pneumothorax, airway injury, alveolar damage, and ventilato r-associated pneumonia. HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventil ation" \l "cite_note-pmid22008397-4#cite_note-pmid22008397-4" [5] In many healthcare systems prolonged ventilation as part of HYPERLINK "http://en .wikipedia.org/wiki/Intensive_care" \o "Intensive care" intensive care is a limite d resource (in that there are only so many patients that can receive care at any given moment). It is used to support a single failing organ system (the lungs) and cannot reverse any underlying disease process (such as terminal cancer). For this reason there can be (occasionally difficult) decisions to be made about wh ether it is suitable to commence someone on mechanical ventilation. Equally many ethical issues surround the decision to discontinue mechanical ventilation. HYPE RLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note-pmid22 035828-5#cite_note-pmid22035828-5" [6] [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=3" \o "Edit section: Application and duration" edit] Application and duration It can be used as a short term measure, for example during an operation or criti cal illness (often in the setting of an HYPERLINK "http://en.wikipedia.org/wiki/ Intensive_care_unit" \o "Intensive care unit" 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. Owing[ HYPERLINK "http:/ /en.wikipedia.org/wiki/Wikipedia:Please_clarify" \o "Wikipedia:Please clarify" cl

arification needed] to the anatomy of the human HYPERLINK "http://en.wikipedia.or g/wiki/Pharynx" \o "Pharynx" pharynx, HYPERLINK "http://en.wikipedia.org/wiki/Lary nx" \o "Larynx" larynx, and HYPERLINK "http://en.wikipedia.org/wiki/Esophagus" \o "Esophagus" esophagus and the circumstances for which ventilation is required then additional measures are often required to secure the HYPERLINK "http://en.wikip edia.org/wiki/Artificial_airway" \o "Artificial airway" airway during positive pre ssure ventilation to allow unimpeded passage of air into the trachea and avoid a ir passing into the esophagus and stomach. Commonly this is by HYPERLINK "http:/ /en.wikipedia.org/wiki/Artificial_airway" \o "Artificial airway" insertion of a t ube into the trachea which provides a clear route for the air. This can be either an HYPERLINK "http://en.wikipedia.org/wiki/Tracheal_tube" \o "Tracheal tube" end otracheal tube, inserted through the natural openings of mouth or nose or a HYPER LINK "http://en.wikipedia.org/wiki/Tracheostomy" \o "Tracheostomy" tracheostomy in serted through an artificial opening in the neck. In other circumstances simple HYPERLINK "http://en.wikipedia.org/w/index.php?title=Artificial_management&actio n=edit&redlink=1" \o "Artificial management (page does not exist)" airway maneuvr es, an HYPERLINK "http://en.wikipedia.org/wiki/Oropharyngeal_airway" \o "Orophary ngeal airway" oropharyngeal airway or HYPERLINK "http://en.wikipedia.org/wiki/Lary ngeal_mask_airway" \o "Laryngeal mask airway" laryngeal mask airway may be employe d. If the patient is able to protect their own airway and HYPERLINK "http://en.w ikipedia.org/wiki/Non-invasive_ventilation" \o "Non-invasive ventilation" non-inv asive ventilation or HYPERLINK "http://en.wikipedia.org/wiki/Iron_lung" \o "Iron lung" negative-pressure ventilation is used then a HYPERLINK "http://en.wikipedia. org/wiki/Artificial_airway" \o "Artificial airway" airway adjunct may not be neede d. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=4" \o "Edit section: Negative pressure machines" edit] Negative p ressure machines HYPERLINK "http://en.wikipedia.org/wiki/File:Poumon_artificiel.jpg" INCLUDEPICTUR E "http://upload.wikimedia.org/wikipedia/commons/thumb/5/56/Poumon_artificiel.jp g/220px-Poumon_artificiel.jpg" \* MERGEFORMATINET HYPERLINK "http://en.wikipedia.org/wiki/File:Poumon_artificiel.jpg" \o "Enlarge" INCLUDEPICTURE "http://bits.wikimedia.org/skins-1.18/common/images/magnify-clip. png" \* MERGEFORMATINET An Iron Lung Main article: HYPERLINK "http://en.wikipedia.org/wiki/Iron_Lung" \o "Iron Lung" I ron Lung The HYPERLINK "http://en.wikipedia.org/wiki/Iron_lung" \o "Iron lung" iron lung, a lso known as the Drinker and Shaw tank, was developed in 1929 and was one of the first negative-pressure machines used for long-term ventilation. It was refined and used in the 20th century largely as a result of the HYPERLINK "http://en.wi kipedia.org/wiki/Polio" \o "Polio" polio HYPERLINK "http://en.wikipedia.org/wiki/E pidemic" \o "Epidemic" epidemic that struck the world in the 1940s. The machine is effectively a large elongated HYPERLINK "http://en.wikipedia.org/wiki/Tank" \o "Tank" tank, which encases the patient up to the neck. The neck is sealed with a r ubber HYPERLINK "http://en.wikipedia.org/wiki/Gasket" \o "Gasket" gasket so that t he patient's face (and airway) are exposed to the room air. While the exchange of HYPERLINK "http://en.wikipedia.org/wiki/Oxygen" \o "Oxygen " oxygen and HYPERLINK "http://en.wikipedia.org/wiki/Carbon_dioxide" \o "Carbon di oxide" carbon dioxide between the bloodstream and the pulmonary airspace works by HYPERLINK "http://en.wikipedia.org/wiki/Diffusion" \o "Diffusion" diffusion and re quires no external work, air must be moved into and out of the HYPERLINK "http:/ /en.wikipedia.org/wiki/Human_lung" \o "Human lung" lungs to make it available to t he HYPERLINK "http://en.wikipedia.org/wiki/Gas_exchange" \o "Gas exchange" gas ex change process. In spontaneous breathing, a negative pressure is created in the H YPERLINK "http://en.wikipedia.org/wiki/Pleural_cavity" \o "Pleural cavity" pleura l cavity by the muscles of respiration, and the resulting gradient between the HY PERLINK "http://en.wikipedia.org/wiki/Atmospheric_pressure" \o "Atmospheric pres sure" atmospheric pressure and the pressure inside the HYPERLINK "http://en.wikipe dia.org/wiki/Human_thorax" \o "Human thorax" thorax generates a flow of air.

In the iron lung by means of a pump, the air is withdrawn mechanically to produc e a vacuum inside the tank, thus creating negative pressure. This negative press ure leads to expansion of the chest, which causes a decrease in intrapulmonary p ressure, and increases flow of ambient air into the lungs. As the vacuum is rele ased, the pressure inside the tank equalizes to that of the ambient pressure, an d the elastic coil of the chest and lungs leads to passive exhalation. However, when the vacuum is created, the abdomen also expands along with the lung, cuttin g off venous flow back to the heart, leading to pooling of venous blood in the l ower extremities. There are large portholes for nurse or home assistant access. The patients can talk and eat normally, and can see the world through a well-pla ced series of mirrors. Some could remain in these iron lungs for years at a time quite successfully. Today, negative pressure mechanical ventilators are still in use, notably with t he polio wing hospitals in HYPERLINK "http://en.wikipedia.org/wiki/England" \o " England" England such as HYPERLINK "http://en.wikipedia.org/wiki/St_Thomas%27_Hosp ital" \o "St Thomas' Hospital" St Thomas' Hospital in London and the HYPERLINK "ht tp://en.wikipedia.org/wiki/John_Radcliffe_Hospital" \o "John Radcliffe Hospital" John Radcliffe in HYPERLINK "http://en.wikipedia.org/wiki/Oxford" \o "Oxford" Oxfo rd. The prominent device used is a smaller device known as the HYPERLINK "http:// en.wikipedia.org/wiki/Cuirass" \o "Cuirass" cuirass. The cuirass is a shell-like u nit, creating negative pressure only to the chest using a combination of a fitti ng shell and a soft bladder. Its main use is in patients with neuromuscular diso rders who have some residual muscular function. However, it was prone to falling off and caused severe chafing and skin damage and was not used as a long term d evice. In recent years this device has re-surfaced as a modern HYPERLINK "http:/ /en.wikipedia.org/wiki/Polycarbonate" \o "Polycarbonate" polycarbonate shell with multiple seals and a high pressure HYPERLINK "http://en.wikipedia.org/w/index.ph p?title=Oscillation_pump&action=edit&redlink=1" \o "Oscillation pump (page does not exist)" oscillation pump in order to carry out HYPERLINK "http://en.wikipedia. org/wiki/Biphasic_cuirass_ventilation" \o "Biphasic cuirass ventilation" biphasic cuirass ventilation. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=5" \o "Edit section: Positive pressure machines" edit] Positive p ressure machines HYPERLINK "http://en.wikipedia.org/wiki/File:VIP_Bird2.jpg" INCLUDEPICTURE "http: //upload.wikimedia.org/wikipedia/commons/thumb/9/94/VIP_Bird2.jpg/220px-VIP_Bird 2.jpg" \* MERGEFORMATINET HYPERLINK "http://en.wikipedia.org/wiki/File:VIP_Bird2.jpg" \o "Enlarge" INCLUDEP ICTURE "http://bits.wikimedia.org/skins-1.18/common/images/magnify-clip.png" \* MERGEFORMATINET Neonatal mechanical ventilator The design of the modern positive-pressure ventilators were mainly based on tech nical developments by the military during World War II to supply oxygen to fight er pilots in high altitude. Such ventilators replaced the iron lungs as safe end otracheal tubes with high volume/low pressure cuffs were developed. The populari ty of positive-pressure ventilators rose during the polio epidemic in the 1950s in Scandinavia and the United States and was the beginning of HYPERLINK "http:// en.wikipedia.org/w/index.php?title=Modern_ventilation_therapy&action=edit&redlin k=1" \o "Modern ventilation therapy (page does not exist)" modern ventilation the rapy. Positive pressure through manual supply of 50% oxygen through a HYPERLINK " http://en.wikipedia.org/wiki/Tracheostomy" \o "Tracheostomy" tracheostomy tube led to a reduced mortality rate among patients with polio and respiratory paralysis . However, because of the sheer amount of man-power required for such manual int ervention, mechanical positive-pressure ventilators became increasingly popular. Positive-pressure ventilators work by increasing the patient's airway pressure t hrough an endotracheal or tracheostomy tube. The positive pressure allows air to flow into the airway until the ventilator breath is terminated. Subsequently, t he airway pressure drops to zero, and the elastic recoil of the chest wall and l ungs push the HYPERLINK "http://en.wikipedia.org/wiki/Tidal_volume" \o "Tidal vo lume" tidal volume the breathout through passive exhalation.

[ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=6" \o "Edit section: Indications for use" edit] Indications for u se Mechanical ventilation is indicated when the patient's spontaneous HYPERLINK "ht tp://en.wikipedia.org/wiki/Breath" \o "Breath" ventilation is inadequate to mainta in life. It is also indicated as prophylaxis for imminent collapse of other phys iologic functions, or ineffective gas exchange in the lungs. Because mechanical ventilation only serves to provide assistance for breathing and does not cure a disease, the patient's underlying condition should be correctable and should res olve over time. In addition, other factors must be taken into consideration beca use mechanical ventilation is not without its complications (see below) Common medical indications for use include: Acute lung injury (including HYPERLINK "http://en.wikipedia.org/wiki/Acute_respi ratory_distress_syndrome" \o "Acute respiratory distress syndrome" ARDS, trauma) HYPERLINK "http://en.wikipedia.org/wiki/Apnea" \o "Apnea" Apnea with respiratory a rrest, including cases from HYPERLINK "http://en.wikipedia.org/wiki/Substance_in toxication" \o "Substance intoxication" intoxication HYPERLINK "http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease" \ o "Chronic obstructive pulmonary disease" Chronic obstructive pulmonary disease ( H YPERLINK "http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease" \o "Chronic obstructive pulmonary disease" COPD) Acute HYPERLINK "http://en.wikipedia.org/wiki/Respiratory_acidosis" \o "Respirat ory acidosis" respiratory acidosis with partial pressure of carbon dioxide (pCO2) > 50 mmHg and pH < 7.25, which may be due to paralysis of the HYPERLINK "http:// en.wikipedia.org/wiki/Thoracic_diaphragm" \o "Thoracic diaphragm" diaphragm due to HYPERLINK "http://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndrome" \o "Guill ain-Barr syndrome" Guillain-Barr syndrome, HYPERLINK "http://en.wikipedia.org/wiki/M yasthenia_Gravis" \o "Myasthenia Gravis" Myasthenia Gravis, HYPERLINK "http://en.w ikipedia.org/wiki/Spinal_cord" \o "Spinal cord" spinal cord injury, or the effect of HYPERLINK "http://en.wikipedia.org/wiki/Anaesthesia" \o "Anaesthesia" anaesthe tic and HYPERLINK "http://en.wikipedia.org/wiki/Muscle_relaxant" \o "Muscle relax ant" muscle relaxant drugs Increased work of breathing as evidenced by significant HYPERLINK "http://en.wik ipedia.org/wiki/Tachypnea" \o "Tachypnea" tachypnea, retractions, and other physic al signs of respiratory distress HYPERLINK "http://en.wikipedia.org/wiki/Hypoxemia" \o "Hypoxemia" Hypoxemia with a rterial partial pressure of oxygen (PaO2) < 55mm Hg with supplemental fraction of inspired oxygen (FiO2) = 1.0 HYPERLINK "http://en.wikipedia.org/wiki/Hypotension" \o "Hypotension" Hypotension including HYPERLINK "http://en.wikipedia.org/wiki/Sepsis" \o "Sepsis" sepsis, HYPE RLINK "http://en.wikipedia.org/wiki/Shock_(circulatory)" \o "Shock (circulatory) " shock, HYPERLINK "http://en.wikipedia.org/wiki/Congestive_heart_failure" \o "Con gestive heart failure" congestive heart failure Neurological diseases such as HYPERLINK "http://en.wikipedia.org/wiki/Muscular_D ystrophy" \o "Muscular Dystrophy" Muscular Dystrophy and HYPERLINK "http://en.wiki pedia.org/wiki/Amyotrophic_Lateral_Sclerosis" \o "Amyotrophic Lateral Sclerosis" Amyotrophic Lateral Sclerosis [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=7" \o "Edit section: Associated risk" edit] Associated risk Barotrauma HYPERLINK "http://en.wikipedia.org/wiki/Pulmonary_barotrauma" \o "Pul monary barotrauma" Pulmonary barotrauma is a well-known complication of positive p ressure mechanical ventilation. HYPERLINK "http://en.wikipedia.org/wiki/Mechanica l_ventilation" \l "cite_note-pmid8420720-6#cite_note-pmid8420720-6" [7] This inclu des HYPERLINK "http://en.wikipedia.org/wiki/Pneumothorax" \o "Pneumothorax" pneum othorax, HYPERLINK "http://en.wikipedia.org/wiki/Subcutaneous_emphysema" \o "Subc utaneous emphysema" subcutaneous emphysema, HYPERLINK "http://en.wikipedia.org/wik i/Pneumomediastinum" \o "Pneumomediastinum" pneumomediastinum, and HYPERLINK "http ://en.wikipedia.org/wiki/Pneumoperitoneum" \o "Pneumoperitoneum" pneumoperitoneum. HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note-pm id8420720-6#cite_note-pmid8420720-6" [7]

Ventilator-associated lung injury HYPERLINK "http://en.wikipedia.org/wiki/Ventil ator-associated_lung_injury" \o "Ventilator-associated lung injury" Ventilator-as sociated lung injury (VALI) refers to acute lung injury that occurs during mechan ical ventilation. It is clinically indistinguishable from HYPERLINK "http://en.w ikipedia.org/wiki/Acute_lung_injury" \o "Acute lung injury" acute lung injury or H YPERLINK "http://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome" \o " Acute respiratory distress syndrome" acute respiratory distress syndrome (ALI/ARDS ). HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note7#cite_note-7" [8] Diaphragm Controlled mechanical ventilation may lead to a rapid type of disuse H YPERLINK "http://en.wikipedia.org/wiki/Atrophy" \o "Atrophy" atrophy involving the diaphragmatic muscle fibers, which can develop within the first day of mechanic al ventilation. HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \ l "cite_note-pmid18367735-8#cite_note-pmid18367735-8" [9] This cause of atrophy in the diaphragm is also a cause of atrophy in all respiratory related muscles dur ing controlled mechanical ventilation. HYPERLINK "http://en.wikipedia.org/wiki/Me chanical_ventilation" \l "cite_note-pmid12472328-9#cite_note-pmid12472328-9" [10] Motility of mucocilia in the airways Positive pressure ventilation appears to im pair mucociliary motility in the airways. HYPERLINK "http://en.wikipedia.org/wik i/Bronchial" \o "Bronchial" Bronchial mucus transport was frequently impaired and associated with retention of secretions and HYPERLINK "http://en.wikipedia.org/w iki/Pneumonia" \o "Pneumonia" pneumonia. HYPERLINK "http://en.wikipedia.org/wiki/Me chanical_ventilation" \l "cite_note-pmid8275739-10#cite_note-pmid8275739-10" [11] [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=8" \o "Edit section: Types of ventilators" edit] Types of ventila tors HYPERLINK "http://en.wikipedia.org/wiki/File:Ballon_ventilation_1.jpg" INCLUDEPIC TURE "http://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Ballon_ventilatio n_1.jpg/220px-Ballon_ventilation_1.jpg" \* MERGEFORMATINET HYPERLINK "http://en.wikipedia.org/wiki/File:Ballon_ventilation_1.jpg" \o "Enlar ge" INCLUDEPICTURE "http://bits.wikimedia.org/skins-1.18/common/images/magnify-cl ip.png" \* MERGEFORMATINET SMART BAG MO Bag-Valve-Mask Resuscitator Ventilators come in many different styles and method of giving a breath to susta in life. Hand controlled Manual ventilators such as HYPERLINK "http://en.wikiped ia.org/wiki/Bag_valve_mask" \o "Bag valve mask" Bag valve masks and HYPERLINK "htt p://en.wikipedia.org/w/index.php?title=Anesthesia_bag&action=edit&redlink=1" \o "Anesthesia bag (page does not exist)" anesthesia bags require the user to hold th e ventilator to the face or to an HYPERLINK "http://en.wikipedia.org/wiki/Artifi cial_airway" \o "Artificial airway" artificial airway and maintain breaths with th eir hands. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=9" \o "Edit section: Mechanical ventilators" edit] Mechanical ven tilators Mechanical ventilators typically require power by a battery or a wall outlet (DC or AC) though some ventilators work on a pneumatic system not requiring power. Transport ventilators These ventilators are small, more rugged, and can be power ed pneumatically or via AC or DC power sources. Intensive-care ventilators These ventilators are larger and usually run on AC po wer (though virtually all contain a battery to facilitate intra-facility transpo rt and as a back-up in the event of a power failure). This style of ventilator o ften provides greater control of a wide variety of ventilation parameters (such as inspiratory rise time). Many ICU ventilators also incorporate graphics to pro vide visual feedback of each breath. Neonatal ventilators Designed with the preterm neonate in mind, these are a spec ialized subset of ICU ventilators which are designed to deliver the smaller, mor e precise volumes and pressures required to ventilate these patients. HYPERLINK "http://en.wikipedia.org/wiki/Positive_airway_pressure" \o "Positive a irway pressure" Positive airway pressure ventilators (PAP) These ventilators are s pecifically designed for HYPERLINK "http://en.wikipedia.org/wiki/Non-invasive_ve

ntilation" \o "Non-invasive ventilation" non-invasive ventilation. this includes v entilators for use at home for treatment of chronic conditions such as HYPERLINK "http://en.wikipedia.org/wiki/Sleep_apnea" \o "Sleep apnea" sleep apnea or HYPERL INK "http://en.wikipedia.org/wiki/COPD" \o "COPD" COPD. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=10" \o "Edit section: Phases of breath delivery" edit] Phases of breath delivery [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=11" \o "Edit section: Breath initiation" edit] Breath initiation Initiation of a mechanical ventilation breath can be triggered by number of vari ables including flow, volume, pressure and time. Flow A breath is initiated when inspiratory flow through the ventilator circuit is recognized by the ventilator. This is normally due to the patient attempting inspiration, but can also be due to other factors, such as a leak in the circuit . On some ventilators the flow sensitivity (the flow rate threshold for initiati ng inspiration) can be set. Pressure A breath is initiated when a negative pressure is measured in the inspi ratory circuit, such as when the patient attempts inspiration. As with flow sens ing, some ventilators allow this parameter to be set. Volume A breath is initiated when volume loss is detected from the circuit, such as when the patient attempts inspiration. Time A breath is initiated at a regular interval which is determined by the set HYPERLINK "http://en.wikipedia.org/wiki/Respiratory_rate" \o "Respiratory rate" r espiratory rate. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=12" \o "Edit section: Inspiration" edit] Inspiration The process of gas delivery to the patient depends on the mode of ventilation (s ee below). Typically a breath can be classified as either volume controlled or p ressure controlled depending on which variable the ventilator actively controls during ventilation. HYPERLINK "http://en.wikipedia.org/wiki/Volume_controlled_continuous_mandatory_v entilation" \o "Volume controlled continuous mandatory ventilation" Volume ventil ation A predetermined HYPERLINK "http://en.wikipedia.org/wiki/Tidal_volume" \o "T idal volume" tidal volume (Vt) is set by the clinician, and is delivered to the pa tient every time a breath is triggered. For example, if the tidal volume is set at 500ml, the ventilator will continue inspiration until 500ml have been deliver ed to the patient. Upon completion of inspiration, the ventilator will cycle to exhalation. The amount of pressure necessary to deliver the tidal volume is dete rmined by the resistance and compliance of the patient and ventilator circuit, a nd may vary from breath to breath. Inspiratory pressures must be closely monitor ed to prevent HYPERLINK "http://en.wikipedia.org/wiki/Barotrauma" \l "Ventilator _induced_barotrauma" \o "Barotrauma" barotrauma. HYPERLINK "http://en.wikipedia.org/wiki/Pressure_control" \o "Pressure control" P ressure ventilation A predetermined HYPERLINK "http://en.wikipedia.org/wiki/Peak_ inspiratory_pressure" \o "Peak inspiratory pressure" peak inspiratory pressure (PI P) is set by the clinician and delivered to the patient throughout the set inspi ratory time (Ti). After the inspiratory time has elapsed, the ventilator will cy cle to expiration. The HYPERLINK "http://en.wikipedia.org/wiki/Tidal_volume" \o "Tidal volume" tidal volume delivered to the patient is determined by the resistan ce and compliance of the patient and circuit, and may vary from breath to breath . Inspiratory volumes must be closely monitored to prevent HYPERLINK "http://en. wikipedia.org/wiki/Hypoventilation" \o "Hypoventilation" hypoventilation or HYPERL INK "http://en.wikipedia.org/wiki/Hyperventilation" \o "Hyperventilation" hyperve ntilation. HYPERLINK "http://en.wikipedia.org/wiki/Pressure_regulated_volume_control" \o "P ressure regulated volume control" Pressure regulated volume control Several manufa ctures have incorporated features from both of these modes. These modes are flow -variable, volume-targeted, pressure-regulated and time-limited. This means that instead of providing an exact tidal volume each breath, a target volume is set and the ventilator will vary the inspiratory pressure (PIP) on a breath to breat

h basis to achieve that volume. As with pressure ventilation, the HYPERLINK "htt p://en.wikipedia.org/w/index.php?title=Inspiratory_time&action=edit&redlink=1" \ o "Inspiratory time (page does not exist)" inspiratory time (Ti) limits the length of the inspiratory cycle. The primary benefit from such modes is that they allo w the set tidal volume to be achieved with the lowest possible peak inspiratory pressure. Pressure regulated modes such as PRVC, Auto-flow (Draeger)or Average V olume Assured Pressure Support (AVAPS) from Philips can most easily be thought o f as turning a volume mode into a pressure mode with the added benefit of mainta ining more control over tidal volume than with strictly pressure-control. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=13" \o "Edit section: Breath termination" edit] Breath terminatio n Termination of a mechanical ventilation breath can occur either at the completio n of the inspiratory phase (see above), or as an alarm condition. Alarm conditio ns typically cause the ventilator to immediately cycle from inspiration to expir ation. An example of this is when the measured pressure exceeds the high pressur e alarm value. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=14" \o "Edit section: Exhalation" edit] Exhalation Exhalation in mechanical ventilation is almost always completely passive. The ve ntilator's expiratory valve is opened, and expiratory flow is allowed until the baseline pressure ( HYPERLINK "http://en.wikipedia.org/wiki/PEEP" \o "PEEP" PEEP) i s reached. Expiratory flow is determined by patient factors such as compliance a nd resistance. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=15" \o "Edit section: Modes of mechanical ventilation" edit] Mode s of mechanical ventilation Main article: HYPERLINK "http://en.wikipedia.org/wiki/Modes_of_mechanical_ventil ation" \o "Modes of mechanical ventilation" Modes of mechanical ventilation Mechanical ventilation utilizes several separate systems for ventilation referre d to as the "mode". Modes come in many different delivery concepts but all modes generally fall into one of the few main flagship categories such as volume cont rolled continuous mandatory ventilation, volume controlled intermittent mandator y ventilation, pressure controlled continuous mandatory ventilation, pressure co ntrolled intermittent mandatory ventilation, continuous spontaneous ventilation and the high frequency ventilation systems. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=16" \o "Edit section: Volume controlled continuous mandatory ve ntilation" edit] Volume controlled continuous mandatory ventilation Controlled mechanical ventilation (CMV) In this mode the ventilator provides a m echanical breath on a preset timing. Patient respiratory efforts are ignored. Th is is generally uncomfortable for children and adults who are conscious and is u sually only used in an unconscious patient. It may also be used in infants who o ften quickly adapt their breathing pattern to the ventilator timing. Since CMV i s no longer contained in its original form the term HYPERLINK "http://en.wikiped ia.org/wiki/Volume_controlled_continuous_mandatory_ventilation" \o "Volume contr olled continuous mandatory ventilation" volume controlled continuous mandatory ve ntilation has consumed it into its definition and overall has combined any CMV mo de for mechanical ventilation into the more accepted term in HYPERLINK "http://e n.wikipedia.org/wiki/Nomenclature_for_mechanical_ventilation" \o "Nomenclature f or mechanical ventilation" nomenclature for mechanical ventilation. HYPERLINK "http://en.wikipedia.org/wiki/Volume_controlled_continuous_mandatory_v entilation" \o "Volume controlled continuous mandatory ventilation" Volume contro lled continuous mandatory ventilation In this mode the ventilator provides a mech anical breath with either a pre-set tidal volume or peak pressure every time the patient initiates a breath. Traditional assist-control used only a pre-set tida l volumewhen a preset peak pressure is used this is also sometimes termed intermi ttent positive pressure ventilation (IPPV). However, the initiation timing is th e sameboth provide a ventilator breath with every patient effort. In most ventila tors a back-up minimum breath rate can be set in the event that the patient beco

mes apnoeic. Although a maximum rate is not usually set, an alarm can be set if the ventilator cycles too frequently. This can alert that the patient is tachypn eic or that the ventilator may be auto-cycling (a problem that results when the ventilator interprets fluctuations in the circuit due to the last breath termina tion as a new breath initiation attempt). [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=17" \o "Edit section: Volume controlled intermittent mandatory ventilation" edit] Volume controlled intermittent mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Volume_controlled_intermittent_mandatory _ventilation" \o "Volume controlled intermittent mandatory ventilation" Volume co ntrolled intermittent mandatory ventilation (VC-IMV). Formerly known as synchroni zed intermittent mandatory ventilation (SIMV). In this mode the ventilator provi des a pre-set mechanical breath (volume limited) every specified number of secon ds (determined by dividing the respiratory rate into 60 seconds thus a respirato ry rate of 12 results in a 5 second cycle time). Within that cycle time the vent ilator waits for the patient to initiate a breath using either a pressure or flo w sensor. When the ventilator senses the first patient breathing attempt within the cycle, it delivers the preset ventilator breath. If the patient fails to ini tiate a breath, the ventilator delivers a mechanical breath at the end of the br eath cycle. Additional spontaneous breaths after the first one within the breath cycle do not trigger another SIMV breath. However, SIMV may be combined with pr essure support (see below). SIMV is frequently employed as a method of decreasin g ventilatory support (weaning) by turning down the rate, which requires the pat ient to take additional breaths beyond the SIMV triggered breath. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=18" \o "Edit section: Pressure controlled continuous mandatory ventilation" edit] Pressure controlled continuous mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Pressure_controlled_continuous_mandatory _ventilation" \o "Pressure controlled continuous mandatory ventilation" Pressure controlled continuous mandatory ventilation (PC-CMV) mechanical ventilation with preset inspiratory pressure (PIP) and inspiratory time (Ti). Every breath is mac hine initiated and mandatory. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=19" \o "Edit section: Pressure controlled intermittent mandator y ventilation" edit] Pressure controlled intermittent mandatory ventilation HYPERLINK "http://en.wikipedia.org/wiki/Pressure_controlled_intermittent_mandato ry_ventilation" \o "Pressure controlled intermittent mandatory ventilation" Press ure controlled intermittent mandatory ventilation (formerly known as SIMV) In thi s mode the ventilator provides a pre-set pressure limited mechanical breath ever y specified number of seconds SIMV is frequently employed as a method of decreas ing ventilatory support (weaning) by turning down the rate, which requires the p atient to take additional breaths beyond the SIMV triggered breath. PC-IMV is fu ndamentally the same as VC-IMV with an emphasis on pressure support and control instead of volume. An example of PC-IMV is in the mode HYPERLINK "http://en.wiki pedia.org/wiki/Pressure_regulated_volume_control" \o "Pressure regulated volume control" pressure regulated volume control. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=20" \o "Edit section: High frequency ventilation" edit] High freq uency ventilation High frequency ventilation refers to ventilation that occurs at rates significan tly above that found in natural breathing. High frequency ventilation is further defined as any ventilation with a respiratory rate (Vf) greater than 150 respir ations per minute. Within the category of high-frequency ventilation, the two pr incipal types are HYPERLINK "http://en.wikipedia.org/wiki/High-frequency_ventila tion_(passive)" \o "High-frequency ventilation (passive)" high-frequency ventilat ion (passive) (i.e. HYPERLINK "http://en.wikipedia.org/wiki/High-frequency_jet_ve ntilation" \o "High-frequency jet ventilation" high-frequency jet ventilation) and HYPERLINK "http://en.wikipedia.org/wiki/High-frequency_ventilation_(active)" \o "High-frequency ventilation (active)" high-frequency ventilation (active) (i.e. H YPERLINK "http://en.wikipedia.org/wiki/High-frequency_oscillatory_ventilation" \

o "High-frequency oscillatory ventilation" high-frequency oscillatory ventilation) . [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=21" \o "Edit section: Continuous spontaneous ventilation" edit] C ontinuous spontaneous ventilation [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=22" \o "Edit section: Pressure Support Ventilation" edit] Pressur e Support Ventilation HYPERLINK "http://en.wikipedia.org/wiki/Continuous_spontaneous_ventilation" \o " Continuous spontaneous ventilation" Pressure support ventilation (PSV). When a pat ient attempts to breathe spontaneously through an endotracheal tube, the narrowe d diameter of the airway results in higher resistance to airflow, and thus a hig her work of breathing. PSV was developed as a method to decrease the work of bre athing in-between ventilator mandated breaths by providing an elevated pressure triggered by spontaneous breathing that "supports" ventilation during inspiratio n. Thus, for example, SIMV might be combined with PSV so that additional breaths beyond the SIMV programmed breaths are supported. However, while the SIMV manda ted breaths have a preset volume or peak pressure, the PSV breaths are designed to cut short when the inspiratory flow reaches a percentage of the peak inspirat ory flow (e.g. 1025%). New generation of ventilators provides user-adjustable ins piration cycling off threshold, and some even are equipped with automatic inspir ation cycling off threshold function. This helps the patient ventilator synchron y. HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note11#cite_note-11" [12] The peak pressure set for the PSV breaths is usually a lower pressure than that set for the full ventilator mandated breath. PSV can be also be used as an independent mode. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=23" \o "Edit section: Continuous positive airway pressure" edit] Continuous positive airway pressure HYPERLINK "http://en.wikipedia.org/wiki/Continuous_positive_airway_pressure" \o "Continuous positive airway pressure" Continuous positive airway pressure (CPAP). A continuous level of elevated pressure is provided through the patient circuit to maintain adequate oxygenation, decrease the work of breathing, and decrease t he work of the heart (such as in left-sided heart failure CHF). Note that no cyc ling of ventilator pressures occurs and the patient must initiate all breaths. I n addition, no additional pressure above the CPAP pressure is provided during th ose breaths. CPAP may be used invasively through an endotracheal tube or tracheo stomy or non-invasively with a face mask or nasal prongs. Non-invasive ventilati on has become more common for treatment of acute respiratory failure. HYPERLINK " http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note-pmid220358270#cite_note-pmid22035827-0" [1] [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=24" \o "Edit section: Choosing amongst ventilator modes" edit] Ch oosing amongst ventilator modes Assist-control mode minimizes patient effort by providing full mechanical suppor t with every breath. This is often the initial mode chosen for adults because it provides the greatest degree of support. In patients with less severe respirato ry failure, other modes such as SIMV may be appropriate. Assist-control mode sho uld not be used in those patients with a potential for HYPERLINK "http://en.wiki pedia.org/wiki/Respiratory_alkalosis" \o "Respiratory alkalosis" respiratory alka losis, in which the patient has an increased respiratory drive. Such hyperventila tion and HYPERLINK "http://en.wikipedia.org/wiki/Hypocapnia" \o "Hypocapnia" hypo capnia (decreased systemic carbon dioxide due to hyperventilation) usually occurs in patients with end-stage liver disease, hyperventilatory sepsis, and head tra uma. HYPERLINK "http://en.wikipedia.org/wiki/Respiratory_alkalosis" \o "Respirat ory alkalosis" Respiratory alkalosis will be evident from the initial HYPERLINK "h ttp://en.wikipedia.org/wiki/Arterial_blood_gas" \o "Arterial blood gas" arterial blood gas obtained, and the mode of ventilation can then be changed if so desired . Positive End Expiratory Pressure may or may not be employed to prevent HYPERLINK

"http://en.wikipedia.org/wiki/Atelectasis" \o "Atelectasis" atelectasis in adult patients. It is almost always used for pediatric and neonatal patients due to th eir increased tendency for atelectasis. High frequency oscillation is used most frequently in neonates, but is also used as an always alternative mode in adults with severe ARDS. HYPERLINK "http://en.wikipedia.org/wiki/Pressure_regulated_volume_control" \o "P ressure regulated volume control" Pressure regulated volume control is another opt ion. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=25" \o "Edit section: Initial ventilator settings" edit] Initial ventilator settings The following are general guidelines that may need to be modified for the indivi dual patient. As a general rule, whenever possible, spontaneous breathing must be maintained o r supported, to avoid muscular atrophy of the diaphragm (Ventilator Induced Dysf unction of Diaphragm, VIDD) . To limit VALI and VILI, protective ventilation pat tern should be applied to the patient. If this results in severe hypercapnia, ex ceeding accepted levels for permissive hypercapnia (pH below 7.2), measures for extracorporeal CO2 removal (iLA Membranventilator, HYPERLINK "http://de.wikipedi a.org/wiki/Novalung" \o "de:Novalung" Novalung) should be installed at an early st age of mechanical ventilation, to terminate cascades of inflammatory response fr om the lung tissue, resulting in multiorgan failure respective. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=26" \o "Edit section: Tidal volume, rate, and pressures" edit] Ti dal volume, rate, and pressures For adult patients and older children without existing lung disease HYPERLINK "http://en.wikipedia.org/wiki/Tidal_volume" \o "Tidal volume" tidal vol ume (Vt) is calculated in milliliters per kilogram (ml/kg) of a patient's ideal b ody weight (IBW). Traditionally 10 ml/kg was considered a standard tidal volume, however lower volumes are now used due to the increasing concern over barotraum a (injury to the lung by overextension). 6 to 8 ml/kg IBW is now common practice in ICU. Hence a patient weighing 70kg would get a Vt of 420560 ml. a HYPERLINK "http://en.wikipedia.org/wiki/Respiratory_rate" \o "Respiratory rate " respiratory rate of 12 breaths per minute is generally used. For infants and younger children without existing lung disease a tidal volume of 48 ml/kg a respiratory rate of 3035 breaths per minute for infants, and lower for older ch ildren With HYPERLINK "http://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome " \o "Acute respiratory distress syndrome" acute respiratory distress syndrome (AR DS) most commonly, a tidal volume of 4-6 ml/kg is used. This reduced tidal volume al lows for minimal volutrauma but may result in an elevated pCO2 (due to the decre ase in alveolar ventilation). This hypercapnia ( HYPERLINK "http://en.wikipedia.o rg/wiki/Permissive_hypercapnia" \o "Permissive hypercapnia" permissive hypercapni a) is accepted as a better alternative to continued volutrauma.[ HYPERLINK "http:/ /en.wikipedia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation needed] respiratory rate is increased in an attempt to maintain a normal pCO2 and minimi ze permissive hypercapnia.[ HYPERLINK "http://en.wikipedia.org/wiki/Wikipedia:Cit ation_needed" \o "Wikipedia:Citation needed" citation needed] Increases in respira tory rate are generally restricted by the onset of air trapping. As the tidal volume increases, the pressure required to administer that volume a lso increases. This pressure is known as the peak airway pressure. If the peak a irway pressure is persistently above 45cmH2O (4.4 kPa) for adults, the risk of ba rotrauma is increased (see below), and efforts should be made to try to reduce t he peak airway pressure (such as acceptable alarm limits). In infants and childr en it is unclear what level of peak pressure may cause damage. In general, keepi ng peak pressures below 30cmH2O (2.9 kPa) is desirable.[ HYPERLINK "http://en.wiki pedia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation

needed] Monitoring for barotrauma can also involve measuring the plateau pressure, which is the pressure after the delivery of the tidal volume but before the patient i s allowed to exhale. Normal breathing pattern involves inspiration, then expirat ion. To determine the plateau pressure, the ventilator can be programmed to perf orm a breath hold maneuver. In this maneuver, the patient is not allowed to exha le for a set period after inspiration occurs. The static lung pressure measured during the set breath hold period is the plateau pressure. Barotrauma is minimiz ed when the plateau pressure is maintained < 3035cmH2O.[ HYPERLINK "http://en.wikip edia.org/wiki/Wikipedia:Citation_needed" \o "Wikipedia:Citation needed" citation needed] [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=27" \o "Edit section: Sighs" edit] Sighs An adult patient breathing spontaneously will usually sigh about 68 times per hou r to prevent micro HYPERLINK "http://en.wikipedia.org/wiki/Atelectasis" \o "Atele ctasis" atelectasis, and this has led some to propose that ventilators should deli ver 12 times the amount of the preset tidal volume 68 times per hour to account for the sighs. However, such high quantity of volume delivery requires very high pe ak pressure that predisposes to barotrauma. Currently, accounting for sighs is n ot recommended if the patient is receiving 1012 mL/kg or is on PEEP. If the tidal volume used is lower, the sigh adjustment can be used, as long as the peak and plateau pressures are acceptable. Sighs are not generally used with ventilation of infants and young children. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=28" \o "Edit section: Initial FiO2" edit] Initial FiO2 Because the mechanical ventilator is responsible for assisting in a patient's br eathing, it must then also be able to deliver an adequate amount of oxygen in ea ch breath. The FiO2 stands for fraction of inspired oxygen, which means the perc ent of oxygen in each breath that is inspired. (Note that normal room air has ~2 1% oxygen content or an FiO2 of 0.21). In adult patients who can tolerate higher levels of oxygen for a period of time, the initial FiO2 may be set at 100% unti l arterial blood gases can document adequate oxygenation. An FiO2 of 100% for an extended period of time can cause atelectasis, but it can protect against hypox emia from unexpected intubation problems. For infants, and especially in prematu re infants, avoiding high levels of FiO2 (>60%) is very important to avoid lung injury and apnea of prematurity. Fraction of inspired oxygen should always be ti trated to meet the patients needs and to avoid unnecessary lung injury. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=29" \o "Edit section: Positive end-expiratory pressure" edit] Pos itive end-expiratory pressure Main article: HYPERLINK "http://en.wikipedia.org/wiki/Positive_end-expiratory_pr essure" \o "Positive end-expiratory pressure" Positive end-expiratory pressure PEEP is an adjuvant to the mode of ventilation used to help maintain HYPERLINK " http://en.wikipedia.org/wiki/Functional_residual_capacity" \o "Functional residu al capacity" functional residual capacity (FRC). At the end of expiration, the PEE P exerts pressure to oppose passive emptying of the lung and to keep the airway pressure above the atmospheric pressure. The presence of PEEP opens up collapsed or unstable alveoli and increases the FRC and surface area for gas exchange, th us reducing the size of the shunt. For example, if a large shunt is found to exi st based on the estimation from 100% FiO2 (see above), then PEEP can be consider ed and the FiO2 can be lowered (< 60%) in order to maintain an adequate PaO2, th us reducing the risk of oxygen toxicity. In addition to treating a shunt, PEEP may also be useful to decrease the work of breathing. In pulmonary physiology, HYPERLINK "http://en.wikipedia.org/wiki/Ela stance" \o "Elastance" compliance is a measure of the "stiffness" of the lung and chest wall. The mathematical formula for compliance (C) equals change in volume divided by change in pressure. The higher the compliance, the more easily the lu ngs will inflate in response to positive pressure. An underinflated lung will ha ve low compliance and PEEP will improve this initially by increasing the FRC, si nce the partially inflated lung takes less energy to inflate further. Excessive

PEEP can however produce overinflation, which will again decrease compliance. Th erefore it is important to maintain an adequate, but not excessive FRC. Indications. PEEP can cause significant haemodynamic consequences through decrea sing venous return to the right heart and decreasing right ventricular function. As such, it should be judiciously used and is indicated for adults in two circu mstances. If a PaO2 of 60 mmHg cannot be achieved with a FiO2 of 60% If the initial shunt estimation is greater than 25% If used, PEEP is usually set with the minimal positive pressure to maintain an a dequate PaO2 with a safe FiO2. As PEEP increases intrathoracic pressure, there c an be a resulting decrease in venous return and decrease in cardiac output. A PE EP of less than 10cmH2O (1 kPa) is usually safe in adults if intravascular volume depletion is absent. Lower levels are used for pediatric patients. Older litera ture recommended routine placement of a HYPERLINK "http://en.wikipedia.org/wiki/ Swan-Ganz_catheter" \o "Swan-Ganz catheter" Swan-Ganz catheter if the amount of PE EP used is greater than 10cmH2O for hemodynamic monitoring. More recent literatur e has failed to find outcome benefits with routine PA catheterisation when compa red to simple HYPERLINK "http://en.wikipedia.org/wiki/Central_venous_pressure" \ o "Central venous pressure" central venous pressure monitoring. HYPERLINK "http://e n.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note-12#cite_note-12" [13] I f cardiac output measurement is required, minimally invasive techniques, such as oesophageal doppler monitoring or arterial waveform contour monitoring may be s ufficient alternatives. HYPERLINK "http://en.wikipedia.org/wiki/Mechanical_ventil ation" \l "cite_note-13#cite_note-13" [14] HYPERLINK "http://en.wikipedia.org/wiki/ Mechanical_ventilation" \l "cite_note-14#cite_note-14" [15] When withdrawing, it i s decreased through 12cmH2O decrements while monitoring haemoglobin-oxygen saturat ions. Any unacceptable haemoglobin-oxygen saturation should prompt reinstitution of the last PEEP level that maintained good saturation. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=30" \o "Edit section: Positioning" edit] Positioning Prone (face down) positioning has been used in patients with HYPERLINK "http://e n.wikipedia.org/wiki/Acute_respiratory_distress_syndrome" \o "Acute respiratory distress syndrome" ARDS and severe HYPERLINK "http://en.wikipedia.org/wiki/Hypoxem ia" \o "Hypoxemia" hypoxemia. It improves FRC, drainage of secretions, and HYPERLI NK "http://en.wikipedia.org/wiki/Ventilation/perfusion_ratio" \o "Ventilation/pe rfusion ratio" ventilation-perfusion matching (efficiency of gas exchange). It may improve oxygenation in >50% of patients, but no survival benefit has been docume nted. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=31" \o "Edit section: Sedation and paralysis" edit] Sedation and paralysis Most intubated patients receive intravenous HYPERLINK "http://en.wikipedia.org/w iki/Sedation" \o "Sedation" sedation through a continuous infusion or scheduled do sing to help with anxiety or psychological stress. Sedation also helps the patie nt tolerate the constant irritation of the endotracheal tube in their mouth, pha rynx and trachea. Without some form of sedation and HYPERLINK "http://en.wikiped ia.org/wiki/Analgesia" \o "Analgesia" analgesia, it is common for patients to "fig ht" the ventilator. This fighting increases work of breathing and may cause furt her lung injury. Daily interruption of sedation is commonly helpful to the patie nt for reorientation and appropriate weaning. These interruptions are frequently described as "sedation vacations" and have been shown to reduce the time patien ts stay on mechanical ventilation. HYPERLINK "http://en.wikipedia.org/wiki/Mechan ical_ventilation" \l "cite_note-15#cite_note-15" [16] It is not uncommon for patients on a mechanical ventilator to be given a HYPERLI NK "http://en.wikipedia.org/wiki/Muscle_relaxant" \o "Muscle relaxant" muscle rel axant or paralytic to aid in ventilation. These "neuromuscular blockades" prevent skeletal muscle from contracting and thereby stop all patient movement includin g respiratory efforts. These types of pharmaceutical agents must always be given in conjunction with sedation as the effects of the paralytics is not only uncom fortable but would cause significant HYPERLINK "http://en.wikipedia.org/wiki/Psy

chological" \o "Psychological" psychological stress and HYPERLINK "http://en.wikip edia.org/wiki/Anxiety" \o "Anxiety" anxiety. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=32" \o "Edit section: Prophylaxis" edit] Prophylaxis To protect against ventilator-associated pneumonia, patients' beds are often ele vated to about 30. HYPERLINK "http://en.wikipedia.org/wiki/Deep_vein_thrombosis" \o "Deep vein thro mbosis" Deep vein thrombosis prophylaxis with HYPERLINK "http://en.wikipedia.org/w iki/Heparin" \o "Heparin" heparin or HYPERLINK "http://en.wikipedia.org/wiki/Seque ntial_compression_device" \o "Sequential compression device" sequential compressi on device is important in older children and adults. A histamine receptor (H2) blocker or proton-pump inhibitor may be used to preven t gastrointestinal bleeding, which has been associated with mechanical ventilati on [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=33" \o "Edit section: Modification of settings" edit] Modificatio n of settings In adults when 100% FiO2 is used initially, it is easy to calculate the next FiO 2 to be used and easy to estimate the shunt fraction. The estimated shunt fracti on refers to the amount of oxygen not being absorbed into the circulation. In no rmal physiology, gas exchange (oxygen/carbon dioxide) occurs at the level of the HYPERLINK "http://en.wikipedia.org/wiki/Alveoli" \o "Alveoli" alveoli in the lung s. The existence of a shunt refers to any process that hinders this gas exchange , leading to wasted oxygen inspired and the flow of un-oxygenated blood back to the left heart (which ultimately supplies the rest of the body with unoxygenated blood). When using 100% FiO2, the degree of shunting is estimated by subtracting the mea sured PaO2 (from an HYPERLINK "http://en.wikipedia.org/wiki/Arterial_blood_gas" \o "Arterial blood gas" arterial blood gas) from 700 mmHg. For each difference of 100 mmHg, the shunt is 5%. A shunt of more than 25% should prompt a search for t he cause of this hypoxemia, such as mainstem intubation or HYPERLINK "http://en. wikipedia.org/wiki/Pneumothorax" \o "Pneumothorax" pneumothorax, and should be tre ated accordingly. If such complications are not present, other causes must be so ught after, and PEEP should be used to treat this intrapulmonary shunt. Other su ch causes of a shunt include: Alveolar collapse from major HYPERLINK "http://en.wikipedia.org/wiki/Atelectasis " \o "Atelectasis" atelectasis Alveolar collection of material other than gas, such as pus from HYPERLINK "http ://en.wikipedia.org/wiki/Pneumonia" \o "Pneumonia" pneumonia, water and protein fr om HYPERLINK "http://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome" \o "Acute respiratory distress syndrome" acute respiratory distress syndrome, wate r from HYPERLINK "http://en.wikipedia.org/wiki/Congestive_heart_failure" \o "Con gestive heart failure" congestive heart failure, or blood from haemorrhage [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=34" \o "Edit section: When to withdraw mechanical ventilation" e dit] When to withdraw mechanical ventilation Withdrawal from mechanical ventilationalso known as weaningshould not be delayed u nnecessarily, nor should it be done prematurely. Patients should have their vent ilation considered for withdrawal if they are able to support their own ventilat ion and oxygenation, and this should be assessed continuously. There are several objective parameters to look for when considering withdrawal, but there is no s pecific criteria that generalizes to all patients. HYPERLINK "http://en.wikipedia.org/wiki/Spontaneous_breathing_trial" \o "Spontan eous breathing trial" Trials of spontaneous breathing have been shown to accuratel y predict the success of spontaneous breathing. HYPERLINK "http://en.wikipedia.or g/wiki/Mechanical_ventilation" \l "cite_note-16#cite_note-16" [17] [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=35" \o "Edit section: Respiratory monitoring" edit] Respiratory m onitoring HYPERLINK "http://en.wikipedia.org/wiki/File:FluxMed_Respiratory_Mechanics_Monit

or.jpg" INCLUDEPICTURE "http://upload.wikimedia.org/wikipedia/commons/thumb/f/f8/ FluxMed_Respiratory_Mechanics_Monitor.jpg/220px-FluxMed_Respiratory_Mechanics_Mo nitor.jpg" \* MERGEFORMATINET HYPERLINK "http://en.wikipedia.org/wiki/File:FluxMed_Respiratory_Mechanics_Monit or.jpg" \o "Enlarge" INCLUDEPICTURE "http://bits.wikimedia.org/skins-1.18/common/ images/magnify-clip.png" \* MERGEFORMATINET Respiratory mechanics monitor One of the main reasons why a patient is admitted to an ICU is for delivery of m echanical ventilation. Monitoring a patient in mechanical ventilation has many c linical applications: Enhance understanding of pathophysiology, aid with diagnos is, guide patient management, avoid complications and assessment of trends. HYPER LINK "http://en.wikipedia.org/wiki/Mechanical_ventilation" \l "cite_note-17#cite _note-17" [18] Most of modern ventilators have basic monitoring tools. There are also monitors that work independently of the ventilator, which allow to measure patients after the ventilator has been removed, such as a T tube test. [ HYPERLINK "http://en.wikipedia.org/w/index.php?title=Mechanical_ventilation&act ion=edit&section=36" \o "Edit section: Artificial airways as a connection to the ventilator" edit] Artificial airways as a connection to the ventilator Main article: HYPERLINK "http://en.wikipedia.org/wiki/Artificial_airway" \o "Art ificial airway" Artificial airway There are various procedures and mechanical devices that provide protection agai nst airway collapse, air leakage, and aspiration: HYPERLINK "http://en.wikipedia.org/wiki/Face_mask" \o "Face mask" Face mask In res uscitation and for minor procedures under anaesthesia, a face mask is often suff icient to achieve a seal against air leakage. Airway patency of the unconscious patient is maintained either by manipulation of the jaw or by the use of nasopha ryngeal or HYPERLINK "http://en.wikipedia.org/wiki/Oropharyngeal_airway" \o "Oro pharyngeal airway" oropharyngeal airway. These are designed to provide a passage o f air to the HYPERLINK "http://en.wikipedia.org/wiki/Pharynx" \o "Pharynx" pharyn x through the nose or mouth, respectively. Poorly fitted masks often cause nasal bridge ulcers, a problem for some patients. Face masks are also used for HYPERLI NK "http://en.wikipedia.org/wiki/Non-invasive_ventilation" \o "Non-invasive vent ilation" non-invasive ventilation in conscious patients. A full face mask does not , however, provide protection against aspiration. HYPERLINK "http://en.wikipedia.org/wiki/Laryngeal_mask_airway" \o "Laryngeal mas k airway" Laryngeal mask airway The laryngeal mask airway (LMA) causes less pain a nd coughing than a tracheal tube. However, unlike tracheal tubes it does not sea l against aspiration, making careful individualised evaluation and patient selec tion mandatory. HYPERLINK "http://en.wikipedia.org/wiki/Tracheal_intubation" \o "Tracheal intuba tion" Tracheal intubation is often performed for mechanical ventilation of hours t o weeks duration. A tube is inserted through the nose (nasotracheal intubation) or mouth (orotracheal intubation) and advanced into the HYPERLINK "http://en.wik ipedia.org/wiki/Vertebrate_trachea" \o "Vertebrate trachea" trachea. In most cases tubes with inflatable cuffs are used for protection against leakage and aspirat ion. Intubation with a cuffed tube is thought to provide the best protection aga inst aspiration. Tracheal tubes inevitably cause pain and coughing. Therefore, u nless a patient is unconscious or anaesthetized for other reasons, sedative drug s are usually given to provide tolerance of the tube. Other disadvantages of tra cheal intubation include damage to the mucosal lining of the HYPERLINK "http://e n.wikipedia.org/wiki/Nasopharynx" \o "Nasopharynx" nasopharynx or HYPERLINK "http: //en.wikipedia.org/wiki/Oropharynx" \o "Oropharynx" oropharynx and HYPERLINK "http ://en.wikipedia.org/wiki/Subglottic_stenosis" \o "Subglottic stenosis" subglottic stenosis. HYPERLINK "http://en.wikipedia.org/w/index.php?title=Esophageal_obturator_airway &action=edit&redlink=1" \o "Esophageal obturator airway (page does not exist)" Es ophageal obturator airway sometimes used by HYPERLINK "http://en.wikipedia.org/wi ki/Emergency_medical_technician" \o "Emergency medical technician" emergency medi cal technicians and basic EMS providers not trained to intubate. It is a tube whi

ch is inserted into the HYPERLINK "http://en.wikipedia.org/wiki/Esophagus" \o "E sophagus" esophagus, past the HYPERLINK "http://en.wikipedia.org/wiki/Epiglottis" \o "Epiglottis" epiglottis. Once it is inserted, a bladder at the tip of the airwa y is inflated, to block ("obturate") the esophagus, and oxygen is delivered thro ugh a series of holes in the side of the tube which is then forced into the lung s. HYPERLINK "http://en.wikipedia.org/wiki/Cricothyrotomy" \o "Cricothyrotomy" Crico thyrotomy Patients who require emergency airway management, in whom tracheal intu bation has been unsuccessful, may require an airway inserted through a surgical opening in the HYPERLINK "http://en.wikipedia.org/wiki/Cricothyroid_membrane" \o "Cricothyroid membrane" cricothyroid membrane. This is similar to a HYPERLINK "ht tp://en.wikipedia.org/wiki/Tracheostomy" \o "Tracheostomy" tracheostomy but a HYPE RLINK "http://en.wikipedia.org/wiki/Cricothyrotomy" \o "Cricothyrotomy" cricothyr otomy is reserved for emergency access. HYPERLINK "http://en.wikipedia.org/wiki/Me chanical_ventilation" \l "cite_note-18#cite_note-18" [19] HYPERLINK "http://en.wikipedia.org/wiki/Tracheostomy" \o "Tracheostomy" Tracheost omy When patients require mechanical ventilation for several weeks, a tracheostom y may provide the most suitable access to the trachea. A tracheostomy is a surgi cally created passage into the HYPERLINK "http://en.wikipedia.org/wiki/Vertebrat e_trachea" \o "Vertebrate trachea" trachea. Tracheostomy tubes are well tolerated and often do not necessitate any use of sedative drugs. Tracheostomy tubes may b e inserted early during treatment in patients with pre-existing severe respirato ry disease, or in any patient who is expected to be difficult to wean from mecha nical ventilation, i.e., patients who have little muscular reserve. Mouthpiece Less common interface, does not provide protection against aspiration . There are lipseal mouthpieces with flanges to help hold them in place if patie nt is unable.

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@ i 3 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / L a r y n g e a l _ m a s k _ a i r w a y < f 6 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / N o n - i n v a s i v e _ v e n t i l a t i o n A c % h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P h a r y n x h ` 2 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / O r o p h a r y n g e a l _ a i r w a y / O ] h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F a c e _ m a s k 0 V Z / h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A r t i f i c i a l _ a i r w a y r W X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 3 6 K > T 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n c i t e _ n o t e - 1 7 # c i t e _ n o t e - 1 7 & W N L h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F i l e : F l u x M e d _ R e s p i r a t o r y _ M e c h a n i c s _ M o n i t o r . j p g & W H L h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F i l e : F l u x M e d _ R e s p i r a t o r y _ M e c h a n i c s _ M o n i t o r . j p g r E X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 3 5 K ? B 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n c i t e _ n o t e - 1 6 # c i t e _ n o t e 1 6 \ ? 9 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / S p o n t a n e o u s _ b r e a t h i n g _ t r i a l r < X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 3 4 E 9 6 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / C o n g e s t i v e _ h e a r t _ f a i l u r e J / 6 A h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A c u t e _ r e s p i r a t o r y _ d i s t r e s s _ s y n d r o m e ( h 3 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o n i a F 0 ) h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A t e l e c t a s i s [ * h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o t h o r a x ) { * 0 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A r t e r i a l _ b l o o d _ g a s P % h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A l v e o l i r $ X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 3 3 7 b ! ; h t t p : / / e n . w i k i p e d i a . o r g / w i k i / S e q u e n t i a l _ c o m p r e s s i o n _ d e v i c e X % h t t p : / / e n . w i k i p e d i a . o r g / w i k i / H e p a r i n v 2 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / D e e p _ v e i n _ t h r o m b o s i s r X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 3 2 F % h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A n x i e t y - z + h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P s y c h o l o g i c a l N # - h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M u s c l e _ r e l a x a n t K <

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4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c l _ v e n t i l a t i o n c i t e _ n o t e - 1 5 # c i t e _ 5 ; j h t t p : / / e n . w i k i p e g / w i k i / A n a l g e s i a X & h t n . w i k i p e d i a . o r g / w i k i / S e d a t i o n X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o t & s e c t i o n = 3 1 4 9 h t t p : / / k i p e d i a . o r g / w i k i / V e n t i l a t i o n / p e r f u s a t i o / s h t t p : / / e n . w i k i . o r g / w i k i / H y p o x e m i a J / A : / / e n . w i k i p e d i a . o r g / w i k i / A c u t e _ r e s p r y _ d i s t r e s s _ s y n d r o m e r X : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e = 3 0 K = 4 h t t p : / / e n . w i k i p e r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n c i t e - 1 4 # c i t e _ n o t e - 1 4 K : 4 h t t p . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t o n c i t e _ n o t e - 1 3 # c i t e _ n o t e - 1 3 K ; 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c a l _ v e n t i l a t i o n c i t e _ n o t e - 1 2 # c i t e _ 1 2 w / 5 h t t p : / / e n . w i k i p e d i a . i k i / C e n t r a l _ v e n o u s _ p r e s s u r e , 0 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / S w a z _ c a t h e t e r ( d h t t p : / / e n p e d i a . o r g / w i k i / E l a s t a n c e z # : h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F u n c t _ r e s i d u a l _ c a p a c i t y t p > h / e n . w i k i p e d i a . o r g / w i k i / P o s i t i v e _ e n d r a t o r y _ p r e s s u r e s X h t t p : w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = s X h t t p : / / e n . w i k i p e d i a . o r g d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o i o n = e d i t & s e c t i o n = 2 8 F ) h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A t a s i s s X h t t p : / / e n . w i k i p o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e t i o n & a c t i o n = e d i t & s e c t i o n = 2 7 b @ 7 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / W i k a : C i t a t i o n _ n e e d e d b @ 7 h / e n . w i k i p e d i a . o r g / w i k i / W i k i p e d i a : C i n _ n e e d e d b @ 7 h t t p : / / e n . e d i a . o r g / w i k i / W i k i p e d i a : C i t a t i o n _ n e b @ 7 h t t p : / / e n . w i k i p e d i a w i k i / W i k i p e d i a : C i t a t i o n _ n e e d e d 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i i s s i v e _ h y p e r c a p n i a J / A h / e n . w i k i p e d i a . o r g / w i k i / A c u t e _ r e s p i r _ d i s t r e s s _ s y n d r o m e j . h / e n . w i k i p e d i a . o r g / w i k i / R e s p i r a t o r y _ x * h t t p : / / e n . w i k i p e d i a . o k i / T i d a l _ v o l u m e s X h t t p : w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = E & h t t p : / / d e . w i k i p e d i a . o r g / N o v a l u n g s X h t t p : / / e n . w d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 2 5

s ? h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P r e s s u r e _ r e g u l a t e d _ v o l u m e _ c o n t r o l F ) c t a s i s i a . o r g / w i 3 r a t o r y _ a l e n . w i k i p e p i r a t o r y _ / e n . w i k i p a n i c a l _ v e 4 L / w i k i / M e c e - p m i d 2 2 0 0 q i / C o n t i n u s w / i n d e x . p h p ? & a c t i o n = e d i t t t p : / / e n . w i k e n t i l a t i o n ? r C o n t i n u o u s _ s X . p h p ? t i t l e = M = e d i t & s e c t i o . w i k i p e d i a . o c a l _ v e n t i l a t ; . k i / H i g h - f r e q n i k i / H i g h - f r e 2 ; w i k i / H i g h - f r Q | H i g h - f r e q u e n s y d e x . p h p ? t i t l i o n = e d i t & s e c / / e n . w i k i p e d e d _ v o l u m e _ c o / e n . w i k i p e d i e d _ i n t e r m i t t p p n d e x . p h p ? t i t t i o n = e d i t & s e p : / / e n . w i k i p o l l e d _ c o n t i n p j i n d e x . p h p ? t i c t i o n = e d i t & s t p : / / e n . w i k i l l e d _ i n t e r m i p d / i n d e x . p h p ? t a c t i o n = e d i t & t p : / / e n . w i k i l l e d _ c o n t i n u e l e p e d s p i : / / f R e s p : / e c h n = 2 o r g n o t 2 7 w i k h t t p : ) i / A r t h t t p : a l o s i i a . o r 3 h t t l k a l o d i a . o t i l a t a n i c a 5 8 2 7 / { e / s g p s r i

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/ e n . w i k i p e d i a . o r g / w i k i / A t 0 h t t p : / / e n . w i k i r i a l _ b l o o d _ g a s f / e n . w i k i p e d i a . o r g / w i k i / R e , } ( h t t p / w i k i / H y p o c a p n i a : / / e n . w i k i p e d i a . o r g / w i k i / i s s X h t t g / w / i n d e x . p h p ? t i t l e = M o n & a c t i o n = e d i t & s e c t i o 4 h t t p : / / e n . w i k i p e d i a . l _ v e n t i l a t i o n 2 c i t e _ 0 # c i t e _ n o t e - p m i d 2 2 0 3 5 8 A h t t p : / / e n . w i k i p e d i a . o r g / s _ p o s i t i v e _ a i r w a y _ p r e s s u r e X h t t p : / / e n . w i k i p e d i a . o r g / t l e = M e c h a n i c a l _ v e n t i l a t i o n e c t i o n = 2 3 K 8 4 h e d i a . o r g / w i k i / M e c h a n i c a l _ v c i t e _ n o t e - 1 1 # c i t e _ n o t e - 1 1 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / n t a n e o u s _ v e n t i l a t i o n s t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x h a n i c a l _ v e n t i l a t i o n & a c t i o n 2 2 s X h t t p : / / e n / w / i n d e x . p h p ? t i t l e = M e c h a n i n & a c t i o n = e d i t & s e c t i o n = 2 1 D h t t p : / / e n . w i k i p e d i a . o r g / w i n c y _ o s c i l l a t o r y _ v e n t i l a t i o A h t t p : / / e n . w i k i p e d i a . o r g / e n c y _ v e n t i l a t i o n _ ( a c t i v e ) < h t t p : / / e n . w i k i p e d i a . o r g / u e n c y _ j e t _ v e n t i l a t i o n h t t p : / / e n . w i k i p e d i a . o r g / w i k i / _ v e n t i l a t i o n _ ( p a s s i v e ) X h t t p : / / e n . w i k i p e d i a . o r g / w / i n M e c h a n i c a l _ v e n t i l a t i o n & a c t o n = 2 0 s v ? h t t p : . o r g / w i k i / P r e s s u r e _ r e g u l a t r o l Q s T h t t p : / o r g / w i k i / P r e s s u r e _ c o n t r o l l t _ m a n d a t o r y _ v e n t i l a t i o n X h t t p : / / e n . w i k i p e d i a . o r g / w / i = M e c h a n i c a l _ v e n t i l a t i o n & a c i o n = 1 9 i ) m R h t t i a . o r g / w i k i / P r e s s u r e _ c o n t r u s _ m a n d a t o r y _ v e n t i l a t i o n X h t t p : / / e n . w i k i p e d i a . o r g / w / e = M e c h a n i c a l _ v e n t i l a t i o n & a t i o n = 1 8 m 2 g R h t d i a . o r g / w i k i / V o l u m e _ c o n t r o e n t _ m a n d a t o r y _ v e n t i l a t i o n X h t t p : / / e n . w i k i p e d i a . o r g / w l e = M e c h a n i c a l _ v e n t i l a t i o n & c t i o n = 1 7 J a P h t d i a . o r g / w i k i / V o l u m e _ c o n t r o s _ m a n d a t o r y _ v e n t i l a t i o n

^ E h t t p : / / e n . w i k i p e d i a . o r g / w i k i / N o m e n c l a t u r e _ f o r _ m e c h a n i c a l _ v e n t i l a t i o n J [ P h t t p : / / e n . w i k i p e d i a . o r g / w i k i / V o l u m e _ c o n t r o l l e d _ c o n t i n u o u s _ m a n d a t o r y _ v e n t i l a t i o n p X X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 6 X . U = h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M o d e s _ o f _ m e c h a n i c a l _ v e n t i l a t i o n p R X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 5 P O " h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P E E P p L X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 4 p I X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 3 N 1 F Q h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = I n s p i r a t o r y _ t i m e & a c t i o n = e d i t & r e d l i n k = 1 s C ? h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P r e s s u r e _ r e g u l a t e d _ v o l u m e _ c o n t r o l P @ . h t t p : / / e n . w i k i p e d i a . o r g / w i k i / H y p e r v e n t i l a t i o n E = - h t t p : / / e n . w i k i p e d i a . o r g / w i k i / H y p o v e n t i l a t i o n x : * h t t p : / / e n . w i k i p e d i a . o r g / w i k i / T i d a l _ v o l u m e + u 7 7 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P e a k _ i n s p i r a t o r y _ p r e s s u r e [ 4 . h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P r e s s u r e _ c o n t r o l 4 n 1 ( h t t p : / / e n . w i k i p e d i a . o r g / w i k i / B a r o t r a u m a V e n t i l a t o r _ i n d u c e d _ b a r o t r a u m a x . * h t t p : / / e n . w i k i p e d i a . o r g / w i k i / T i d a l _ v o l u m e J + P h t t p : / / e n . w i k i p e d i a . o r g / w i k i / V o l u m e _ c o n t r o l l e d _ c o n t i n u o u s _ m a n d a t o r y _ v e n t i l a t i o n p ( X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 2 j % . h t t p : / / e n . w i k i p e d i a . o r g / w i k i / R e s p i r a t o r y _ r a t e p " X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 1 p X h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 0 Z

/ h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A r t i f i c i a l _ a i r w a y j O h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = A n e s t h e s i a _ b a g & a c t i o n = e d i t & r e d l i n k = 1 " { , h t t p : / / e n . w i k i p e d i a . o r g / w i k i / B a g _ v a l v e _ m a s k g ; h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F i l e : B a l l o n _ v e n t i l a t i o n _ 1 . j p g g ; h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F i l e : B a l l o n _ v e n t i l a t i o n _ 1 . j p g y W h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 8 C 1 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 2 c i t e _ n o t e - p m i d 8 2 7 5 7 3 9 - 1 0 # c i t e _ n o t e - p m i d 8 2 7 5 7 3 9 - 1 0 ( h h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o n i a t h t t p : / / e n . w i k i p e d i a . o r g / w i k i / B r o n c h i a l L 7 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 2 c i t e _ n o t e - p m i d 1 2 4 7 2 3 2 8 - 9 # c i t e _ n o t e - p m i d 1 2 4 7 2 3 2 8 - 9 M 7 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 2 c i t e _ n o t e - p m i d 1 8 3 6 7 7 3 5 - 8 # c i t e _ n o t e - p m i d 1 8 3 6 7 7 3 5 - 8 F % h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A t r o p h y b 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n c i t e _ n o t e - 7 # c i t e _ n o t e - 7 J / A h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A c u t e _ r e s p i r a t o r y _ d i s t r e s s _ s y n d r o m e Q / h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A c u t e _ l u n g _ i n j u r y ? h t p : / / e n . w i k i p e d i a . o r g / w i k i / V e n t i l a t o r - a s s o c i a t e d _ l u n g _ i n j u r y b 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 0 c i t e _ n o t e - p m i d 8 4 2 0 7 2 0 - 6 # c i t e _ n o t e - p m i d 8 4 2 0 7 2 0 - 6 G . h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o p e r i t o n e u m " x / h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o m e d i a s t i n u m , N 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / S u b c u t a n e o u s _ e m p h y s e m a [ * h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o t h o r a x b 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 0 c i t e _ n o t e p m i d 8 4 2 0 7 2 0 - 6 # c i t e _ n o t e - p m i d 8 4 2 0 7 2 0 - 6 g 2 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P u l m o n a r y _ b a r o t r a u m a v W h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 7 9 | ; h t t p : / / e n . w i k i p e d i a . o r g /

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k i / A m y o t r o p h i c _ L a t e r a l _ S c l e r o s i s 0 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / s c u l a r _ D y s t r o p h y E 6 h t t p : / / . w i k i p e d i a . o r g / w i k i / C o n g e s t i v e _ h e a r t _ f l u r e r 1 h t t p : / / e n . w i k i p i a . o r g / w i k i / S h o c k _ ( c i r c u l a t o r y ) # $ h t t p : / / e n . w i k i p e d i a . o r g / w i k i / S p s i s Z ) h t t p : / / e n . w i k i p e d i a . r g / w i k i / H y p o t e n s i o n / s h t t : / / e n . w i k i p e d i a . o r g / w i k i / H y p o x e m i a ) ~ h t t p : / / e n . w i k i p e d i a . o r g / w i k i T a c h y p n e a N # - h t t p : / / e n . w i k p e d i a . o r g / w i k i / M u s c l e _ r e l a x a n t F ) h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A n a e t h e s i a V 0 ) h t t p : / / e n . w i k i p e i a . o r g / w i k i / S p i n a l _ c o r d 7 C / h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M y a s t h e n i a G r a v i s i W : h t t p : / / e n . w i k i p e i a . o r g / w i k i / G u i l l a i n - B a r r % C 3 % A 9 _ s y n d r o m # _ 0 h t t p : / / e n . w i k i p e d i a . o r g w i k i / T h o r a c i c _ d i a p h r a g m 2 h p : / / e n . w i k i p e d i a . o r g / w i k i / R e s p i r a t o r y _ a i d o s i s z C h t t p : / / e n . w i k i p e d i . o r g / w i k i / C h r o n i c _ o b s t r u c t i v e _ p u l m o n a r y d i s e a s e z C h t t p : / / e n . w i k i p e i a . o r g / w i k i / C h r o n i c _ o b s t r u c t i v e _ p u l m o n a y _ d i s e a s e l 4 h t t p : / / e n . w i k i e d i a . o r g / w i k i / S u b s t a n c e _ i n t o x i c a t i o n q # h t t p : / / e n . w i k i p e d i a . o r g / w i k / A p n e a J / A h t t p : / / e n . w i k i p e i a . o r g / w i k i / A c u t e _ r e s p i r a t o r y _ d i s t r e s s _ y n d r o m e & l $ h t t p : / / e n . w i k i p d i a . o r g / w i k i / B r e a t h w W h t t p : / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = x } * h t t p : / / e n . w i k i p e d i a . o r / w i k i / T i d a l _ v o l u m e ] z * h t t p : / e n . w i k i p e d i a . o r g / w i k i / T r a c h e o s t o m y $ r w [ h t t p : / / e n . w i k i p e d i a . o r g / w / i d e x . p h p ? t i t l e = M o d e r n _ v e n t i l a t i o n _ t h e r a p & a c t i o n = e d i t & r e d l i n k = 1 w J q 0 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F i l e : V I P _ B r d 2 . j p g w J k 0 h t t p : / / e n . w i k i p d i a . o r g / w i k i / F i l e : V I P _ B i r d 2 . j p g t h W h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = d i t & s e c t i o n = 5 E e : h t t p : / / e n w i k i p e d i a . o r g / w i k i / B i p h a s i c _ c u i r a s s _ v e n i l a t i o n H ? b Q h t t p : / / e n . w i k i p d i a . o r g / w / i n d e x . p h p ? t i t l e = O s c i l l a t i o n _ p m p & a c t i o n = e d i t & r e d l i n k = 1 : y _ + h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P o l y c a r b n a t e A \ % h t t p : / / e n . w i k i p e d i . o r g / w i k i / C u i r a s s " d Y $ h t t p / / e n . w i k i p e d i a . o r g / w i k i / O x f o r d ^ V 5 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / J o h n R a d c l i f f e _ H o s p i t a l : / S 3 h t t : / / e n . w i k i p e d i a . o r g / w i k i / S t _ T h o m a s % 2 7 _ H s p i t a l Y P % h t t p : / / e n . w i k i p e i a . o r g / w i k i / E n g l a n d d M * h t t

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2 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / A e r i c _ p r e s s u r e u G , h t t p : i k i p e d i a . o r g / w i k i / P l e u r a l _ c a v i t y D * h t t p : / / e n . w i k i p e d i a . o r g / w i _ e x c h a n g e v A ( h t t p : / / e n e d i a . o r g / w i k i / H u m a n _ l u n g & o > ' h t t p : / / e n . w i k i p e d i a . o r g / w i k i / D i f f s i o n : K ; , h t t p : / / e n . w i k i p e d a . o r g / w i k i / C a r b o n _ d i o x i d e * l 8 $ h t t p : / / e n . w i k i p e d i a . o r g / w i k i / O x y g e n ? n 5 $ h t t p : / / e n . w i k i p e d i a . o r g / w k i / G a s k e t T 2 " h t t p : / / e n . w i k i e d i a . o r g / w i k i / T a n k L / & h t t p : / e n . w i k i p e d i a . o r g / w i k i / E p i d e m i c 3 l # h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P o i o + T ) ' h t t p : / / e n . w i k i p e d i a o r g / w i k i / I r o n _ l u n g + T & ' h t t : / / e n . w i k i p e d i a . o r g / w i k i / I r o n _ L u n g h 8 h t t p : / / e n . w i k i p e d i a . o r g / w i k i F i l e : P o u m o n _ a r t i f i c i e l . j p g h h t t p : / / e n . w i k i p e d i a . o r g / w i k i / F i l e : P o u m n _ a r t i f i c i e l . j p g u W h t t p : / / e . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 4 0 V / h t t p : / / e n . w i k i p e d i a . o r g / w k i / A r t i f i c i a l _ a i r w a y + T ' h t p : / / e n . w i k i p e d i a . o r g / w i k i / I r o n _ l u n g

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3 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / L e a l _ m a s k _ a i r w a y h 2 h t t p . w i k i p e d i a . o r g / w i k i / O r o p h a r y n g e a l _ a x X V h t t p : / / e n . w i k i p e d i a w / i n d e x . p h p ? t i t l e = A r t i f i c i a l _ m a n a g e a c t i o n = e d i t & r e d l i n k = 1 ] * : / / e n . w i k i p e d i a . o r g / w i k i / T r a c h e o s t o m ; L + h t t p : / / e n . w i k i p e d i a . o r / w i k i / T r a c h e a l _ t u b e 0 V / h t p : / / e n . w i k i p e d i a . o r g / w i k i / A r t i f i c i a l _ a i w a y 0 V / h t t p : / / e n . w i k i p e d i . o r g / w i k i / A r t i f i c i a l _ a i r w a y " i ' h t t p : / / e n . w i k i p e d i a . o r g / w i k i / E s o p h a g u s - o $ h t t p : / / e n . w i k i p e d i a . o r g / w i k i / L a r y n x A % h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P h a r y n x 7 6 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / W i k i p e d i a : P l e a s e _ c l a r i f y | 4 1 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / I n t e n s i v e _ c a r e _ u n i t r W h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 3 C 4 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 2 c i t e _ n o t e - p m i d 2 2 0 3 5 8 2 8 - 5 # c i t e _ n o t e - p m i d 2 2 0 3 5 8 2 8 - 5 q , h t t p : / / e n . w i k i p e d i a . o r g / w i k i / I n t e n s i v e _ c a r e B 4 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n 2 c i t e _ n o t e - p m i d 2 2 0 0 8 3 9 7 - 4 # c i t e _ n o t e - p m i d 2 2 0 0 8 3 9 7 - 4 [ * h t t p : / / e n . w i k i p e d i a . o r g / w i k i / P n e u m o t h o r a x s W h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 2 b 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n ( c i t e _ n o t e - s m o t h e r - 3 # c i t e _ n o t e - s m o t h e r - 3 7 @ ( h t t p : / / e n . w i k i p e d i a . o r g / w i k i / G e o r g e _ P o e b 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n c i t e _ n o t e - R C P - 2 # c i t e _ n o t e - R C P - 2 ? S 0 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / V e r t e b r a t e _ t r a c h e a X & h t t p : / / e n . w i k i p e d i a . o r g / w i k i / V e s a l i u s b 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n ( c i t e _ n o t e - t o b i n 0 6 - 1 # c i t e _ n o t e - t o b i n 0 6 - 1 1 z # h t t p : / / e n . w i k i p e d i a . o r g / w i k i / G a l e n p W h t t p : / / e n . w i k i p e d i a . o r g / w / i n d e x . p h p ? t i t l e = M e c h a n i c a l _ v e n t i l a t i o n & a c t i o n = e d i t & s e c t i o n = 1 A p 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n E x t e r n a l _ l i n k s # E x t e r n a l _ l i n k s h Y 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n R e f e r e n c e s # R e f e r e n c e s M } 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n j A r t i f i c i a l _ a i r w a y s _ a s _ a _ c o n n e c t i o n _ t o _ t h e _ v e n t i l a t o r # A r t i f i c i a l _ a i r w a y s _ a s _ a _ c o n n e c t i o n _ t o _ t h e _ v e n t i l a t o r I l 4 h t t p : / / e n . w i k i p e d i a . o r g / w i k i / M e c h a n i c a l _ v e n t i l a t i o n . R r / r o e h y g t r a y / w r n t n e a g t t g n y / & p

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