Modes of mechanical ventilation

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Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional preferences, since there is a paucity of evidence indicating that the mode affects clinical outcome. The most frequently used forms of volume-limited mechanical ventilation are intermittent mandatory ventilation (IMV) and continuous mandatory ventilation (CMV). There have been substantial changes in the nomenclature of mechanical ventilation over the years, but more recently it has become standardized by many respirology and pulmonology groups. Writing a mode is most proper in all capital letters with a dash between the control variable and the strategy (i.e. PC-IMV, or VC-MMV etc.). The taxonomy is a logical classification system based on 10 maxims of ventilator design A breath is one cycle of positive flow (inspiration) and negative flow (expiration) defined in terms of the flow-time curve. Inspiratory time is defined as the period from the start of positive flow to the start of negative flow. Expiratory time is defined as the period from the start of expiratory flow to the start of inspiratory flow. The flow-time curve is the basis for many variables related to ventilator settings. A breath is assisted if the ventilator does work on the patient. An assisted breath is one for which the ventilator does some portion of the work of breathing. For constant flow inflation, work is defined as inspiratory pressure multiplied by tidal volume. Therefore, an assisted breath is identified as a breath for which airway pressure (displayed on the ventilator) rises above baseline during inspiration. An unassisted breath is one for which the ventilator simply provides the inspiratory flow demanded by the patient and pressure stays constant throughout the breath. A ventilator assists breathing using either pressure control or volume control based on the equation of motion for the respiratory system.

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Negative pressure ventilator

A negative pressure ventilator (NPV) is a type of mechanical ventilator that stimulates an ill person's breathing by periodically applying negative air pressure to their body to expand and contract the chest cavity. In most NPVs (such as the iron lung in the diagram), the negative pressure is applied to the patient's torso, or entire body below the neck, to cause their chest to expand, expanding their lungs, drawing air into the patient's lungs through their airway, assisting (or forcing) inhalation.

Positive airway pressure

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well.

Ventilator

A ventilator is a type of breathing apparatus, a class of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators may be computerized microprocessor-controlled machines, but patients can also be ventilated with a simple, hand-operated bag valve mask. Ventilators are chiefly used in intensive-care medicine, home care, and emergency medicine (as standalone units) and in anesthesiology (as a component of an anesthesia machine).

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