Critical Care Fundamentals: Basics of Mechanical Ventilation Part 1

Mechanical Ventilation is a modality commonly used in the critically ill, but many providers, may not have a strong understanding of the basics of mechanical ventilation. Emergency Medicine and Critical Care Physicians need to have a firm grasp of the basic concepts of mechanical ventilation because without it, we can do serious harm to our patients. Airway management is not complete once the endotracheal tube is placed through the cords, and the proper selection of both the ventilator mode and initial settings is essential to ensure your patient has the best possible outcomes. You should not simply rely on the respiratory therapist to know your patients physiology. Clear communication with your therapist about the patient’s physiology and initial ventilator setting is crucial.

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The Basics of Mechanical Ventilation: Part 1

Goals of MV:

1. Provide patient comfort
2. Decrease WOB/Allow spontaneous breathing
3. Adequate gas exchange (Oxygenation & Ventilation)
4. Minimize Ventilator Induced Lung Injury

Oxygenation: Works by simple diffusion

1. Fi02 (caution >60%)
2. PEEP
3. Inspiratory Time

Mean Airway Pressure

Ventilation: Convection: Works by convection

1. Respiratory Rate
2. Tidal Volume (limit to 4-8 mL/Kg PBW)
3. Expiratory Time

Minute Ventilation = RR x Vt

Complications:

1. Ventilator Induced Lung Injury: Volutrauma, Barotrauma, Atelectotrauma ,Biotrauma, 02 Toxicity
2. Hemodynamic Consequences: Decreased Preoad, Increased RV afterload, Decreased LV afterload

For More on this Topic Checkout:

• Frank Lodeserto at REBEL EM: Simplifying Mechanical Ventilation – Part I
• Frank Lodeserto at REBEL EM: Simplifying Mechanical Ventilation Part 2 – Goals of Mechanical Ventilation & Factors Controlling Oxygenation and Ventilation
• Frank Lodeserto at REBEL EM: Simplifying Mechanical Ventilation Part 3 – Severe Metabolic Acidosis
• Frank Lodeserto at REBEL EM: Simplifying Mechanical Ventilation Part 4 – Obstructive Physiology
• Frank Lodeserto at REBEL EM: Simplifying Mechanical Ventilation Part 5 – Refractory Hypoxemia & APRV
• Frank Lodeserto at REBEL EM: Simplifying Mechanical Ventilation Part 6 – Choosing Your Initial Settings

Critical Care Education Curriculum

Please watch Critical Care Fundamentals – Mechanical Ventilation Part 2 as well

Mechanical Ventilation – Educational Reinforcement Material

Mechanical Ventilation – Supplemental Educational Material

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

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