Mechanical ventilation indications for use
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Indications for Use
The indications of the mechanical ventilation is as follows:[1][2]
Mechanical ventilation is indicated when the patient's spontaneous ventilation is inadequate to maintain life. It is also indicated as prophylaxis for the imminent collapse of other physiologic 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 resolve over time. In addition, other factors must be taken into consideration because mechanical ventilation is not without its complications.
Common indications for mechanical ventilation include the following:
- Bradypnea
- Apnea with respiratory arrest including cases from intoxication
- Acute lung injury and the acute respiratory distress syndrome
- Tachypnea (respiratory rate >30 breaths per minute)
- Vital capacity less than 15 mL/kg
- Minute ventilation greater than 10 L/min
- Reduced respiratory drive
- Chest wall abnormalities
- Respiratory muscle fatigue
- Intrapulmonary shunt
- Ventilation-perfusion mismatch
- Decreased FRC
- Arterial partial pressure of oxygen (PaO 2) with a supplemental fraction of inspired oxygen (FIO 2) of less than 55 mm Hg
- Alveolar-arterial gradient of oxygen tension (A-a DO 2) with 100% oxygenation of greater than 450 mm Hg
- Clinical deterioration
- Respiratory muscle fatigue
- Coma
- Hypotension due to sepsis, shock, CHF
- Acute partial pressure of carbon dioxide (PaCO 2) greater than 50 mm Hg with an arterial pH less than 7.25
- Acute lung injury (including ARDS, trauma)
- Chronic obstructive pulmonary disease (COPD)
- Acute respiratory acidosis with
- Partial pressure of carbon dioxide (pCO2) > 50 mmHg
- pH < 7.25, which may be due to paralysis of the diaphragm due to
- Guillain-Barré syndrome
- Myasthenia Gravis
- spinal cord injury
- The effect of anaesthetic and muscle relaxants
- Increased work of breathing as evidenced by significant tachypnea, retractions, and other physical signs of respiratory distress
- Hypoxemia with arterial partial pressure of oxygen (PaO2) with supplemental fraction of inspired oxygen (FiO2) < 55 mm Hg
- Neuromuscular disease
References
- ↑ Tung A (1997). "Indications for mechanical ventilation". Int Anesthesiol Clin. 35 (1): 1–17. PMID 9113518.
- ↑ Kreppein U, Litterst P, Westhoff M (2016). "[Hypercapnic respiratory failure. Pathophysiology, indications for mechanical ventilation and management]". Med Klin Intensivmed Notfmed (in German). 111 (3): 196–201. doi:10.1007/s00063-016-0143-2. PMID 26902369.