Principles of Mechanical Ventilation

Mechanical ventilation (MV) is central to critical care and came into routine practice after the polio outbreak in the mid-20th century. A contemporary mechanical ventilator is a device made to deliver breaths using positive pressure (pressure above atmospheric level). The technology, initially mostly mechanical, has become increasingly electronic-based and sophisticated in efforts to improve patient comfort and synchrony, as well as to enhance monitoring. The skills required to understand and master MV have also expanded significantly as has our knowledge of the pathophysiology of respiratory failure and of the risks and complications of MV. MV is used for many indications, mainly for respiratory failure either from pulmonary or extrapulmonary causes, as well as during anesthesia for interventions. This chapter summarizes the principles of mechanical ventilation; the respiratory physiology, most frequent modes used in pediatric patients, patient-ventilator interactions, advanced respiratory monitoring, and complications associated with MV. Disease-specific considerations for MV as well as weaning from MV are also addressed..