Mechanical ventilation in critically ill patients - a practical guide

Mechanical ventilation is an essential part in the treatment of patients with respiratory insufficiency to achieve adequate oxygenation and decarboxylation during respiratory failure. Critically ill patients with preserved protective reflexes and sufficient alertness benefit from non-invasive mechanical ventilation by facial mask or helmet due to a reduced breathing effort and an improved pulmonary gas-exchange. With respect to "invasive" ventilation, pressure-controlled or pressure-assisted modes are preferable and allow additional spontaneous breathing. Ventilator settings are adjusted by interpretation of arterial blood-gas analysis with application of adequate PEEP levels and low inspiratory pressures. Weaning from mechanical ventilation may be difficult and can be supported by a standardized weaning protocol with daily spontaneous breathing trials.