In most patients who are ventilated, the tidal volume should be 4 to 8 mL/kg predicted body weight (PBW) and the plateau pressure should be less than 30 cm H 2O, and PEEP should be set to avoid the collapse of unstable lung units. Ventilator-induced lung injury is primarily caused by localized overdistension and the opening and closing of unstable lung units.

In most critically ill patients, a Pa O 2 of 60 mm Hg or higher is acceptable, and permissive hypercapnia may be useful in treating some patients. It is unnecessary to achieve normal Pa O 2 and Pa CO 2. The 2 basic forms of mechanical ventilation are pressure ventilation (peak airway pressure constant, tidal volume variable) and volume ventilation (tidal volume constant, peak airway pressure variable).Īlthough numerous modes of ventilation exist, few data are available to differentiate the benefits of one mode over another, and no mode has been shown to improve patient outcome.Ī major concern during assisted ventilation is patient–ventilator synchrony-the ventilator should be set to match the patient's ventilatory demands.Īuto positive end-expiratory pressure (PEEP) is a common cause of patient–ventilator dyssynchrony in patients with obstructive lung disease, properly set applied PEEP can improve synchrony and decrease patient efforts to ventilate.

Patients require mechanical ventilation because of apnea, acute or impending acute respiratory failure, or severe refractory hypoxemia.

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