Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV) is the medical

term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical
ventilation helps move air into and out of the lungs, with the main goal of helping the delivery of oxygen
and removal of carbon dioxide. Mechanical ventilation is used for many reasons, including to protect the
airway due to mechanical or neurologic cause, to ensure adequate oxygenation, or to remove excess
carbon dioxide from the lungs. Various healthcare providers are involved with the use of mechanical
ventilation and people who require ventilators are typically monitored in an intensive care unit.

Mechanical ventilation is termed invasive if it involves an instrument to

create an airway that is placed inside the trachea. This is done through an endotracheal tube or
nasotracheal tube.[1]

For non-invasive ventilation in people who are conscious, face or nasal masks are used.

The two main types of mechanical ventilation include positive pressure ventilation where air is pushed
into the lungs through the airways, and negative pressure ventilation where air is pulled into the lungs.
There are many specific modes of mechanical ventilation, and their nomenclature has been revised over
the decades as the technology has continually developed

Settings for mechanical ventilation:

In general, the clinician can determine the following parameters for mechanical ventilation:

Respiratory rate: normal 10-16

Tidal Volume: amount of volume with each mechanical breath (mL per breath)

Oxygen concentration: 20-100%

Positive End Expiration Pressure (PEEP): amount of pressure at the end of the expiration that helps keep
alveoli open for O2/CO2 exchange (typically 5-20mmHg) Most patients should have at least a PEEP of 5
to start. Obese or larger patients may need more PEEP.

Pressure Support ventilation: a mode of ventilation that adjusts the amount of pressure used to keep
the large airways open (typically 5-15mmHg), which helps to decrease the work of breathing

Continuous mechanical ventilation (CMV): a full breath is given each time the patient initiates a breath

Indications for mechanical ventilation:

Use of mechanical ventilation is indicated for when patients cannot maintain a patent airway (after
trauma, severe altered mental status, intoxicants), have acute respiratory failure (resulting from sepsis
or conditions like pancreatitis), have compromised lung function (from conditions like pneumonia or
cystic fibrosis), and have difficulty breathing (weakness from frailty, pain from fracture ribs).

Other indications are;

Surgical procedures

Acute lung injury, including acute respiratory distress syndrome (ARDS),[7] trauma, or COVID-19

Pneumonia

Pulmonary hemorrhage

Apnea with respiratory arrest

Hypoxemia

Acute severe asthma requiring intubation

Obstruction, such as a tumor

Acid/base derangements such as respiratory acidosis

Neurological diseases such as muscular dystrophy, amyotrophic lateral sclerosis (ALS), Guillain–Barré
syndrome, myasthenia gravis, etc.

Newborn premature infants with neonatal respiratory distress syndrome

Respiratory failure due to paralysis of the respiratory muscles caused by botulism[10]