The indications for heliox during mechanical ventilation are lower-airway obstruction, especially with hypercarbia; need to enhance aerosol delivery to lung periphery; and need to facilitate weaning from mechanical ventilation. Certain ventilators perform relatively well with heliox and are not substantially affected by it. It is preferable to connect the heliox to the air inlet of the ventilat...

Approximately 20% of all mechanically ventilated patients fail their first attempt to wean. Prolonged mechanical ventilation increases morbidity, mortality, and costs. No single weaning parameter predicts patient ability to wean. Weaning studies suggest that daily trials of spontaneous breathing for appropriate patients assured by standing protocol and driven by respiratory care practitioners a...

OBJECTIVE To review a large population of children receiving mechanical ventilation to establish a baseline rate of extubation success and failure and to identify those characteristics that place a patient at greater risk of failing planned extubation. DESIGN Retrospective chart review. SETTING University-affiliated children's hospital with a 20-bed pediatric ICU. PATIENTS All 632 patient...

Although the majority of patients can be easily weaned from mechanical ventilation, a substantial minority pose considerable difficulty. These patients account for a disproportionate amount of health care costs, and they pose enormous clinical, economic, and ethical problems. The major determinants of weaning outcome include the adequacy of pulmonary gas exchange, respiratory muscle pump functi...

Definition and goals ofhome mechanical ventilation Born during the polio epidemics of 50 years ago, home mechanical ventilation has evolved towards two distinct concepts-a life support system for patients without respiratory independence (high cervical spinal cord injury, end stage neuromuscular disease, or chronic obstructive pulmonary disease), and elective therapy for patients with progressi...

The prognostic assessment of patients requiring mechanical ventilation has two important aspects. Firstly, it has sound therapeutic implications, derived from a better understanding of the factors influencing outcome. Secondly, it has important ethical implications, in helping to identify the patients who are not likely to benefit from mechanical ventilation. In these patients, the use of mecha...

PURPOSE OF REVIEW A critical review of the most recent literature regarding use and clinical indications of noninvasive mechanical ventilation (NIV). RECENT FINDINGS According to several randomized controlled trials, NIV has gained acceptance as the preferred ventilatory modality to treat acute respiratory failure (ARF) due to chronic obstructive pulmonary disease exacerbations, cardiogenic p...

INTRODUCTION — Conventional mechanical ventilation refers to the delivery of full or partial ventilatory support by a volume-cycled mechanical ventilator or by pressure support. It also can include the maintenance of positive airway pressure at the end of exhalation, ie, positive end-expiratory pressure (PEEP) [1]. (See "Physiologic and pathophysiologic consequences of positive pressure ventila...

Patients requiring prolonged mechanical ventilation are rapidly increasing in number. Improved ICU care has resulted in many patients surviving acute respiratory failure to require prolonged mechanical ventilation during convalescence. Also, mechanical ventilation is increasingly used as a therapeutic option for patients with symptomatic chronic hypoventilation, with an increased effort to pre...

Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined ...