Physiologic and pathophysiologic consequences of mechanical ventilation
- Robert C Hyzy, MD
Robert C Hyzy, MD
- Professor of Medicine
- University of Michigan Medical Center
Mechanical ventilation can be performed using positive pressure or negative pressure. Positive pressure ventilation is the primary type of mechanical ventilation used today. During positive pressure ventilation, the ventilator forces air into the central airways and the resulting pressure gradient causes airflow into the small airways and alveoli. (See "Overview of mechanical ventilation", section on 'Types of breaths'.)
Physiologic and pathophysiologic consequences of positive pressure ventilation are discussed in this topic review. Two major consequences of positive pressure ventilation, pulmonary barotrauma and ventilator-associated lung injury, are reviewed separately. (See "Diagnosis, management, and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults" and "Ventilator-associated lung injury".)
Barotrauma — Pulmonary barotrauma is a well-known complication of positive pressure ventilation. Consequences include pneumothorax, subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. Pulmonary barotrauma during mechanical ventilation is discussed separately. (See "Diagnosis, management, and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults".)
Ventilator-associated lung injury — Ventilator-associated lung injury (VALI) refers to acute lung injury that occurs during mechanical ventilation. It is clinically indistinguishable from acute lung injury or acute respiratory distress syndrome (ALI/ARDS) due to other causes. VALI is discussed separately. (See "Ventilator-associated lung injury".)
Auto-PEEP — Auto-positive end-expiratory pressure (auto-PEEP, also called intrinsic PEEP) exists when there is positive airway pressure at the end of expiration due to incomplete exhalation . In other words, inspiration is initiated before expiratory airflow from the preceding breath has ceased. (See "Positive end-expiratory pressure (PEEP)".)
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- PULMONARY EFFECTS
- Ventilator-associated lung injury
- - Causes
- - Detection
- - Consequences
- - Treatment
- Heterogeneous ventilation
- Ventilation/perfusion mismatch
- - Increased dead space
- - Reduced shunt
- Respiratory muscles
- Mucociliary motility
- SYSTEMIC EFFECTS
- - Monitoring
- Central nervous system
- Immune system
- SUMMARY AND RECOMMENDATIONS