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Physiologic and pathophysiologic consequences of mechanical ventilation

Author
Robert C Hyzy, MD
Section Editor
Polly E Parsons, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

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".)

PULMONARY EFFECTS

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 [1]. 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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Literature review current through: Nov 2016. | This topic last updated: Fri Jul 15 00:00:00 GMT+00:00 2016.
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References
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  1. Pepe PE, Marini JJ. Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect. Am Rev Respir Dis 1982; 126:166.
  2. Rossi A, Polese G, Brandi G, Conti G. Intrinsic positive end-expiratory pressure (PEEPi). Intensive Care Med 1995; 21:522.
  3. Younes M, Kun J, Webster K, Roberts D. Response of ventilator-dependent patients to delayed opening of exhalation valve. Am J Respir Crit Care Med 2002; 166:21.
  4. Lessard MR, Lofaso F, Brochard L. Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 1995; 151:562.
  5. Kress JP, O'Connor MF, Schmidt GA. Clinical examination reliably detects intrinsic positive end-expiratory pressure in critically ill, mechanically ventilated patients. Am J Respir Crit Care Med 1999; 159:290.
  6. Valta P, Corbeil C, Chassé M, et al. Mean airway pressure as an index of mean alveolar pressure. Am J Respir Crit Care Med 1996; 153:1825.
  7. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358:1327.
  8. Jaber S, Petrof BJ, Jung B, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med 2011; 183:364.
  9. Picard M, Jung B, Liang F, et al. Mitochondrial dysfunction and lipid accumulation in the human diaphragm during mechanical ventilation. Am J Respir Crit Care Med 2012; 186:1140.
  10. Konrad F, Schreiber T, Brecht-Kraus D, Georgieff M. Mucociliary transport in ICU patients. Chest 1994; 105:237.
  11. Qvist J, Pontoppidan H, Wilson RS, et al. Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 1975; 42:45.
  12. Fougères E, Teboul JL, Richard C, et al. Hemodynamic impact of a positive end-expiratory pressure setting in acute respiratory distress syndrome: importance of the volume status. Crit Care Med 2010; 38:802.
  13. Bersten AD, Holt AW, Vedig AE, et al. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991; 325:1825.
  14. Marini JJ, O'Quin R, Culver BH, Butler J. Estimation of transmural cardiac pressures during ventilation with PEEP. J Appl Physiol Respir Environ Exerc Physiol 1982; 53:384.
  15. Teboul JL, Pinsky MR, Mercat A, et al. Estimating cardiac filling pressure in mechanically ventilated patients with hyperinflation. Crit Care Med 2000; 28:3631.
  16. Teboul, JL, Besbes, M, Andrivet, P, et al. A bedside index assessing the reliability of pulmonary artery occlusion pressure measurements during mechanical ventilation with positive end-expiratory pressure. J Crit Care 1992; 7:22.
  17. De Backer D. The effects of positive end-expiratory pressure on the splanchnic circulation. Intensive Care Med 2000; 26:361.
  18. Kiefer P, Nunes S, Kosonen P, Takala J. Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. Intensive Care Med 2000; 26:376.
  19. Dive A, Moulart M, Jonard P, et al. Gastroduodenal motility in mechanically ventilated critically ill patients: a manometric study. Crit Care Med 1994; 22:441.
  20. Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest 2001; 119:1222.
  21. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294:813.
  22. Kuiper JW, Groeneveld AB, Slutsky AS, Plötz FB. Mechanical ventilation and acute renal failure. Crit Care Med 2005; 33:1408.
  23. González-López A, López-Alonso I, Aguirre A, et al. Mechanical ventilation triggers hippocampal apoptosis by vagal and dopaminergic pathways. Am J Respir Crit Care Med 2013; 188:693.
  24. Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007; 131:1541.
  25. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373:1874.
  26. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 1999; 282:54.
  27. Nahum A, Hoyt J, Schmitz L, et al. Effect of mechanical ventilation strategy on dissemination of intratracheally instilled Escherichia coli in dogs. Crit Care Med 1997; 25:1733.
  28. Cooper AB, Thornley KS, Young GB, et al. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000; 117:809.
  29. Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care 2013; 17:R46.
  30. Drouot X, Roche-Campo F, Thille AW, et al. A new classification for sleep analysis in critically ill patients. Sleep Med 2012; 13:7.
  31. Gabor JY, Cooper AB, Crombach SA, et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003; 167:708.
  32. Parthasarathy S, Tobin MJ. Effect of ventilator mode on sleep quality in critically ill patients. Am J Respir Crit Care Med 2002; 166:1423.
  33. Cabello B, Thille AW, Drouot X, et al. Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes. Crit Care Med 2008; 36:1749.
  34. Rittayamai N, Wilcox E, Drouot X, et al. Positive and negative effects of mechanical ventilation on sleep in the ICU: a review with clinical recommendations. Intensive Care Med 2016; 42:531.
  35. Hamburg NM, McMackin CJ, Huang AL, et al. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler Thromb Vasc Biol 2007; 27:2650.
  36. Clavet H, Hébert PC, Fergusson D, et al. Joint contracture following prolonged stay in the intensive care unit. CMAJ 2008; 178:691.
  37. Peterson M, Schwab W, McCutcheon K, et al. Effects of elevating the head of bed on interface pressure in volunteers. Crit Care Med 2008; 36:3038.