Mechanical ventilation during anesthesia in adults
- Ralph Gertler, MD
Ralph Gertler, MD
- Executive senior physician
- Clinic for Anesthesiology, Intensive Care Medicine and Emergency Medicine
Mechanical ventilation is used during general anesthesia for patients with endotracheal tubes or supraglottic airways in place. This topic will discuss the modes of ventilation, ventilator settings, and lung protective ventilation during anesthesia. The deleterious effects of mechanical ventilation are discussed in detail separately. (See "Ventilator-associated lung injury" and "Physiologic and pathophysiologic consequences of mechanical ventilation" and "Inflammatory mechanisms of lung injury during mechanical ventilation".)
Strategies for mechanical ventilation for specific patient populations and surgical procedures are also discussed separately. (See "Anesthesia for laparoscopic and abdominal robotic surgery in adults", section on 'Mechanical ventilation' and "Anesthesia for the obese patient", section on 'Ventilation management' and "Anesthesia for patients with chronic obstructive pulmonary disease", section on 'Mechanical ventilation' and "General principles of one lung ventilation", section on 'Ventilation strategies'.)
MODES OF INTRAOPERATIVE MECHANICAL VENTILATION
Ventilators on anesthesia work stations increasingly allow modes of ventilation with most, but not all, of the capabilities of ventilators used in the intensive care unit (ICU). Terminology for the modes of ventilation is not standardized, and comparison between the technologies available in the ICU and in the operating room can be confusing. The modes of assisted and controlled ventilation that are available with most anesthesia machines are discussed here. Modes of ventilation in the intensive care unit are discussed separately. (See "Modes of mechanical ventilation".)
Volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) are the basic modes of controlled mechanical ventilation used during general anesthesia. Pressure support and pressure control with volume guarantee (PV-VG) are also available on newer anesthesia machines.
Volume-controlled ventilation — Volume-controlled ventilation (VC) is also called volume-limited, or volume-cycled ventilation. At a minimum, the clinician sets the tidal volume and respiratory rate (and thus the minute ventilation), and the ventilator delivers the tidal volume at a constant flow rate. Advantages of VCV are that the set minute ventilation is essentially guaranteed (unless peak pressures exceed the set limit), and the fact that VCV is a commonly used technique, familiar to clinicians. However, VCV is associated with higher peak pressure for a given inspired volume, compared with PCV. Barotrauma is possible, and gas distribution in the lung may be uneven, particularly in patients with lung disease.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- MODES OF INTRAOPERATIVE MECHANICAL VENTILATION
- Volume-controlled ventilation
- Pressure controlled ventilation
- Pressure control with volume guarantee
- Pressure support
- Synchronized intermittent mandatory ventilation modes
- CHOICE OF MODE OF VENTILATION
- FRACTION OF INSPIRED OXYGEN
- GOAL END TIDAL CARBON DIOXIDE
- RESPIRATORY RATE
- INSPIRATORY TO EXPIRATORY RATIO
- MONITORING PULMONARY MECHANICS
- Pressure volume loops
- Flow volume loops
- LUNG PROTECTIVE VENTILATION DURING ANESTHESIA
- Pulmonary effects of general anesthesia
- Our approach
- Components of intraoperative lung protective ventilation
- Tidal volume
- Plateau pressure
- Positive end expiratory pressure
- Recruitment maneuvers
- NONINVASIVE VENTILATION
- CRITICALLY ILL PATIENTS
- SUMMARY AND RECOMMENDATIONS