Talk:Mechanical ventilation

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Dead links and mild confusion[edit]

At least ASB is a dead end link, others may be as well but I am a wikipedia rookie and don't have the time to check them all. Some of these terms are very new to me (a medic with 8+ years experience). Perhaps the "old" terms could be listed more clearly in the article? I came to reasearch PSV and only found a reference to it in the links section (which directed me to the dead link). ~wikiRookie 11/8/09

Old, unsectioned comments[edit]

victims can no longer breathe easily or cough to clear their lungs of dangerous mucus. Typically, these patients get a tracheotomy - a tube inserted through a hole drilled in the throat so air can be pumped in and secretions suctioned out. The opening is vulnerable to lethal bacteria and patients routinely get pneumonia. Often, they can't speak. Constant care to keep the tubes open forces many into nursing homes.

There is a noninvasive alternative that few doctors offer, contends Dr. John Bach of the University of Medicine and Dentistry of New Jersey. The key is a 1952 machine called the Cof-flator that, when held to the mouth, sucks air from the bronchial tubes to induce a cough that patients can't force unaided.

Once patients can clear their lungs, they can breathe with standard oxygen masks or with an easily learned inhaling technique

I wonder where this can be inserted into this article...
~ender 2003-09-10 02:11:MST

Cof-flator[edit]

Sucking air out of the lungs can cause lung collapse. A device called the Hayek RTX which has a secretion clearance mode has been shown to be at least if not more effective, without any of the problems of the cof-later, an old out dated technology. —Preceding unsigned comment added by 217.34.149.45 (talk) 11:16, 12 September 2007 (UTC)


removed from article: This process usually also stabilizes patients' heart rhythyms, so in many cases, a ventilator is sufficient to keep a patient with a severely damaged body alive. This is, at least, very vague. Perhaps this sentence refers to the life-saving properties of ventilation in severe hypoxemic states? Anyway, needs to be clarified before it can go into the introduction. Kosebamse 07:57, 9 Oct 2003 (UTC)

Mechanical vs. hand ventilation[edit]

Have just put a wee bit about Vesalius and his method of inflating (animal lungs) in the history. On re-reading I feel that the history is focused on the mechanical aspects (i.e. machine-based) rather than the ventilation bit. I was going to add a bit about Lassen's work in Copenhagen during the polio epidemic which involved intubating patients due to the lack of iron lungs. Do people think this would be appropriate here? Anyone bothered if I re-jig the history bit to add a bit on manual (as opposed to mechanical) ventilation?Mmoneypenny 18:22, 16 September 2006 (UTC)

On second thoughts, what about renaming this page "Artificial ventilation" because that's what being described and the term encompasses manual and mechanical ventilation. What do YOU think? Yeah, you, with the blue eyes, glasses...Mmoneypenny 18:45, 16 September 2006 (UTC)

Requested move[edit]

The following discussion is an archived debate of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the debate was Not moved. —Centrxtalk • 04:47, 6 October 2006 (UTC) Mechanical ventilationArtificial ventilation – Artificial ventilation is an umbrella term for mechanical and hand ventilation, the current article covers both terms but is called Mechanical Ventilation Mmoneypenny 16:59, 17 September 2006 (UTC)

Survey[edit]

  • Strongly oppose. If it has already been relisted, and still nobody cares, don't be messing around with it forever. Gene Nygaard 15:47, 2 October 2006 (UTC)
  • Stongly support. Somebody does care! Me! And we aren't messing around forever. This is a simple name change for the article, which actually suits the article better and makes sense! (Apologies for the many exclamation marks!) I'd do it myself but artificial ventilation already exists.Mmoneypenny 17:51, 2 October 2006 (UTC)
  • If nobody but you, the original nominator, cares, and it has already been relisted, then there obviously isn't any crying need for a change. The closers at RM ought to have more sense than to drag these things on forever. Just close it out, and if after a sufficient period of time has passed the development of the articles may make the reasoning sensible enough that you'd actually get some support. Gene Nygaard 02:57, 3 October 2006 (UTC)
  • oppose. "artificial", as opposed to "natural" or medicaly speaking "spontaneaous" breathing describes every external way ta assist non or partialy breathing subjects. No doubt the term "artificial ventilation" is legitimate but limitates the options and was indead widely used in France, for example, until the late 90's. Todays consensus is to define by "mechanical ventilation" all means to support one's breathing with any external device,electricaly powered or not. eliemalka 09:43, 5 October 2006 (UTC)

Discussion[edit]

  • I think there should be a clarifier. "Artificial ventilation (medicine)", say. -- Beardo 22:05, 2 October 2006 (UTC)
  • Yes, I think that is a good idea--which could involve just creating an article there without moving this one. There isn't any indicator in the current to article name to suggest that is what these deal with, and maybe making this one broader than medicine, incorporating and expanding the disambiguation lines at the top, or changing the disamb line to just a link to the disambiguation page at ventilation and including it there. The "mechanical" adjective is used in many contexts other than medicine, whereas "artificial" is likely less used outside medicine. Gene Nygaard 04:00, 3 October 2006 (UTC)
There is also a mechanical ventilator redirect to medical ventilator that needs to be considered (switching the redirects is apparently why the nominator of this move couldn't accomplish it himself), and whether or not the process needs to be covered in an article separate from the machine should be considered. Gene Nygaard 04:03, 3 October 2006 (UTC)
The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Spam or not?[edit]

Upon brief inspection, I'm not sure this link [1] that was removed citing spam qualifies as spam. Opinions, anyone? Random wiki denizen from 24.166.2.5 21:45, 29 Dec 2006 (UTC)

It may be a useful link however it was added as part of a batch anonymously and without edit summaries by an IP address belonging to the publisher (see User talk:12.40.112.190). That sort of campaign-linking by the company itself is always inappropriate per the Conflict of Interest Guideline (and perhaps some other policies or guidelines as well). I did not remove that particular link however the editor that did was following the standard procedure for cleaning up after a linking campaign.
The appropriate step for someone with a conflict of interest is to suggest edits or links on the talk page and then let others decide.
If you want to to keep the link, by all means do so. --A. B. (talk) 23:12, 29 December 2006 (UTC)
Oh, I see. I was unaware it was added by the publisher. Thank you for clarifying that.24.166.2.5 03:35, 30 December 2006 (UTC)

Mechanical vs artificial[edit]

IMO, mechanical refers to the use of electrical, automated machines to provide assistance to breathing, whereas artificial ventilation is an umbrella term that includes both mechanical as well as hand-assisted ventilation. At least in the emedicine.com website listed at the end, mechanical ventilation does not include hand-assisted ventilation. Hand assisted, CPAP, BIPAP are categorized as noninvasive ventilation while mechanical ventilation refers to invasive ventilation requiring an ET or trach tubes.

And in addition, I don't think hand ventilation is mechanical at all in any sense Andrewr47 01:21, 11 January 2007 (UTC)

You can still bag someone (breath for them by hand) if they have an endotracheal tube or a trach. Your Three categories are mechanical ventilation, non-invasive ventilation, and manual ventilation. Keep in mind, there are differences within each of these categories as well, such as: Is the patient breathing spontaneously and only receiving pressure support, or is the machine doing all of the work? —Preceding unsigned comment added by 170.232.128.10 (talk) 21:18, 24 October 2010 (UTC)

Initial ventilator and patient settings[edit]

This heading, IMHO, may lead to a description of how ventilators are set in any contributors own ICU, and also addresses more controversial issues of management a little too early in the article. At the moment, the article has a definate slant to adult ICU, and the comment about Assist control being the primary setting on a ventilator is certainly not true for many neonatal intensive care units, transport services (where the servos required fo AC ventilators may be too heavy and unweildy) and even those in countries with less wealth (these ventilators are up to 10 times the price of IMV). The article may be more informative if the heading modes of ventilation were to include AC ventilation, with a comment about its common use in adult ICU, rather than under this heading. would ventilator settings (as this is a more technical and controversial aspect of mechanical ventilation) be better towards the end of the article? Whyso 14:57, 11 February 2007 (UTC)

Agree with adult slant point. Removed following from HFOV description: "Mean airway pressure in HFOV is most often significantly higher than pressures provided with conventional PEEP (30-40 cmH2O or higher) and is usually started at ~10 cmH2O above the MAP measured during conventional ventilation." In infants the MAP is generally set at 1-2 cmH2O higher than with conventional. If comment is correct for adults, replace with qualification. Hallbrianh 19:53, 14 March 2007 (UTC)

Alternative modes of Ventilation[edit]

can this be changed to simply 'modes of ventilation'? I do not feel confident to counter the coment IMV 'is rarely used', but wonder if our anaesthetic colleagues would comment - I was under the impression it was commonly used for anaesthesia in which muscle relaxation was required (ie it was used on many thousands of people on a daily basis).Whyso 15:12, 11 February 2007 (UTC)

You are correct that CMV is frequently used in anesthesia. I added this comment. Have been looking at this entire page for a while. The page needed significant reorganization as it had an almost single focus on assist control use in adults from a somewhat one-sided point of view, together with a hodge podge listing of other modes without unifying explanation. Attempted to reorganize into more logical order and balance out presentation of modes and treatment decisions. Would welcome other suggestions. Still need to add references to much of this. 69.250.107.161 23:56, 14 March 2007 (UTC) Somehow signed out while I was making changes. They are mine. Hallbrianh 00:00, 15 March 2007 (UTC)
Thankyou very much - I have only had a quick look at the changes, but really like the logical progression of ideas - thankyou very much for making the changes Whyso 03:14, 18 March 2007 (UTC)

External links[edit]

External links on Wikipedia are supposed to be "encyclopedic in nature" and useful to a worldwide audience. Please read the external links policy (and perhaps the specific rules for medicine-related articles) before adding more external links.

The following kinds of links are inappropriate:

  • Online discussion groups or chat forums
  • Personal webpages and blogs
  • Multiple links to the same website
  • Fundraising events or groups
  • Websites that are recruiting for clinical trials
  • Websites that are selling things (e.g., books or memberships)

I realize that some links are helpful to certain users, but they still do not comply with Wikipedia policy, and therefore must not be included in the article. WhatamIdoing (talk) 07:00, 17 January 2008 (UTC)

Tehrani is not the only authority on mechanical ventilation, please include additional sources for your information and citation. —Preceding unsigned comment added by 96.252.1.138 (talk) 17:40, 16 January 2009 (UTC)

Additional Tasks[edit]

Other sections needed for this article, in my view, include discussions of: 1. Ventilator triggering 2. Minute ventilation 3. ETT sizing and technique of placement 4. Flow loops and flow patterns 5. I:E ratio 6. Sedation and other medications, including nitric oxide 7. Oxygen delivery 8. Barotrauma Hallbrianh (talk) 18:49, 18 March 2008 (UTC)

Ventilator-associated lung injury[edit]

I think it is time to create an article or a section called ventilator-associated complications. There is already a separate ventilator-associated lung injury article. Nephron  T|C 06:42, 3 April 2008 (UTC)

Copy edit: head section[edit]

I've just done a first pass on the article head to fix what I felt were some slightly awkward phrases. I welcome your thoughts on the subject. I placed a note at Wikipedia_talk:WikiProject_Medicine#Mechanical_ventilation:_copy_edit to ask for more experienced eyes than mine. Cheers, Basie (talk) 18:57, 16 January 2009 (UTC)

Galen the first?[edit]

I've come across an interesting and relatively new (2006) reference which asserts Galen was the first to describe mechanical ventilation, not Vesalius.

Galen is the first to have described ventilating and animal: "If you take a dead animal and blow air through its larynx [through a reed], you will fill its bronchi and watch its lungs attain the greatest distention." He was fascinated by the question of how air could be drawn into the heart. Unfortunately for Galen, this was a question that could not be solved before the development of the microscope and the concept of diffusion. Also unfortunate for Galen was his failure to appreciate how ventilating the lungs could help him in his vivisection work. Galen operated on many living animals but his studies on the function of the heart were limited by the risk of pneumothorax. Opening the thoracic cavity almost certainly resulted in the death of the animal. It was over a thousand years later that Vasalius realized that ventilation could protect animals from pneumothorax. The beating heart would almost stop when Vesalius opened the chest cavity, and the lungs would collapse but could be restarted by inflating the lungs through a reed tied into the trachea. It is unclear whether Vesalius learned this procedure from others or developed the idea directly from Galen's work. A fascinating coincidence is that Paracelsus, a contemporary of Vesalius, is reported to have used a similar technique around 1530 in attempting to resuscitate a human. Did Paracelsus adapt Vesalius's research efforts, or vice versa?"

Ref: Colice, Gene L (2006). "Historical Perspective on the Development of Mechanical Ventilation". In Martin J Tobin. Principles & Practice of Mechanical Ventilation (2 ed.). New York: McGraw-Hill. ISBN 978-0071447676.

Interesting stuff. I wrote "may have been" in my addition because different sources seem to suggest different things. Colice quotes

  • Galen, C (1954). C Daremberg (translator), ed. On the functions of parts of the human body. Paris: JB Bailliere.,

and references

  • Vesalius, A (1543). De humani corporis Fabrica. Basel: Oporinus..

Cheers, Basie (talk) 02:39, 18 January 2009 (UTC)


The Diagram[edit]

The Diagram at the start of the article is of the Nasotracheal Suctioning process not Nasotracheal Intubation.

Mohshamy1976 (talk) 19:37, 6 October 2009 (UTC)

terminology section[edit]

should the terminology section be split into a sub-article so it can be made bigger with all terminology associated with mechanical ventilation and a brief sentence explaining it? Je.rrt (talk) 03:51, 23 August 2011 (UTC)

Adaptive Support Ventilation[edit]

ASV is a type of PC-SIMV with added intelligence, it is not an independent mode type. Removal may be necessary but I moved it to the appropriate section. It may not be appropriate to include here since there is an article for a more detailed look at modes of mechanical ventilation and this section provides an overview of modes. Je.rrt (talk) 14:23, 14 September 2011 (UTC)

This is a citation I found that might be the one you are looking for:


Your statement on this page: http://en.wikipedia.org/wiki/Mechanical_ventilation Mechanical ventilation is often a life-saving intervention, but carries many potential complications including pneumothorax, airway injury, alveolar damage, and ventilator-associated pneumonia. Citation Ref Colice, Gene L (2006). "Historical Perspective on the Development of Mechanical Ventilation". In Martin J Tobin. Principles & Practice of Mechanical Ventilation (2 ed.). New York: McGraw-Hill.

74.100.215.47 (talk) 19:32, 4 November 2011 (UTC)

Changes[edit]

I noticed that there were a few orphan sections in the article that seemed to be left over from newer edits to the the ventilator mode section. Other parts seemed either factually incorrect, didn't seem to fit, or were redundant considering the more lengthy discussion below regarding ventilator modes. I reworked the breath initiation/termination section into information regarding the phases of breath delivery, but I'm not even sure that it should be included in this main article.

I kept the following in the article, but it doesn't seem to fit where it is, and may even be redundant.

  • Volume ventilation — A predetermined tidal volume (Vt) is set by the clinician, and is delivered to the patient every time a breath is triggered. For example, if the tidal volume is set at 500ml, the ventilator will continue inspiration until 500ml have been delivered to the patient. Upon completion of inspiration, the ventilator will cycle to exhalation. The amount of pressure necessary to deliver the tidal volume is determined by the resistance and compliance of the patient and ventilator circuit, and may vary from breath to breath. Inspiratory pressures must be closely monitored to prevent barotrauma.

Several manufactures have incorporated features from both of these modes in an attempt to accommodate patients needs.
These modes are flow-variable, volume-targeted, pressure-regulated, time-limited modes (for example, pressure regulated volume controlPRVC). This means that instead of providing an exact tidal volume each breath, a target volume is set and the ventilator will vary the inspiratory flow at each breath to achieve the target volume at the lowest possible peak pressure. The inspiratory time (Ti) limits the length of the inspiratory cycle and therefore the I:E ratio. Pressure regulated modes such as PRVC, Auto-flow (Draeger)or Average Volume Assured Pressure Support (AVAPS) from Philips can most easily be thought of as turning a volume mode into a pressure mode with the added benefit of maintaining more control over tidal volume than with strictly pressure-control.

I removed this portion as it didn't seem to fit with the addition of other sections.

--Ventilation process in conventional mechanical ventilation-- The three traditional categories of ventilators are listed below. As microprocessor technology is incorporated into ventilator design, the distinction among these types has become less clear as ventilators may use combinations of all of these modes as well as flow-sensing, which controls the ventilator breath based on the flow-rate of gas versus a specific volume, pressure, or time. Cglion (talk) 23:50, 24 November 2011 (UTC)

Modes of mechanical ventilation[edit]

The modes listed under this heading are a bit of a sprawling mess beyond a brief introduction to the main article modes of mechanical ventilation. Main articles should be linked to wherever possible and introductions to concepts that have main articles should be kept brief. Wrin (talk) 21:36, 9 June 2012 (UTC)

Non-invasive ventilation?[edit]

I noticed that this edit removed the entire section on “Non-invasive Positive Pressure Ventilation (NIPPV).” The edit summary suggests the information would be moved to Modes of mechanical ventilation, but as it stands now, “Modes of mechanical ventilation” is a somewhat technical article that lacks the overview found in the removed material; therefore, please provide more details on why the “non-invasive ventilation” section was removed. Thank you. Bwrs (talk) 01:03, 27 July 2013 (UTC)

Non-invasive ventilation - split off?[edit]

Numerous articles discuss noninvasive ventilation. The applications of NIV are becoming ever more widespread, and significant numbers of people with COPD, sleep disordered breathing and neuromuscular weakness are receiving home NIV through clinical networks. Unfortunately the evidence base for many interventions has not kept trend with the development of the devices, but I think it's time to split everything off into its own article.

For acute NIV, I think doi:10.1016/S0140-6736(09)60496-7 is an amazing source. JFW | T@lk 14:46, 9 December 2013 (UTC)

Agree, there is clearly enough literature to support NIV as its own article. Yobol (talk) 16:54, 9 December 2013 (UTC)

Non-ARDS[edit]

Low tidal volume ventilation is good for non-ARDS cases also doi:10.1001/jama.2012.13730 JFW | T@lk 16:00, 14 July 2014 (UTC)

A wikibook on Intensive Care Medicine[edit]

Dear all, I have linked this page to the wikibook on Intensive Care Medicine under Pulmonary Intensive Care

Section 'Medical uses'[edit]

Do non-medical uses exist? If so, what are they. If not, as I suspect, this section should be called 'Uses', which doesn't imply existence of non-medical uses. Batternut (talk) 10:12, 11 October 2016 (UTC)

Article changed - more clearly exclusively medical. Batternut (talk) 10:28, 15 October 2016 (UTC)

Intermittent abdominal pressure ventilator, and article organization[edit]

@Fountains of Bryn Mawr: As Intermittent abdominal pressure ventilator is neither a 'Negative pressure machine', nor 'Positive pressure' in the sense of pushing air into the lungs, I have moved it to its own subsection. However I find the organisation of this article rather confusing. Batternut (talk) 00:57, 13 October 2016 (UTC)

Possible typo 'on' instead of 'or'[edit]

Under the section 'Uses' in the dot points is this sentence:

Acute on chronic respiratory acidosis most commonly with Chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome

I thought acute and chronic were effectively opposites, so shouldn't that second word be or instead of on?

If so, can someone wiser please fix it?

Thanks.

Mathsgirl (talk) 13:04, 3 November 2017 (UTC)

No, in this case "acute on chronic" indicates a patient who has a chronic disease (like emphysema) but then develops an acute illness (like influenza) on top of their usual problems. It could probably be worded more clearly for the layperson, but a lot of WP medical content is written more for the provider than for the layperson. EricEnfermero (Talk) 14:47, 3 November 2017 (UTC)
Now that I read more carefully, even though "acute on chronic" is a common phrase, I'm not sure that's the intended meaning here. Ventilation is definitely used in patients who have both acute and chronic acidosis. Someone else should weigh in, but I think you might be right. EricEnfermero (Talk) 14:52, 3 November 2017 (UTC)

I wonder if @Atulaimatcch: whose edit introduced "Acute on chronic" last year. To me, considering that edit though, I'd say it should be "Acute or chronic". Batternut (talk) 16:13, 3 November 2017 (UTC)

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