September 2002 / Volume 47 / Number 9 / Page 1007
Mechanical Ventilation Strategies: What’s New and What's Worth Keeping?
IntroductionMany technologic and management strategies related to mechanical ventilation have been introduced in recent years. Strategies that avoid intubation and get patients extubated sooner decrease costs related to mechanical ventilation. In general, “people” solutions such as weaning protocols are preferable to "technology" solutions such as new ventilator modes. It must be remembered that mechanical ventilation is supportive—it is not curative—and has the potential to do harm if applied incorrectly. There is an increasing list of examples in which short-term physiologic outcomes such as improvements in blood gas values are not related to patient-important outcomes such as survival. When new mechanical ventilation technology and strategies are introduced, a question we need to ask ourselves is whether these are solutions for problems or whether these are simply solutions in search of problems.
Is Endotracheal Intubation Needed for Mechanical Ventilation?
Is the Ventilator Circuit a Source of Ventilator-Associated Pneumonia?
Is the Goal of Mechanical Ventilation to Normalize Blood Gases?
Is the Goal of PEEP to Raise the PaO2 so that the Fraction of Inspired—Oxygen Can Be Decreased?
Are Nebulizers Superior to Inhalers During Mechanical Ventilation?
Is Pressure Support a Simple Mode?
Does the Endotracheal Tube Impose a Significant Resistance to Spontaneous Breathing?
Is Synchronized Intermittent Mandatory Ventilation a Useful Weaning Mode?
Are Weaning Protocols Safe and Effective?
Do New Ventilator Modes Facilitate Weaning?
I was very honored to present the Simon Rodbard Memorial Lecture at the 2001 Annual International Scientific Assembly of the American College of Chest Physicians. I am equally pleased to have the opportunity to share these thoughts with the readers of RESPIRATORY CARE. In recent years, many new technologic and management strategies related to mechanical ventilation have been introduced. I take 10 topics, briefly describe each, address some of the evidence, and inject some of my own bias in relation to each of these issues.