Guide to Ventilator Support and Respiratory Health

Breathing, the most fundamental physiological activity, sustains life by delivering oxygen to the lungs for distribution throughout the body while removing metabolic waste products like carbon dioxide. This continuous gas exchange maintains cellular energy production and acid-base balance. However, when compromised by disease, trauma, or other factors, respiratory function can deteriorate into life-threatening conditions like dyspnea or respiratory failure.

The respiratory system comprises airways (nasal passages, pharynx, larynx, trachea, bronchi) and lungs. Airways filter, humidify, and warm incoming air, while the lungs' alveoli facilitate gas exchange through their thin, vascularized walls.

Defined as impaired gas exchange (PaO₂ <60mmHg with/without PaCO₂ >50mmHg), respiratory failure stems from:

• CNS disorders (stroke, trauma, intoxication)
• Neuromuscular diseases (myasthenia gravis, muscular dystrophy)
• Thoracic abnormalities (deformities, pleural diseases)
• Airway obstruction (asthma, stenosis)
• Pulmonary conditions (pneumonia, COPD, edema)

Ventilators deliver pressurized air to maintain oxygenation and carbon dioxide elimination. Devices can operate at fixed rates or synchronize with patient-initiated breaths.

• By interface: Non-invasive (mask) vs. invasive (intubation)
• By control mode: Volume-controlled, pressure-controlled, or pressure-supported
• By application: ICU, transport, or home ventilators

Comprehensive evaluation includes medical history, physical exam (respiratory rate, chest movement, auscultation), arterial blood gases, and imaging studies to determine ventilation needs and settings.

Delivered via masks, NIV avoids intubation while providing:

• Reduced complications (tracheal injury, infection)
• Preserved speech/swallowing
• Lower pneumonia risk

Common modes include CPAP (constant pressure) and BiPAP (variable inspiratory/expiratory pressure).

Required for severe respiratory failure, this method involves endotracheal intubation or tracheostomy with various modes:

• Volume Control (VCV)
• Pressure Control (PCV)
• Synchronized Intermittent Mandatory Ventilation (SIMV)

For patients requiring prolonged ventilation (>2 weeks), surgical tracheostomy offers stable airway access while facilitating secretion management and reducing respiratory effort.

Patients may experience dryness, nasal congestion, or anxiety during ventilation. Continuous monitoring tracks respiratory parameters, blood gases, hemodynamics, and potential complications like ventilator-associated pneumonia (VAP).

Gradual withdrawal occurs when:

• Underlying conditions stabilize
• Respiratory function improves
• Patients demonstrate adequate spontaneous breathing

Methods include SIMV rate reduction, pressure support titration, and T-piece trials.

Extracorporeal Membrane Oxygenation (ECMO) provides temporary cardiopulmonary support by oxygenating blood externally, serving as a bridge to recovery or transplantation for refractory cases.

Ventilation technology continues evolving toward smarter, more personalized systems with enhanced portability, while ECMO expands treatment possibilities for critical cardiopulmonary failure.