TY - CHAP M1 - Book, Section TI - Mechanical Ventilation for the Surgical Patient A1 - Kacmarek, Robert M. A1 - Hess, Dean R. A2 - Longnecker, David E. A2 - Mackey, Sean C. A2 - Newman, Mark F. A2 - Sandberg, Warren S. A2 - Zapol, Warren M. Y1 - 2017 N1 - T2 - Anesthesiology, 3e AB - KEY POINTSPatients require mechanical ventilation because of apnea, acute or impending acute respiratory failure, or severe refractory hypoxemia.The two basic forms of mechanical ventilation are pressure ventilation (peak airway pressure constant, tidal volume variable) and volume ventilation (tidal volume constant, peak airway pressure variable).Although numerous modes of ventilation exist, few data are available to differentiate the benefits of one mode over another, and no mode has been shown to improve patient outcome.A major concern during assisted ventilation is patient-ventilator synchrony—the ventilator should be set to match the patient’s ventilatory demands. Increasing data indicates asynchrony may have a negative affect on patient outcome.Automatic positive end-expiratory pressure (PEEP) is a common cause of patient-ventilator dyssynchrony; in patients with obstructive lung disease, properly set applied PEEP can improve synchrony and decrease patient efforts to ventilate.It is unnecessary to achieve normal Pao2 and Paco2. In most critically ill patients, a Pao2 of ≥60 mmHg is acceptable, and permissive hypercapnia may be useful in treating some patients.Ventilator-induced lung injury is primarily caused by localized overdistension and the opening and closing of unstable lung units.In most patients who are ventilated, the tidal volume should be 4-8 mL/kg predicted body weight (PBW), the plateau pressure should be <28 cm H2O, driving pressure should be <15 cm H2O, and PEEP should be set to avoid the collapse of unstable lung units.High-frequency ventilation has been shown to negatively affect the outcome of patients with acute respiratory distress syndrome (ARDS).Airway pressure release ventilation has not been shown to positively affect outcome in any population of patients and demonstrates no outcome benefits over conventional pressure or volume ventilation.Noninvasive positive-pressure ventilation is useful to transition patients who are at high risk of extubation failure from invasive ventilation to spontaneous breathing. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/09 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1144135631 ER -