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A historical perspective on ventilator management

B A Shapiro1

  • 1Department of Anesthesia, Northwestern University Medical School, Chicago IL.

New Horizons (Baltimore, Md.)
|February 1, 1994
PubMed
Summary
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Mechanical ventilation has evolved significantly, with traditional volume-limited ventilators remaining suitable for most ICU patients. However, severe lung disease may necessitate pressure-control ventilation to avoid lung injury.

Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Medical Technology

Background:

  • Review of historical technological advances in mechanical ventilation.
  • Emphasis on the evolution of ventilatory management concepts and their impact on neuromuscular blocking agent use.
  • Definition and consistent utilization of nomenclature for ventilatory management.

Observation:

  • Pre-1970: Transition from pressure-limited to reliable volume-limited ventilators.
  • Post-1970: Development of positive end-expiratory pressure (PEEP), avoidance of hyperoxia, and partial ventilatory support.
  • Emergence of pressure-support and pressure-control techniques for total ventilatory support.

Findings:

  • Traditional volume-preset ventilation with large tidal volumes is suitable for most patients.

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  • Neuromuscular blockade is generally not recommended for standard mechanical ventilation.
  • Severe lung disease may benefit from total ventilatory support (e.g., pressure control) to prevent ventilator-induced lung injury.

    • Implications:

    • Volume-preset ventilation remains a valid and desirable approach for the majority of mechanically ventilated ICU patients.
    • Neuromuscular blockade should be avoided when possible, with adequate sedation and analgesia being crucial.
    • Pressure-control ventilation offers an alternative for severe lung disease, though it requires neuromuscular blockade and may impact eucapnic ventilation.