AANA journal course: update for nurse anesthetists--advances in ventilating the patient with severe lung disease

Mechanical ventilation has become commonplace in critical care environments and a number of improvements designed to improve the interface between patient and machine are finding their way into the operating room as well. Strategies which are discussed include differential lung ventilation, inspiratory pause, inverse ratio ventilation, mandatory minute volume, pressure support ventilation, and airway pressure release ventilation. These strategies are discussed individually in terms of both their theoretical and clinical utility. A user-friendly classification of ventilatory approaches based on the rate of breathing is also provided as is treatment of the issue of the cardiovascular effects of positive end-expiratory pressure. Conditions which increase ventilatory demand in mechanically ventilated patients are reviewed, as these require consideration when caring for the patient receiving mechanical ventilation. While conventional positive pressure approaches are suitable for the majority of patients who present for anesthesia and surgery, patients with significant pulmonary dysfunction should be availed the newer approaches to management when possible. This will only become feasible when practitioners recognize the importance and application of these approaches and urge their introduction into operating room based equipment.