Initiating Mechanical Ventilation in Critically Ill Patients: Case-based Clinical Review

Abstract Mechanical Ventilation continues to be an integral part of critical care on which patients with respiratory failure often depend on for their survival. Specific criteria that need to be met to justify initiating MV include a patient dependency assessment, a clinical indication as well as the ventilator settings that are most appropriate. Hypoxemic respiratory failure, hypercapnic respiratory failure and the need for airway protection are the common indications to initiate MV. This review uses case-based to discuss the initiation of MV. Some of the clinical use settings include Acute Respiratory Distress Syndrome (ARDS), Pneumonia, Chronic Obstructive Pulmonary Disease (COPD) exacerbations, Trauma with altered mental status. Specific scenarios of patients, clinical management and intervention measures are described for every condition to help with the best approach. The review placed special focus on assessment before intubation, the type of mechanical ventilation to choose-VCV or PCV, and the settings to be used: TVs, RR, PEEP and FiO2. Further, it highlights the topic of focussed monitoring, common ventilator problems, and the Weaning phase from MV. The review outlines certain well-documented antecedent knowledge failures of young medicos and also intensivists that need to be corrected in their curriculums for enhancing their ventilator management competencies. Knowledge of MV initiation, strict supervision, and preparation for the cessation of MV is important in order to enhance the results of the patients within the Intensive Care Unit. It is mandatory and more important to see clinical signs like bilateral symmetric chest expansion than looking at the values on the ventilator alone. The presented case-based examples provide practical translation of theoretical information into the clinical practice and enhance the development of the clinical decision-making in the framework of critical care medicine. We definitely need a curriculum integration to decrease the phobia among the new entrants to the intensive care unit whether its medical or paramedical personnel.