Mechanical Ventilation: Modes, Settings, and Clinical Considerations

Since its initial use during the polio epidemic in the 1950s, positive pressure mechanical ventilation has become an indispensable therapy to support critically ill patients in the intensive care unit. Over the past 70 years, ventilators have increased in technical sophistication and capability. Although these advances have increased our ability to support complex conditions such as acute respiratory distress syndrome, the development of new modes and applications, often assigned manufacturer-specific trade names, can cause confusion among clinicians who must use them. This article will review the classification of ventilator modes, initial ventilator settings, alarms, and clinical considerations when using mechanical ventilation. From these basics, we will explore more advanced modes that may be used for lung protection and recruitment to improve oxygenation and ventilation. Additionally, we will discuss potential complications of mechanical ventilation and strategies to mitigate them.