Controlled versus assisted mechanical ventilation.
On the basis of currently available data, it can be suggested that maintained spontaneous breathing during mechanical ventilation should not be suppressed even in patients with severe pulmonary dysfunction if no contraindications, such as increased intracranial pressure, are present. Improvements in pulmonary gas exchange, systemic blood flow, and oxygen supply to tissues, which have been observed when spontaneous breathing was allowed during ventilatory support, are reflected in the clinical improvement in the patient's condition, as indicated by significantly fewer days with ventilation, earlier extubation, and shorter stays in the intensive care unit. The positive effects of spontaneous breathing have been documented only for some of the available partial ventilatory support modalities. If ventilatory modalities are limited to those whose positive effects have been documented, then partial ventilatory support can be used as a primary modality even in patients with severe pulmonary dysfunction. Whereas controlled mechanical ventilation followed by weaning with partial ventilatory support modalities has been the earlier standard in ventilation therapy, this approach should be reconsidered in view of the available data.
Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Germany. putensen@uni-bonn.de
Christian
C
Putensen
Rudolf
R
Hering
Hermann
H
Wrigge
D006801:Humans; D007384:Intermittent Positive-Pressure Breathing / Q000379:methods; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume / Q000502:physiology; D015300:Ventilator Weaning; D014939:Work of Breathing