Invasive and Noninvasive Ventilation in the Emergency Department - 07/04/12

Doi : 10.1016/j.emc.2011.10.008

Patrick M. Archambault, MD, MSc, FRCPC ^a,^b,^c,^d,^⁎ , Maude St-Onge, MD, MSc, FRCPC ^e,^f
^a Department of Family Medicine and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
^b Division of Critical Care, Department of Anesthesiology, Université Laval, 1050 Avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
^c Department of Emergency Medicine, Centre de santé et services sociaux Alphonse-Desjardins (CHAU de Lévis), 143 Rue Wolfe, Lévis, Quebec, G6V 3Z1, Canada
^d Department of Anesthesiology, Centre de santé et services sociaux Alphonse-Desjardins (CHAU de Lévis), 143 Rue Wolfe, Lévis, Quebec, G6V 3Z1, Canada
^e Department of Emergency Medicine, Centre hospitalier universitaire de Quebec, 2705, Boulevard Laurier, Quebec CIty, Quebec, G1V 4G2, Canada
^f Adult Critical Care Medicine Residency Program, University of Toronto, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Room D134, Toronto, Ontario, M4N 3M5, Canada

Corresponding author. CSSS Alphonse-Desjardins (CHAU de Lévis), 143 Rue Wolfe, Lévis, Quebec, G6V 3Z1, Canada.

Résumé

This article reviews invasive and noninvasive ventilation for emergency physicians. It presents an overview of respiratory physiology principles that will help emergency physicians adapt their ventilation strategies to any clinical situation. The basic modes of ventilation are summarized. The advantages and limitations of certain novel modes of ventilation are presented. This review highlights a variety of ventilation strategies to be used for patients with normal lung mechanics and gas exchange, acute hypoxemic respiratory failure, decreased lung compliance, airflow obstruction, and weakness or restriction of the chest wall. This article will help clinicians prevent, recognize, and treat complications of mechanical ventilation.

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Keywords : Invasive mechanical ventilation, Noninvasive ventilation, Positive pressure ventilation, Intermittent positive pressure ventilation, Respiratory insufficiency, Closed-loop systems, Dual-control modes