Mechanical ventilation indications for use

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]Syed Hassan A. Kazmi BSc, MD [3]

Mechanical ventilation can be used in patients who have labored breathing and are unable to maintain adequate gaseous excange leading to hypoxemia and/or hypercapnia. Common clinical indications of mechanical ventilation include moderate to severe dyspnea, respiratory rate (RR) > 24-30/min, signs of increased breathing, accessory muscle use for breathing and abdominal paradox. It may also be used in patients who have inadequate arterial partial pressure of oxygen or critically low PaO2 (PaO2 < 70 mm Hg), hypercapnia PaCO2 > 45 mm Hg and PaO2/FiO2 < 200. Patients suffering from acute exacerbation of COPD, asthma/asthmatic attack, neuromuscular disease that prevents chest movement to allow gas exchange, central nervous system depression (CNS depression due to drugs, cardiac arrest, trauma), chest injury, chest malformation, acute and chronic respiratory failure, heart failure and ventilation-perfusion mismatch may also be candidates for mechanical ventilation.

The indications of the mechanical ventilation is as follows:^{[1][2][3][4][5][6][7]}

• The three most common indications for mechanical ventilation:
  • Inadequate oxygenation
  • Inadequate ventilation
  • Inability to protect the airway

Other indications for mechanical ventilation include the following:

• Bradypnea
• Tachypnea (>30 breaths/minute)
• Apnea with respiratory arrest including cases from intoxication
• Acute respiratory distress syndrome
• Vital capacity less than 15 ml/kg
• Minute ventilation greater than 10 Lts/min
• Reduced respiratory drive
• Abnormalities of the chest wall
• Respiratory muscle fatigue
• Intrapulmonary shunt
• V/Q mismatch (ventilation-perfusion)
• Decreased Functional Residual Capacity
• Arterial partial pressure of oxygen (PaO₂) with a supplemental fraction of inspired oxygen (FIO₂) of less than 55 mm Hg
• Alveolar-arterial gradient of oxygen tension (A-a DO₂) with 100% oxygenation of greater than 450 mm Hg
• Coma
• Hypotension due to sepsis, shock, CHF
• Acute partial pressure of carbon dioxide (PaCO₂) greater than 50 mm Hg with an arterial pH less than 7.25
• Chronic obstructive pulmonary disease (COPD)
• Acute respiratory acidosis with
  • Partial pressure of carbon dioxide (pCO₂) > 50 mmHg
  • pH < 7.25, which may be due to paralysis of the diaphragm due to
    • Guillain-Barré syndrome
    • Myasthenia Gravis
    • spinal cord injury
    • The effect of anaesthetic and muscle relaxants
• Increased work of breathing as evidenced by significant tachypnea, retractions, and other physical signs of respiratory distress
• Hypoxemia with arterial partial pressure of oxygen (PaO₂) with supplemental fraction of inspired oxygen (FiO₂) < 55 mm Hg
• Neuromuscular disease

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