Mechanical ventilation connection to ventilators

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Vishnu Vardhan Serla M.B.B.S. [2]

## Overview

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There are various procedures and mechanical devices that provide protection against airway collapse, air leakage, and aspiration. Face mask, laryngeal mask airway, tracheal intubation, esophageal obturator airway, cricothyroidotomy and tracheostomy may be used to provide mechanical ventilation.

## Connection to Ventilators

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There are various procedures and mechanical devices that provide protection against airway collapse, air leakage, and aspiration:[1][2][3][4][5][5][6]

* Face mask \- In resuscitation and for minor procedures under anesthesia, a face mask is often sufficient to achieve a seal against air leakage. Airway patency of the unconscious patient is maintained either by manipulation of the jaw or by the use of nasopharyngeal or oropharyngeal airway. These are designed to provide a passage of air to the pharynx through the nose or mouth, respectively. Poorly fitted masks often cause nasal bridge ulcers which is a problem for some patients. Face masks are also used for non-invasive ventilation in conscious patients. A face mask does not, however, provide protection against aspiration.
* Laryngeal mask airway \- The laryngeal mask airway (LMA), causes less pain and coughing than a tracheal tube. However, unlike tracheal tubes it does not seal against aspiration, making careful individualised evaluation and patient selection mandatory.
* Tracheal intubation is often performed for mechanical ventilation of hours to weeks duration. A tube is inserted through the nose (nasotracheal intubation) or mouth (orotracheal intubation) and advanced into the trachea. In most cases tubes with inflatable cuffs are used for protection against leakage and aspiration. Intubation with a cuffed tube is thought to provide the best protection against aspiration. Tracheal tubes inevitably cause pain and coughing. Therefore, unless a patient is unconscious or anesthetized for other reasons, sedative drugs are usually given to provide tolerance of the tube. Other disadvantages of tracheal intubation include damage to the mucosal lining of the nasopharynx or oropharynx and subglottic stenosis.
* Esophageal obturator airway - commonly used by emergency medical technicians, if they are not authorized to intubate (the "esophageal airway" familiar to fans of the television series, Emergency!). It is a tube which is inserted into the esophagus, past the epiglottis. Once it is inserted, a bladder at the tip of the airway is inflated, to block ("obturate") the esophagus, and air or oxygen is delivered through a series of holes in the side of the tube.
* Cricothyrotomy \- Patients who require emergency airway management, in whom tracheal intubation has been unsuccessful, may require an airway inserted through a surgical opening in the cricothyroid membrane. This is similar to a tracheostomy but a cricothyrotomy is reserved for emergency access. [3]
* Tracheostomy \- When patients require mechanical ventilation for several weeks a tracheostomy may provide the most suitable access to the patient's trachea. A tracheostomy is a surgically created passage into the trachea. Tracheostomy tubes are well tolerated and often do not necessitate any use of sedative drugs. Tracheostomy tubes may be inserted early during treatment in patients with pre-existing severe respiratory disease, or in any patient who are expected to be difficult to wean from mechanical ventilation, i.e., patients who have little muscular reserve.

## References

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1. ↑ Ferrone G, Cipriani F, Spinazzola G, Festa O, Arcangeli A, Proietti R, Antonelli M, Conti G, Costa R (September 2013). "A bench study of 2 ventilator circuits during helmet noninvasive ventilation". Respir Care. 58 (9): 1474–81. doi:10.4187/respcare.02060. PMID 23431311.
2. ↑ "Hazard Report. Medical vacuum system connection to ventilator breathing circuit may have contributed to patient's death". Health Devices. 38 (3): 90–1. March 2009. PMID 19580096.
3. ↑ Boukhettala N, Porée T, Diot P, Vecellio L (April 2015). "In vitro performance of spacers for aerosol delivery during adult mechanical ventilation". J Aerosol Med Pulm Drug Deliv. 28 (2): 130–6. doi:10.1089/jamp.2013.1091. PMID 25050644.
4. ↑ Türköz A, Balcı ŞT, Gönen H, Çınar Ö, Özker E, Türköz R (2014). "The effects of different ventilator modes on cerebral tissue oxygen saturation in patients with bidirectional superior cavopulmonary connection". Ann Card Anaesth. 17 (1): 10–5. doi:10.4103/0971-9784.124122. PMID 24401296.
5. ↑ 5.0 5.1 Dai B, Kang J, Sun LF, Tan W, Zhao HW (April 2014). "Influence of exhalation valve and nebulizer position on albuterol delivery during noninvasive positive pressure ventilation". J Aerosol Med Pulm Drug Deliv. 27 (2): 125–32. doi:10.1089/jamp.2012.1024. PMID 23668546.
6. ↑ Hidalgo V, Giugliano-Jaramillo C, Pérez R, Cerpa F, Budini H, Cáceres D, Gutiérrez T, Molina J, Keymer J, Romero-Dapueto C (2015). "Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective". Open Respir Med J. 9: 120–6. doi:10.2174/1874306401509010120. PMC 4541452. PMID 26312104.

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