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Ventilatory Failure, Ventilator Support, and Ventilator Weaning

  1. Martin J. Tobin,
  2. Franco Laghi,
  3. Amal Jubran

Published Online: 1 OCT 2012

DOI: 10.1002/cphy.c110030

Comprehensive Physiology

Comprehensive Physiology

How to Cite

Tobin, M. J., Laghi, F. and Jubran, A. 2012. Ventilatory Failure, Ventilator Support, and Ventilator Weaning. Comprehensive Physiology. 2:2871–2921.

Author Information

  1. 1Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois

Publication History

  1. Published Online: 1 OCT 2012

Abstract

The development of acute ventilatory failure represents an inability of the respiratory control system to maintain a level of respiratory motor output to cope with the metabolic demands of the body. The level of respiratory motor output is also the main determinant of the degree of respiratory distress experienced by such patients. As ventilatory failure progresses and patient distress increases, mechanical ventilation is instituted to help the respiratory muscles cope with the heightened workload. While a patient is connected to a ventilator, a physician's ability to align the rhythm of the machine with the rhythm of the patient's respiratory centers becomes the primary determinant of the level of rest accorded to the respiratory muscles. Problems of alignment are manifested as failure to trigger, double triggering, an inflationary gas-flow that fails to match inspiratory demands, and an inflation phase that persists after a patient's respiratory centers have switched to expiration. With recovery from disorders that precipitated the initial bout of acute ventilatory failure, attempts are made to discontinue the ventilator (weaning). About 20% of weaning attempts fail, ultimately, because the respiratory controller is unable to sustain ventilation and this failure is signaled by development of rapid shallow breathing. Substantial advances in the medical management of acute ventilatory failure that requires ventilator assistance are most likely to result from research yielding novel insights into the operation of the respiratory control system. © 2012 American Physiological Society. Compr Physiol 2:2871-2921, 2012.