[[Image:Ballon ventilation 1.jpg|thumb|ventilation balloon]] In medicine, mechanical ventilation method to assist or replace spontaneous respiration. Mechanical ventilation can be life-saving and is a mainstay of cardiopulmonary resuscitation, intensive care medicine, and general anaesthesia. ==Clinical use== Mechanical ventilation is used when natural (spontaneous) breathing is absent (apnea) or insufficient. This may be the case in cases of intoxication, circulatory arrest, list of neurological diseases or head trauma, paralysis of the breathing muscles due to spinal cord injury, or the effect of anaesthesia or muscle relaxant drugs. Various lung diseases or chest trauma, cardiac disease such as congestive heart failure, sepsis and shock may also necessitate ventilation. Depending on the situation, mechanical ventilation may be continued for a few minutes or many years. While returning to spontaneous breathing is rarely a problem in routine anaesthesia, weaning an intensive care patient from prolonged mechanical ventilation can take weeks or even months. Some patients never adequately regain the ability to breathe and require permanent mechanical ventilation. This is often the case with severe brain injury, spinal cord injury, or neurological disease. ==Techniques== ===Positive and negative pressure ventilation=== While the exchange of oxygen and carbon dioxide between the bloodstream and the pulmonary airspace works by diffusion and requires no external work, air must be moved into and out of the lungs to make it available to the gas exchange process. In spontaneous breathing, a negative pressure is created in the pleural cavity by the muscles of respiration, and the resulting gradient between the atmospheric pressure and the pressure inside the thorax generates a flow of air. This is imitated by the ''negative-pressure ventilation'' that is employed in iron lungs. An iron lung works by creating an underpressure in a chamber which encloses the body and is sealed at the neck. With the patient's airways open, the resulting gradient to the atmospheric pressure serves to inflate the lungs. All other techniques of ventilation are ''positive pressure ventilation'' techniques, meaning that air is forced into the lungs by an external overpressure. =====There are various procedures and mechanical devices that provide protection against airway collapse, air leakage, and aspiration: * 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. A face mask does, however, not provide protection against aspiration. Face masks are also used for "non-invasive (medical) ventilation" in conscious patients. Non-invasive ventilation is aimed at minimizing patient discomfort and ventilation-related disease. It is often used in cardiac or pulmonary disesase. * 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. * ''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. * ''Tracheotomy'' - When patients require mechanical ventilation for more than days or a few weeks, tracheostomy provides the most suitable access to the patient's airways. A tracheostomy is a surgically created passage to the trachea. Tracheostomy tubes are well tolerated and often do not necessitate any use of sedative drugs. == History == The iron lung was used through much of the middle 20th century, mostly for long-term ventilation. It was refined and used largely as a result of the polio epidemic that struck the world in the 1950s. The machine is effectively a big elongated tank, which encases the patient up to the neck. The neck is sealed with a rubber gasket so that the patient's face (and airway) are exposed to the room air. By means of a pump, the air is withdrawn mechanically to provide inspiration and released to room pressure to allow expiration. Thus the patient inhales room air by a means of negative pressure applied to the patient's thorax area. There are large portholes for nurse or home assistant access. patients could remain in these iron lungs for years at a time quite successfully. Some are still in use, notably with the Polio Wing Hospitals in England such as St Thomas' (by Westminster in London) and the John Radcliffe in Oxford. The patients can talk and eat normally and see the world through a well-placed series of mirrors. A smaller device known as the cuirass was invented to place onto the chest wall like a giant plumber's suction plunger. It was prone to falling off and caused severe chaffing and skin damage and was not used as a long term device. In recent years this device has re-surfaced as a modern polycarbonate shell with multiple seals and a high pressure oscillation pump. It has mostly been effective with children and is still in use in domiciliary ventilation in West England and Wales. Emergency medicine Intensive care medicine Prehospital care
victims can no longer breathe easily or cough to clear their lungs of dangerous mucus. Typically, these patients get a tracheotomy - a tube inserted through a hole drilled in the throat so air can be pumped in and secretions suctioned out. The opening is vulnerable to lethal bacteria and patients routinely get pneumonia. Often, they can't speak. Constant care to keep the tubes open forces many into nursing homes.
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Mechanical ventilation
[[Image:Ballon ventilation 1.jpg|thumb|ventilation balloon]] In medicine, mechanical ventilation method to assist or replace spontaneous respiration. Mechanical ventilation can be life-saving and is a mainstay of cardiopulmonary resuscitation, intensive care medicine, and general anaesthesia. ==Clinical use== Mechanical ventilation is used when natural (spontaneous) breathing is absent (apnea) or insufficient. This may be the case in cases of intoxication, circulatory arrest, list of neurological diseases or head trauma, paralysis of the breathing muscles due to spinal cord injury, or the effect of anaesthesia or muscle relaxant drugs. Various lung diseases or chest trauma, cardiac disease such as congestive heart failure, sepsis and shock may also necessitate ventilation. Depending on the situation, mechanical ventilation may be continued for a few minutes or many years. While returning to spontaneous breathing is rarely a problem in routine anaesthesia, weaning an intensive care patient from prolonged mechanical ventilation can take weeks or even months. Some patients never adequately regain the ability to breathe and require permanent mechanical ventilation. This is often the case with severe brain injury, spinal cord injury, or neurological disease. ==Techniques== ===Positive and negative pressure ventilation=== While the exchange of oxygen and carbon dioxide between the bloodstream and the pulmonary airspace works by diffusion and requires no external work, air must be moved into and out of the lungs to make it available to the gas exchange process. In spontaneous breathing, a negative pressure is created in the pleural cavity by the muscles of respiration, and the resulting gradient between the atmospheric pressure and the pressure inside the thorax generates a flow of air. This is imitated by the ''negative-pressure ventilation'' that is employed in iron lungs. An iron lung works by creating an underpressure in a chamber which encloses the body and is sealed at the neck. With the patient's airways open, the resulting gradient to the atmospheric pressure serves to inflate the lungs. All other techniques of ventilation are ''positive pressure ventilation'' techniques, meaning that air is forced into the lungs by an external overpressure. =====There are various procedures and mechanical devices that provide protection against airway collapse, air leakage, and aspiration: * 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. A face mask does, however, not provide protection against aspiration. Face masks are also used for "non-invasive (medical) ventilation" in conscious patients. Non-invasive ventilation is aimed at minimizing patient discomfort and ventilation-related disease. It is often used in cardiac or pulmonary disesase. * 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. * ''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. * ''Tracheotomy'' - When patients require mechanical ventilation for more than days or a few weeks, tracheostomy provides the most suitable access to the patient's airways. A tracheostomy is a surgically created passage to the trachea. Tracheostomy tubes are well tolerated and often do not necessitate any use of sedative drugs. == History == The iron lung was used through much of the middle 20th century, mostly for long-term ventilation. It was refined and used largely as a result of the polio epidemic that struck the world in the 1950s. The machine is effectively a big elongated tank, which encases the patient up to the neck. The neck is sealed with a rubber gasket so that the patient's face (and airway) are exposed to the room air. By means of a pump, the air is withdrawn mechanically to provide inspiration and released to room pressure to allow expiration. Thus the patient inhales room air by a means of negative pressure applied to the patient's thorax area. There are large portholes for nurse or home assistant access. patients could remain in these iron lungs for years at a time quite successfully. Some are still in use, notably with the Polio Wing Hospitals in England such as St Thomas' (by Westminster in London) and the John Radcliffe in Oxford. The patients can talk and eat normally and see the world through a well-placed series of mirrors. A smaller device known as the cuirass was invented to place onto the chest wall like a giant plumber's suction plunger. It was prone to falling off and caused severe chaffing and skin damage and was not used as a long term device. In recent years this device has re-surfaced as a modern polycarbonate shell with multiple seals and a high pressure oscillation pump. It has mostly been effective with children and is still in use in domiciliary ventilation in West England and Wales. Emergency medicine Intensive care medicine Prehospital care
Mechanical ventilation
victims can no longer breathe easily or cough to clear their lungs of dangerous mucus. Typically, these patients get a tracheotomy - a tube inserted through a hole drilled in the throat so air can be pumped in and secretions suctioned out. The opening is vulnerable to lethal bacteria and patients routinely get pneumonia. Often, they can't speak. Constant care to keep the tubes open forces many into nursing homes.
There is a noninvasive alternative that few doctors offer, contends Dr. John Bach of the University of Medicine and Dentistry of New Jersey. The key is a 1952 machine called the Cof-flator that, when held to the mouth, sucks air from the bronchial tubes to induce a cough that patients can't force unaided.
Once patients can clear their lungs, they can breathe with standard oxygen masks or with an easily learned inhaling technique
I wonder where this can be inserted into this article...
~ender 2003-09-10 02:11:MST
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removed from article:
''This process usually also stabilizes patients' heart rhythyms, so in many cases, a ventilator is sufficient to keep a patient with a severely damaged body alive.''
This is, at least, very vague. Perhaps this sentence refers to the life-saving properties of ventilation in severe hypoxemic states? Anyway, needs to be clarified before it can go into the introduction. User:Kosebamse 07:57, 9 Oct 2003 (UTC)
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