Mechanical ventilation, especially intermittent positive pressure ventilation (IPPV) is the mainstay of modern intensive care practice and of fundamental importance to intensive care unit (ICU) therapy.

Care of the ventilated patient

General issues

• Airway. Access via cuffed tracheal tube or tracheostomy. Secure the tube. Do not overinflate the tracheal cuff. Cuff pressure should be regularly measured, even in tubes with a high-volume/low-pressure cuff.

• Provide adequate humidification and clearance of secretions. The absence of humidification will encourage heat loss and dehydration of the upper respiratory tract. This can cause upper airway epithelial damage, and difficulties with clearance of dry secretions. Conversely, excess heat and/or humidification can cause problems.

• Routine nursing care including care of the unconscious patient.

• Monitor appropriately. In view of the unpredictable and complex effects of IPPV on the circulation be prepared to monitor the central vascular pressures and cardiac output (CO). An arterial line is mandatory to facilitate blood gas sampling for all but the shortest periods of ventilation.

• Nasogastric (N/G) tube to relieve gastric distension and permit administration of medications and nutrition.

• Ensure patient comfort as far as possible. See Chapter 14, Sedation, Analgesia and Neuromuscular Blockade.

• Ensure adequate nutrition and hydration.

Specific issues

Deep vein thrombosis prevention

Deep vein thrombosis (DVT) is common among patients requiring prolonged mechanical ventilation in the ICU setting despite the use of prophylaxis measures.