الفهرس 
Indications for Mechanical VentilationOnly 14 pages are availabe for public view
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Abstract
Mechanical ventilatory support is needed for critically ill patients in intensive care units .mechanical ventilation decrease the patient’s work of breathing by unloading respiratory muscles, it is indicated to normalize arterial blood gas level and acid base imbalance.
Many factors affect the decision to begin mechanical ventilation. Because no mode of mechanical ventilation can cure a disease process, the patient should have a correctable underlying problem that can be resolved with the support of mechanical ventilation. This intervention should not be started without thoughtful consideration because intubation and positive-pressure ventilation are not without potentially harmful effects.
Mechanical ventilation is indicated when the patient’s spontaneous ventilation is inadequate to sustain life. In addition, it is indicated as a measure to control ventilation in critically ill patients and as prophylaxis for impending collapse of other physiologic functions. Physiologic indications include respiratory or mechanical insufficiency and ineffective gas exchange.
There are many modes in mechanical ventilation so good understanding of the common ventilator settings will assist in providing breathing comfort.
Mechanical ventilations has many complications like pneumothorax, ventilator associated pneumonia , toxicity with prolonged exposure to FiO2 >60 % and others so early weaning from mechanical ventilation is a must and the clinician must be aware of the criteria of weaning to achieve this goal.
Weaning failure is defined as either failure of spontaneous breathing trial or the need for reintubation within 48 hour following extubation.
Predictors of extubation and weaning failure have been reported such as excess secretions . arteria carbon dioxide tension > 45 , duration of mechanical ventilation > 72 hour, upper airway disorders and a prior failed weaning attempt.
Cardiac dysfunction is probably one of the most common causes of weaning failure and should be diagnosed by all means because it can be effectively treated by diuretic and vasodilators.
Other factors that have been associated with extubation failure include age, primary reason for intubation, neurological dysfunction, also other hidden factors as delirium, prolonged sedation or ICU acquired weakness.
Causes of difficult weaning must be promptly treated, also the clinician must select an appropriate mechanical ventilator mode that aid in the weaning process. Also the specialized weaning units SWUs provide an appropriate environment for such patients and an appropriate bridge to home and relieve pressure on scarce ICU beds.