Advances in mechanical ventilation.

The chief reason that patients are admitted to an intensive care unit is to receive ventilatory support. In this article, I update the basic principles of mechanical ventilation, which I reviewed in the Journal in 1994,1 and discuss recent advances. Basic Principles The indications for mechanical ventilation, as derived from a study of 1638 patients in eight countries,2 are acute respiratory failure (66 percent of patients), coma (15 percent), acute exacerbation of chronic obstructive pulmonary disease (13 percent), and neuromuscular disorders (5 percent). The disorders in the first group include the acute respiratory distress syndrome, heart failure, pneumonia, sepsis, complications . . .

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