In medicine and respiratory therapy,, artificial respiration is "Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have respiratory insufficiency to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2)."
Airway access and protection
The methods differ by the means used to protect or provide access to the airway, and the way in which air is provided. For the mechanical methods in the field, capnography has become an important adjunct to pulse oximetry to verify correct positioning of the airway.
Mouth-to-mouth or mouth-to-nose respiration can be performed with no equipment. A slight variant uses a thin mask to protect the rescuer, to be distinguished from positive ventilation masks. Yet another variant uses a thicker mask, with a rescuer port, which is heavy enough to stay in position and not need repositioning after each round of chest compressions.
The standard of care in Basic Life Support is a bag-mask-valve device, minimally on room air and preferably with supplemental oxygen. The mask may be non-rebreathing or partial rebreathing.
Using intratracheal intubation
Types of air delivery
According to the U.S. National Library of Medicine, the terms for the types of nonvinvasive ventilation, also called noninvasive positive pressure ventilation (NPPV) are:
- Continuous positive airway pressure (CPAP).
- Bilevel positive airway pressure (bilevel PAP).
- Intermittent positive-pressure breathing (IPPB or NIPPB or called pressure support).
Inconsistent terminology of noninvasive modes
The terminology for noninvasive respiratory support is inconsistently used in the medical literature.
- Some authors interchange IPPB with IPPV. B indicates the patient is spontaneously breathing while V indicates ventilation via intratracheal intubation.
- Some authors interchange IPPB and IPPV with bilevel PAP as done in a recent randomized controlled trial.
- Some authors interchange bilevel PAP with BiPAP. The latter is a specific brand of a bilevel PAP ventilator.
Although intratracheal intubation frequently involves sedating patients, continuous sedation may prolong intubation.
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Antipsychotic agents, in a small study, found that an average of 15 mgs per day of haloperidol and 113 mg per day of ziprasidone increased akathisia (see table for benefits which did not have statistical significance).
Chronic obstructive pulmonary disease
All types of noninvasive ventilation studied through 2003 may help respiratory insufficiency due to chronic obstructive pulmonary disease according to systematic reviews of randomized controlled trials, especially if the exacerbations are severe. In one trial:
- Patients were included if PaCO2 was greater than 45 mm Hg.
- Bilevel PAP was started at:
- Inspiratory pressure 10 cm H20
- Expiratory pressure 4 cm H20
- Encouraged for up to:
- Day 1: As much as tolerated
- Day 2: 16 hours
- Day 3: 12 hours
- Inspiratory pressure was increased by 5 cm H20 as needed up to 20 H20 as tolerated.
Noninvasive ventilation may help treat respiratory insufficiency due to heart failure, but the optimal mode of noninvasive ventilation is not clear according to a systematic review. One randomized controlled trial in the systematic review found that neither CPAP or bilevel PAP reduced mortality as compared to standard oxygen therapy; however, both of the noninvasive methods provided similar symptomatic and metabolic improvement. In this trial:
- CPAP was started at 5 cm of water and increased as needed to 15 cm of water.
- Bilevel PAP was started at an inspiratory positive airway pressure of 8 cm of water and an expiratory positive airway pressure of 4 cm of water and was increased as needed to an inspiratory pressure of 20 cm of water and expiratory pressure of 10 cm of water.
IPPB may help, but may also increase gastrointestinal complications.
Weaning from ventilation
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