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Research ArticleConference Proceedings

Monitoring During Mechanical Ventilation

Craig R Rackley
Respiratory Care June 2020, 65 (6) 832-846; DOI: https://doi.org/10.4187/respcare.07812
Craig R Rackley
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Abstract

Mechanical ventilation is an indispensable form of life support for patients undergoing general anesthesia or experiencing respiratory failure in the setting of critical illness. These patients are at risk for a number of complications related to both their underlying disease states and the mechanical ventilation itself. Intensive monitoring is required to identify early signs of clinical worsening and to minimize the risk of iatrogenic harm. Pulse oximetry and capnography are used to ensure that appropriate oxygenation and ventilation are achieved and maintained. Assessments of driving pressure, transpulmonary pressure, and the pressure-volume loop are performed to ensure that adequate PEEP is applied and excess distending pressure is minimized. Finally, monitoring and frequent adjustment of airway cuff pressures is performed to minimize the risk of airway injury and ventilator-associated pneumonia. We will discuss monitoring during mechanical ventilation with a focus on the accuracy, ease of use, and effectiveness in preventing harm for each of these monitoring modalities.

  • mechanical ventilation
  • pulse oximetry
  • capnography
  • driving pressure
  • transpulmonary pressure
  • pressure-volume curve
  • airway cuff pressure

Footnotes

  • Correspondence: Craig R Rackley MD, Division of Pulmonary, Allergy, and Critical Care Medicine, Box 102355, Duke University Medical Center, Durham, NC 27710. E-mail: craig.rackley{at}duke.edu
  • A version of this paper was presented at the 58th Respiratory Care Journal Conference, held June 10–11, 2019, in St. Petersburg, Florida.

  • The author has disclosed no conflicts of interest.

  • ↵* Dean R Hess PhD RRT FAARC is Managing Editor of Respiratory Care.

  • Copyright © 2020 by Daedalus Enterprises
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In this issue

Respiratory Care: 65 (6)
Respiratory Care
Vol. 65, Issue 6
1 Jun 2020
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Monitoring During Mechanical Ventilation
Craig R Rackley
Respiratory Care Jun 2020, 65 (6) 832-846; DOI: 10.4187/respcare.07812

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Monitoring During Mechanical Ventilation
Craig R Rackley
Respiratory Care Jun 2020, 65 (6) 832-846; DOI: 10.4187/respcare.07812
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  • Article
    • Abstract
    • Introduction
    • Should Pulse Oximetry Be Used With Every Mechanically Ventilated Patient?
    • Should Capnography Be Used With Every Mechanically Ventilated Patient?
    • Is Monitoring Driving Pressure Useful?
    • Should Transpulmonary Pressure Be Monitored for All Mechanically Ventilated Patients?
    • Is the Respiratory System Pressure-Volume Curve Useful?
    • Why Is Monitoring Airway Cuff Pressure Important?
    • What Methods Are Available to Measure Airway Cuff Pressure?
    • Conclusion
    • Discussion
    • Footnotes
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    • References
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Keywords

  • mechanical ventilation
  • pulse oximetry
  • capnography
  • driving pressure
  • transpulmonary pressure
  • pressure-volume curve
  • airway cuff pressure

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