Assisted Ventilation

Severe acute respiratory failure is one of the most frequent causes for patient admission to the intensive care unit (ICU). In the most severe conditions, invasive mechanical ventilation is a required life support in these patients.

The polio epidemic that occurred in Denmark in 1952 demonstrated how careful airway management and the application of positive-pressure ventilation could dramatically reduce mortality in patients presenting with paralysis of the respiratory muscles. The focus on airway care and ventilator management encouraged the way forward for critical care facilities. Technological advances in the 1960s led to the development of sophisticated, physiological monitoring equipment. Later, further developments were introduced that included: improved understanding of mechanical ventilation pathophysiology in patients with severe-acute respiratory failure; the production of ventilators with improved technology, new ventilator modes that were aimed at improving patient outcomes; and since the early 1990s, the introduction of noninvasive ventilation (NIV) as a less invasive mode of ventilatory support in patients with intermediate severity of respiratory failure.

Assisted mechanical ventilation is currently the life support technique most frequently used in critically ill patients who are admitted to the ICU, and an extensive body of literature has been published within this topic. The appropriate knowledge indications and settings for mechanical ventilation are mandatory to develop and implement protective ventilation strategies and avoid possible iatrogenic effects.

This issue of Seminars in Respiratory and Critical Care Medicine is intended as an update on various aspects and novel developments that have occurred in recent years within the field of assisted ventilation. Topics that have been included are ventilator strategies in different clinical conditions and in the withdrawal of mechanical ventilation, adjuvant therapies that include sedation and analgesia, modes of extracorporeal support, weaning from mechanical ventilation, complications of mechanical ventilation and prevention, and NIV in the most relevant clinical indications.

As Guest Editors, we invited international experts to write up-to-date reviews based on their expertise and long-time experiences within this field. We would like to thank all the contributors for their enthusiasm and hard work. We are also indebted to Prof. Joseph P. Lynch, Editor-in-Chief of Seminars in Respiratory and Critical Care Medicine, as well as all those at the Editorial Office for their excellent technical help with producing this issue of Seminars in Respiratory and Critical Care Medicine.