Chest
Intermittent Mandatory Ventilation: A New Approach to Weaning Patients from Mechanical Ventilators
Section snippets
RATIONALE AND THEORETIC ADVANTAGES OF IMV
Intermittent mandatory ventilation decreases the complexity and amount of equipment required for mechanical respiratory support and subsequent weaning. With the IMV assembly, it is not necessary to switch equipment or to utilize a separate device to provide PEEP during weaning. In addition, the intricate and expensive sigh and assist mechanisms incorporated into many recently marketed ventilators are unnecessary. Weaning with IMV also lessens the necessity for ventilatory measurements, and
CASE 1
A 62-year-old woman with chronic obstructive lung disease sustained a fractured pelvis, clavicle, and second rib, a ruptured urinary bladder, laceration of the liver, and right-sided tension pneumothorax in an automobile accident. During induction of general anesthesia, she vomited and aspirated liquid gastric contents. She was given methylprednisolone sodium succinate (Solu-Medrol) 2 gm intravenously, and after operation her respirations were assisted with a volume-limited ventilator (MA-1,
COMMENT
The above six cases represent weaning problems of varying etiology. The first two patients had severe chronic obstructive pulmonary disease and resultant CO2 retention. Abrupt discontinuation of mechanical ventilation resulted in anxiety, tachypnea, and CO2 retention in both cases. The gradual discontinuation of mechanical ventilation with IMV was successful in both cases. The third, fourth and fifth patients developed hypoxemia when subjected to “Tee-piece” trials, but not with IMV and PEEP.
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Cited by (193)
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2016, Advances in SurgeryCitation Excerpt :This has been shown to improve the patient-ventilator interaction [24] and has theoretic cost savings [25], but there has not yet been a study done on patient-centered outcomes. IMV was initially designed for comfort and to allow spontaneous breathing with underlying mandatory breaths that could be weaned by the physician as the patient improved [26]. There are now modes that have the spontaneous breaths suppress the mandatory breaths, including Mandatory Minute Ventilation (Dräger), Adaptive Support Ventilation (Hamilton), and AutoMode (Maquet).
Real-time pulmonary graphics
2015, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Intermittent blood gases, radiographs, and basic physiologic monitoring gave some help, but the data were often either equivocal or too late to prevent significant clinical events, such as pneumothorax, respiratory acidosis or alkalosis, and intraventricular hemorrhage. Intermittent mandatory ventilation was the first mode that allowed patient interaction with the ventilator [13]. The key to this support type was a change in how gas was delivered to the patient.
Observational Studies
2023, Respiratory CareThe Evolution of Intermittent Mandatory Ventilation
2023, Respiratory Care
Supported in part by an NIH Research Training Grant 5 T01 GM00427-12.
Manuscript received February 1; revision accepted March 29, 1973.