Mechanical Ventilation: Modes & Basics

Creator: Progress Note
Published: 2026-09-03
Keywords: mechanical ventilation, mechanical ventilation modes, invasive vs noninvasive ventilation, ventilator settings, PEEP tidal volume, ventilator complications

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check_circleVentilation can be noninvasive (mask) or invasive (endotracheal tube).
check_circleKey settings include mode, tidal volume, respiratory rate, FiO2, and PEEP.
check_circlePEEP keeps alveoli open to improve oxygenation.
check_circleLung-protective ventilation uses low tidal volumes, especially in ARDS.
check_circleComplications include barotrauma, ventilator-associated pneumonia, and hemodynamic effects.

Invasive vs Noninvasive

Noninvasive ventilation (such as CPAP and BiPAP) delivers positive pressure through a tight mask and is used for conditions like COPD exacerbations and cardiogenic pulmonary edema in patients who can protect their airway. Invasive mechanical ventilation delivers breaths through an endotracheal or tracheostomy tube and is used when noninvasive support fails, the airway is unprotected, or respiratory failure is severe. Choosing between them depends on severity and airway status.

Modes and Settings

Ventilator modes define how breaths are delivered — for example, assist-control (every breath is fully supported), synchronized intermittent mandatory ventilation, and pressure support. Key settings include the tidal volume (or inspiratory pressure), respiratory rate, the fraction of inspired oxygen (FiO2) to target oxygenation, and positive end-expiratory pressure (PEEP), which keeps alveoli open at the end of expiration to improve oxygenation and prevent collapse.

Indications and Lung Protection

Mechanical ventilation is indicated for respiratory failure (hypoxemic or hypercapnic), airway protection in a patient who cannot maintain it, and to support work of breathing. A key principle is lung-protective ventilation: using low tidal volumes (about 6 mL/kg of predicted body weight) and limiting plateau pressure, which reduces ventilator-induced lung injury and improves survival, most notably in ARDS.

Complications

Positive-pressure ventilation carries risks. Barotrauma and volutrauma can cause pneumothorax; high intrathoracic pressure can reduce venous return and lower blood pressure. Ventilator-associated pneumonia is a major infectious complication, mitigated by preventive care bundles. Other issues include oxygen toxicity at high FiO2, and complications of sedation and immobility. Weaning is undertaken as the underlying condition improves.

Frequently asked questions

What is the difference between invasive and noninvasive ventilation?expand_more

Noninvasive ventilation (CPAP, BiPAP) delivers positive pressure through a mask and is used when the patient can protect their airway, as in COPD exacerbations. Invasive ventilation delivers breaths through an endotracheal tube and is used when noninvasive support fails, the airway is unprotected, or respiratory failure is severe.

What is PEEP?expand_more

PEEP (positive end-expiratory pressure) is pressure maintained in the airways at the end of expiration to keep alveoli open. It improves oxygenation and prevents alveolar collapse, and is an important adjustable setting in mechanical ventilation, particularly in conditions like ARDS.

What is lung-protective ventilation?expand_more

Lung-protective ventilation uses low tidal volumes (about 6 mL/kg of predicted body weight) and limits plateau pressure to reduce ventilator-induced lung injury. It improves survival, especially in ARDS, and is a core principle of modern mechanical ventilation.

What are the complications of mechanical ventilation?expand_more

Complications include barotrauma and volutrauma (such as pneumothorax), reduced venous return and hypotension from high intrathoracic pressure, ventilator-associated pneumonia, oxygen toxicity at high FiO2, and complications of sedation and immobility.

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