The need for mechanical ventilation arises in the patient with respiratory failure. Causes of respiratory failure include inadequate alveolar ventilation (e.g. coma, neuromuscular disorders, cord injury), inadequate oxygenation (e.g. pneumonia, pulmonary edema, acute respiratory distress syndrome), disorders of the thoracic wall (e.g. multiple rib fractures, scoliosis, obesity), airway obstruction (e.g. edema, foreign body, trauma, infection), and cardiac failure (e.g. left ventricular failure, cardiopulmonary resuscitation).

Decisions to introduce respiratory support are based on evidence obtained from clinical history and examination, the Pao2 measurement in relation to the inspired oxygen fraction (Fio2), the Paco2 in relation to the arterial pH, the vital capacity, the shunt fraction, the ratio of dead-space to tidal volume, and inspiratory pressure measurement.

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