Mechanical ventilation

Mechanical ventilation is perhaps the cornerstone of contemporary critical care. Indeed, the history of critical care medicine, especially pediatric critical care medicine, is inextricably tied with that of mechanical ventilation. The first Pediatric Intensive Care Units (PICUs) arose during the polio epidemic with negative pressure ventilation (the so-called “iron lung”). However, while mechanical ventilation is clearly life-sustaining, one should remember that it is only a supportive modality and does not reverse the underlying disease process. Moreover, mechanical ventilation can be associated with a number of adverse effects, which in turn can be associated with significant morbidity and risk of mortality. A thorough understanding of the physiologic basis of mechanical ventilation is therefore essential to providing safe, effective care in the PICU.