Modes of Ventilation and Weaning Strategies

  • C. Putensen
  • F. Stüber
  • H. Wrigge
Conference paper


The traditional mechanically ventilatory management of patients with acute lung injury has been based on the perception of a uniformly distributed lung damage. Conventionally, full ventilatory support has been provided with large tidal volumes of 10 to 15 ml/kg, low ventilatory frequencies of 10 to 15 breaths/min, and PEEP levels that allowed adequate arterial oxygenation without using toxic inspiratory oxygen fractions (FiO2) = 0.5 [1]. Discontinuation of mechanical ventilation has been determined mainly by the clinical and often subjective judgment of a well trained physician and was accomplished with T-tube trials (“sink or swim” technique). Downs et al. [2] in 1973 introduced intermittent mandatory ventilation (IMV), that allows unsupported spontaneous breathing to occur between mechanically delivered tidal volumes. Although introduced as a weaning technique [2, 3], IMV rapidly became a standard technique for primary mechanical ventilatory support in most intensive care units [4]. This occurred despite a debate regarding the usefulness of IMV, because clinical experience demonstrated that an adjustable ventilatory support was advantageous. However, controlled mechanical ventilation and IMV represent different levels of ventilatory support administered by using the same technique.


Continuous Positive Airway Pressure Acute Lung Injury Acute Respiratory Distress Syndrome Ventilatory Support Spontaneous Breathing 


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Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • C. Putensen
    • 1
  • F. Stüber
    • 1
  • H. Wrigge
    • 1
  1. 1.Dept. of Anaesthesiology and Intensive CareUniversity of BonnBonnGermany

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