Respiratory support Lungs bypassed completely.

Blood oxygenated directly via

extracorporeal membrane machine.
For very severe respiratory failure only. ECMO
Specialist centres only.

Used in severe respiratory failure.

Consider Requires heavy sedation, completely different
escalating if mode of action to other ventilator modes.
patient needs HFOV
more than
50% O2 Allows spontaneous breaths with at high PEEP,
with intermittent pressure releases. Consultant
guidance recommended Wean by reducing
APRV O2, frequency and
pressures (medically
led) until patient
Gives set number of breaths per minute (set with f ) ready for trial of
which will be delivered whether or not the patient takes conventional mode
PC or VC
their own pressure supported breaths.
(BIPAP or SIMV) Weaning medically
Can be used to take over patients breathing completely,
or protocol led
or weaned to allow the patient to do more of the work.
+ PS (ASB) & CPAP

Like NIV, but usually delivered via ETT or tracheostomy

All breaths are spontaneous - if the patient doesn’t
breathe, the machine won’t deliver a breath.
Like CPAP, but helps the patient take bigger breaths by
also pushing the gas into the patient when they
breathe in (pressure support). NIV
Needs tight fitting mask, can be difficult to tolerate. (not home
machines)
PS (ASB) Optimise tidal volumes and ABGs
+CPAP using pinsp, or VT, PEEP and rate (f).
Wean by reducing rate, or increasing
amounts of increasing time spent on
ASB alone
Wean by reducing top pressure, or
increasing time periods spent on
CPAP alone.

Does not allow airway pressure to return to zero at end

of breath .Helps splint alveoli and small airways open. CPAP
Reduces work of breathing, improves oxygenation, and Occasionally used for a short while to
Added to hi-flo
helps to mobilise secretions. circuit, bridge patient between extubation
Need to wear tight fitting mask if artificial airway or through vent as and using O2 mask without support
not in place PEEP

Accurate O2 delivery, good humidification High flow

Reasonably tolerated, can feel hot and Wean by reducing amount of CPAP
claustrophobic oxygen, via (if >5) or increasing time periods
face mask spent on High flow

Accurate O2 delivery, excellent

humidification. HFNC
Comfortable, well tolerated,
delivers very low level of CPAP. (High flow Wean to low flow O2, when
nasal cannulae) stable on < 45% O2

Can deliver up to 90% O2.

Can’t wean O2 Non-
Short term use only – no
humidification rebreathe
mask Consider weaning
if patient needs
Inaccurate O2 less than 45% O2*
delivery (unless Low flow
venturi) oxygen
Max 65% O2.
Humidification can via face
be added mask

Max Nasal Most patients will be more comfortable

5 lpm
cannulae with nasal cannulae rather than a mask;
consider swapping from mask if on
<35% / 5lO2
Clare Hepworth 2020