limited assist control ventilation, SIMV-PSV).

In contrast, pressure support or pressure-

limited modes including APRV are generally avoided. (See "Invasive mechanical
ventilation in acute respiratory failure complicating chronic obstructive pulmonary
disease" and "Invasive mechanical ventilation in adults with acute exacerbations of
asthma".)

● Presence of an air leak – In patients with a prolonged air leak (eg, from
pneumothorax or lung surgery) pressure-limited ventilation or SIMV-PSV, or even PSV
alone, are preferred in order to limit additional barotrauma and worsening of the air
leak.

● Concern for elevated intracranial pressure (ICP) – While volume-limited modes are
frequently used in patients with an elevated ICP (eg, traumatic brain injury or stroke),
pressure-limited modes are popular due to the theoretical concern that elevated
intrathoracic pressures hamper venous return from the brain and therefore worsen
ICP. However, there are no data in this population to suggest that one mode is superior
to the other and practice varies widely. (See "Management of acute moderate and
severe traumatic brain injury", section on 'Ventilation'.)

● Paralysis – For patients who are paralyzed or heavily sedated (ie, those in whom the
initiation of a spontaneous breath is limited), PSV is contraindicated and assist
controlled modes (volume- or pressure-limited) are typically used, provided the set
minute ventilation is adequate.

● Others – Clinician familiarity and institutional preferences often dictate common

modes used.

SETTINGS

Once the mode is selected, there are numerous parameters that need to be set, many of
which depend upon the mode selected.

Mode-specific settings — Included in this section are suggested initial settings for the
commonly used modes of ventilation ( table 5). However, it should be noted that settings
should be tailored to the individual who is being ventilated. Importantly, it is critical that the
patient be monitored and settings adjusted according to clinical and, when available, blood
gas findings. (See 'Follow-up' below.)

Volume-limited assist control ventilation — For patients in whom volume-limited assist

control ventilation is chosen as the initial mode of ventilation, we typically use the following
initial settings: