What are the key principles of initiating invasive mechanical ventilation in a patient with acute respiratory failure?

Key principles of initiating invasive mechanical ventilation in a patient with acute respiratory failure include:

• Use volume-targeted ventilation (VTV) combined with synchronised ventilation as the primary mode of invasive respiratory support to optimise ventilation and reduce lung injury, especially in neonatal care but principles apply broadly to acute respiratory failure management.
• Consider alternative modes such as high-frequency oscillatory ventilation (HFOV) if volume-targeted ventilation is ineffective or unsuitable.
• Avoid certain synchronised pressure-limited ventilation modes such as assist control (AC), synchronised intermittent positive pressure ventilation (SIPPV), patient-triggered ventilation (PTV), pressure support ventilation (PSV), or synchronised time-cycled pressure-limited ventilation (STCPLV) when initiating invasive ventilation, as these are not recommended in some contexts.
• Ensure appropriate oxygen delivery and humidification when providing respiratory support, especially at higher flow rates, to maintain mucosal integrity and patient comfort.
• Administer surfactant early in preterm babies requiring invasive ventilation for stabilisation, recognising that minimally invasive techniques are preferred if feasible.
• Prepare a comprehensive care plan involving a multidisciplinary team that addresses the patient’s needs, ventilator settings, monitoring, and support systems before and during invasive ventilation.
• Monitor respiratory function and clinical signs closely to guide ventilation adjustments and detect complications early.

These principles ensure effective ventilation while minimising complications and supporting patient safety during invasive mechanical ventilation initiation in acute respiratory failure.

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