Snapshot A 55-year-old alcoholic man presents to the emergency department acutely altered. Upon initial workup it is noted that the patient has a Glasgow coma scale of 7 and is hypoxic and hypercapneic. He is subsequently intubated and mechanically ventilated. Secondary exam reveals a patient covered in vomit and urine who smells like alcohol. (Acute respiratory distress syndrome). Introduction Clinical definition a ventilator that mechanically oxygenates/ventilates the patients with settings determined by the physician Therapeutic indications for intubation and mechanical ventilation include failure to oxygenate failure to ventilate inability to protect airway login to view 1 more bullet suspected clinical course requiring intubation and ventilation Main modes assist-control (volume-cycled or pressure-targeted) login to view 6 more bullets pressure-support ventilation login to view 5 more bullets synchronized intermittent mechanical ventilation (SIMV) login to view 1 more bullet Complications Cardiovascular impairment positive intrathoracic pressure can decrease venous return, decreasing cardiac output Barotrauma (trauma from high pressures) findings login to view 5 more bullets etiologies login to view 5 more bullets Ventilator-induced lung injury (atelectrauma or trauma caused by atelectasis) PEEP to prevent widespread alveolar unit closure and atelectasis Acid-base status derangements generally, changing the respiratory rate is preferred for responding to derangements (because TV is based on height) login to view 5 more bullets Infections ventilator-associated pneumonia login to view 5 more bullets