Continuous mandatory ventilation

Continuous Mandatory Ventilation (CMV) is a mode of mechanical ventilation where the ventilator delivers a set number of breaths per minute at a predetermined volume or pressure, regardless of the patient's own respiratory efforts. This mode is often used in patients who are unable to breathe spontaneously or require complete respiratory support.

Overview

CMV is a form of mechanical ventilation that provides full ventilatory support to patients. It is typically used in intensive care settings for patients with severe respiratory failure. In CMV, the ventilator is set to deliver a specific tidal volume or pressure at a fixed rate, ensuring that the patient receives a consistent amount of ventilation.

Indications

CMV is indicated in situations where the patient is unable to initiate breaths on their own or when spontaneous breathing is insufficient to meet their respiratory needs. Common indications include:

• Acute respiratory distress syndrome (ARDS)
• Severe pneumonia
• Chronic obstructive pulmonary disease (COPD) exacerbations
• Post-operative support following major surgery
• Neuromuscular disorders affecting respiratory muscles

Mechanism

In CMV, the ventilator controls both the rate and volume (or pressure) of breaths. The two primary types of CMV are:

• Volume-controlled ventilation (VCV): The ventilator delivers a preset tidal volume with each breath.
• Pressure-controlled ventilation (PCV): The ventilator delivers breaths at a preset pressure, with the volume varying based on the patient's lung compliance.

Advantages

• Provides complete respiratory support, allowing for rest of the respiratory muscles.
• Ensures consistent ventilation, which is crucial in patients with severe respiratory failure.

Disadvantages

• Can lead to barotrauma or volutrauma if not carefully monitored.
• May cause ventilator-induced lung injury (VILI) due to high pressures or volumes.
• Risk of respiratory alkalosis if the set rate is too high.

Complications

• Ventilator-associated pneumonia (VAP)
• Atelectasis
• Oxygen toxicity

Also see

• Mechanical ventilation
• Intermittent mandatory ventilation (IMV)
• Synchronized intermittent mandatory ventilation (SIMV)
• Positive end-expiratory pressure (PEEP)

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