[Mechanical ventilation in pediatrics (III). Weaning, complications and other types of ventilation. Compications of mechanical ventilation]. / Ventilación mecánica en pediatría (III). Retirada de la ventilación, complicaciones y otros tipos de ventilación. Complicaciones de la ventilación mecánica.

Mechanical ventilation can produce multiple complications. The most important acute complications are mechanical problems (respirator failure, problems with the connections and circuit, incorrect parameters or alarms), problems in the airway (disconnection, extubation, mal-positioning of the endotracheal tube, leaks, nose erosions, obstruction of the endotracheal tube due to secretions or kinking, mainstem bronchus intubation, bronchospasm, postextubation croup), pulmonary complications (ventilator-induced lung injury with barotrauma, volutrauma and biotrauma), hemodynamic complications, nosocomial infections (tracheobronchitis, pneumonia, otitis, sinusitis), failure of adjustment of the respirator to the patient, and nutritional complications. The most important chronic problems are subglottal stenosis, chronic pulmonary injury, and psychological alterations.

[Control and assist-control modes of mechanical ventilation]. / Ventilación mecánica controlada y asistida-controlada.

Control ventilation is a mode of ventilation in which the respirator delivers the preset volume or pressure regardless of the patient's own inspiratory efforts. It is indicated in patients with severe neurological alterations, deep sedation, shock or severe respiratory failure. In this mode, breathing is performed by the respirator, diminishing energy expenditure and reducing the risk of hypo- and hyperventilation. In the assist-control ventilation mode the respirator delivers the preset number of breaths and the patient may also obtain further breaths by making a sufficient respiratory effort to open the triggering sensor. All respiration (preset and patient initiated) is performed by the respirator. Assist-control ventilation is indicated inpatients without deep sedation who are able to initiate respiration but who cannot maintain spontaneous respiration.