Artificial respiration

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Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration.[1] Assistance takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own[2] (although it must be used on a patient with a beating heart or as part of cardiopulmonary resuscitation to achieve the internal respiration).

Pulmonary ventilation (and hence external respiration) is achieved through manual insufflation of the lungs either by the rescuer blowing into the patient's lungs, or by using a mechanical device to do so. This method of insufflation has been proved more effective than methods which involve mechanical manipulation of the patient's chest or arms, such as the Silvester method.[3] It is also known as Expired Air Resuscitation (EAR), Expired Air Ventilation (EAV), mouth-to-mouth resuscitation, rescue breathing or colloquially the kiss of life.

Artificial respiration is a part of most protocols for performing cardiopulmonary resuscitation (CPR)[4][5] making it an essential skill for first aid. In some situations, artificial respiration is also performed separately, for instance in near-drowning and opiate overdoses. The performance of artificial respiration in its own is now limited in most protocols to health professionals, whereas lay first aiders are advised to undertake full CPR in any case where the patient is not breathing sufficiently.

Mechanical ventilation involves the use of a mechanical ventilator to move air in and out of the lungs when an individual is unable to breathe on his or her own, for example during surgery with general anesthesia or when an individual is in a coma.

Contents

Insufflations

Insufflation, also known as 'rescue breaths' or 'ventilations', is the act of mechanically forcing air into a patient's respiratory system. This can be achieved via a number of methods, which will depend on the situation and equipment available. All methods require good airway management to perform, which ensures that the method is effective. These methods include:

  • Mouth to mouth - This involves the rescuer making a seal between their mouth and the patient's mouth and 'blowing', to pass air into the patient's body
  • Mouth to nose - In some instances, the rescuer may need or wish to form a seal with the patient's nose. Typical reasons for this include maxillofacial injuries, performing the procedure in water or the remains of vomit in the mouth
  • Mouth to mouth and nose - Used on infants (usually up to around 1 year old), as this forms the most effective seal
  • Mouth to mask – Most organisations recommend the use of some sort of barrier between rescuer and patient to reduce cross infection risk. One popular type is the 'pocket mask'. This may be able to provide higher tidal volumes than a Bag Valve Mask.[6]
  • Bag valve mask (BVM) - This is a simple device manually operated by the rescuer, which involves squeezing a bag to expel air into the patient.
  • Mechanical resuscitator - An electric unit designed to breathe for the patient

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