Talk:Mechanical ventilation

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comments
victims can no longer breathe easily or cough to clear their lungs of dangerous mucus. Typically, these patients get a tracheotomy - a tube inserted through a hole drilled in the throat so air can be pumped in and secretions suctioned out. The opening is vulnerable to lethal bacteria and patients routinely get pneumonia. Often, they can't speak. Constant care to keep the tubes open forces many into nursing homes. There is a noninvasive alternative that few doctors offer, contends Dr. John Bach of the University of Medicine and Dentistry of New Jersey. The key is a 1952 machine called the Cof-flator that, when held to the mouth, sucks air from the bronchial tubes to induce a cough that patients can't force unaided. Once patients can clear their lungs, they can breathe with standard oxygen masks or with an easily learned inhaling technique I wonder where this can be inserted into this article... ~ender 2003-09-10 02:11:MST

— Preceding unsigned comment added by 209.86.26.171 (talk • contribs) 09:11, 10 September 2003 (UTC)

Removed
removed from article: This process usually also stabilizes patients' heart rhythyms, so in many cases, a ventilator is sufficient to keep a patient with a severely damaged body alive. This is, at least, very vague. Perhaps this sentence refers to the life-saving properties of ventilation in severe hypoxemic states? Anyway, needs to be clarified before it can go into the introduction. Kosebamse 07:57, 9 Oct 2003 (UTC)

Mechanical vs. hand ventilation
Have just put a wee bit about Vesalius and his method of inflating (animal lungs) in the history. On re-reading I feel that the history is focused on the mechanical aspects (i.e. machine-based) rather than the ventilation bit. I was going to add a bit about Lassen's work in Copenhagen during the polio epidemic which involved intubating patients due to the lack of iron lungs. Do people think this would be appropriate here? Anyone bothered if I re-jig the history bit to add a bit on manual (as opposed to mechanical) ventilation?Mmoneypenny 18:22, 16 September 2006 (UTC)

On second thoughts, what about renaming this page "Artificial ventilation" because that's what being described and the term encompasses manual and mechanical ventilation. What do YOU think? Yeah, you, with the blue eyes, glasses...Mmoneypenny 18:45, 16 September 2006 (UTC)

Requested move (2006)

 * The following discussion is an archived debate of the . Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section. 

Not moved. —Centrx→talk • 04:47, 6 October 2006 (UTC) Mechanical ventilation → Artificial ventilation – Artificial ventilation is an umbrella term for mechanical and hand ventilation, the current article covers both terms but is called Mechanical Ventilation Mmoneypenny 16:59, 17 September 2006 (UTC)

Survey

 * Strongly oppose. If it has already been relisted, and still nobody cares, don't be messing around with it forever.  Gene Nygaard 15:47, 2 October 2006 (UTC)
 * Stongly support. Somebody does care! Me! And we aren't messing around forever. This is a simple name change for the article, which actually suits the article better and makes sense! (Apologies for the many exclamation marks!) I'd do it myself but artificial ventilation already exists.Mmoneypenny 17:51, 2 October 2006 (UTC)
 * If nobody but you, the original nominator, cares, and it has already been relisted, then there obviously isn't any crying need for a change. The closers at RM ought to have more sense than to drag these things on forever.  Just close it out, and if after a sufficient period of time has passed the development of the articles may make the reasoning sensible enough that you'd actually get some support.  Gene Nygaard 02:57, 3 October 2006 (UTC)


 * oppose. "artificial", as opposed to "natural" or medicaly speaking "spontaneaous" breathing describes every external way ta assist non or partialy breathing subjects. No doubt the term "artificial ventilation" is legitimate but limitates the options and was indead widely used in France, for example, until the late 90's. Todays consensus is to define by "mechanical ventilation" all means to support one's breathing with any external device,electricaly powered or not. eliemalka 09:43, 5 October 2006 (UTC)

Discussion

 * I think there should be a clarifier. "Artificial ventilation (medicine)", say. -- Beardo 22:05, 2 October 2006 (UTC)
 * Yes, I think that is a good idea--which could involve just creating an article there without moving this one. There isn't any indicator in the current to article name to suggest that is what these deal with, and maybe making this one broader than medicine, incorporating and expanding the disambiguation lines at the top, or changing the disamb line to just a link to the disambiguation page at ventilation and including it there.  The "mechanical" adjective is used in many contexts other than medicine, whereas "artificial"  is likely less used outside medicine.  Gene Nygaard 04:00, 3 October 2006 (UTC)
 * There is also a mechanical ventilator redirect to medical ventilator that needs to be considered (switching the redirects is apparently why the nominator of this move couldn't accomplish it himself), and whether or not the process needs to be covered in an article separate from the machine should be considered. Gene Nygaard 04:03, 3 October 2006 (UTC)
 * The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Spam or not?
Upon brief inspection, I'm not sure this link that was removed citing spam qualifies as spam. Opinions, anyone? Random wiki denizen from 24.166.2.5 21:45, 29 Dec 2006 (UTC)


 * It may be a useful link however it was added as part of a batch anonymously and without edit summaries by an IP address belonging to the publisher (see User talk:12.40.112.190). That sort of campaign-linking by the company itself is always inappropriate per the Conflict of Interest Guideline (and perhaps some other policies or guidelines as well). I did not remove that particular link however the editor that did was following the standard procedure for cleaning up after a linking campaign.


 * The appropriate step for someone with a conflict of interest is to suggest edits or links on the talk page and then let others decide.


 * If you want to to keep the link, by all means do so. --A. B. (talk) 23:12, 29 December 2006 (UTC)


 * Oh, I see. I was unaware it was added by the publisher. Thank you for clarifying that.24.166.2.5 03:35, 30 December 2006 (UTC)

Mechanical vs artificial
IMO, mechanical refers to the use of electrical, automated machines to provide assistance to breathing, whereas artificial ventilation is an umbrella term that includes both mechanical as well as hand-assisted ventilation. At least in the emedicine.com website listed at the end, mechanical ventilation does not include hand-assisted ventilation. Hand assisted, CPAP, BIPAP are categorized as noninvasive ventilation while mechanical ventilation refers to invasive ventilation requiring an ET or trach tubes.

And in addition, I don't think hand ventilation is mechanical at all in any sense Andrewr47 01:21, 11 January 2007 (UTC)

You can still bag someone (breath for them by hand) if they have an endotracheal tube or a trach. Your Three categories are mechanical ventilation, non-invasive ventilation, and manual ventilation. Keep in mind, there are differences within each of these categories as well, such as: Is the patient breathing spontaneously and only receiving pressure support, or is the machine doing all of the work? —Preceding unsigned comment added by 170.232.128.10 (talk) 21:18, 24 October 2010 (UTC)

Initial ventilator and patient settings
This heading, IMHO, may lead to a description of how ventilators are set in any contributors own ICU, and also addresses more controversial issues of management a little too early in the article. At the moment, the article has a definate slant to adult ICU, and the comment about Assist control being the primary setting on a ventilator is certainly not true for many neonatal intensive care units, transport services (where the servos required fo AC ventilators may be too heavy and unweildy) and even those in countries with less wealth (these ventilators are up to 10 times the price of IMV). The article may be more informative if the heading modes of ventilation were to include AC ventilation, with a comment about its common use in adult ICU, rather than under this heading. would ventilator settings (as this is a more technical and controversial aspect of mechanical ventilation) be better towards the end of the article? Whyso 14:57, 11 February 2007 (UTC)
 * Agree with adult slant point. Removed following from HFOV description: "Mean airway pressure in HFOV is most often significantly higher than pressures provided with conventional PEEP (30-40 cmH2O or higher) and is usually started at ~10 cmH2O above the MAP measured during conventional ventilation."  In infants the MAP is generally set at 1-2 cmH2O higher than with conventional. If comment is correct for adults, replace with qualification. Hallbrianh 19:53, 14 March 2007 (UTC)

Alternative modes of Ventilation
can this be changed to simply 'modes of ventilation'? I do not feel confident to counter the coment IMV 'is rarely used', but wonder if our anaesthetic colleagues would comment - I was under the impression it was commonly used for anaesthesia in which muscle relaxation was required (ie it was used on many thousands of people on a daily basis).Whyso 15:12, 11 February 2007 (UTC)
 * You are correct that CMV is frequently used in anesthesia. I added this comment.  Have been looking at this entire page for a while.  The page needed significant reorganization as it had an almost single focus on assist control use in adults from a somewhat one-sided point of view, together with a hodge podge listing of other modes without unifying explanation.  Attempted to reorganize into more logical order and balance out presentation of modes and treatment decisions.  Would welcome other suggestions.  Still need to add references to much of this.  69.250.107.161 23:56, 14 March 2007 (UTC)  Somehow signed out while I was making changes.  They are mine. Hallbrianh 00:00, 15 March 2007 (UTC)
 * Thankyou very much - I have only had a quick look at the changes, but really like the logical progression of ideas - thankyou very much for making the changes Whyso 03:14, 18 March 2007 (UTC)

Cof-flator
Sucking air out of the lungs can cause lung collapse. A device called the Hayek RTX which has a secretion clearance mode has been shown to be at least if not more effective, without any of the problems of the cof-later, an old out dated technology. —Preceding unsigned comment added by 217.34.149.45 (talk) 11:16, 12 September 2007 (UTC)

Additional Tasks
Other sections needed for this article, in my view, include discussions of: 1. Ventilator triggering 2. Minute ventilation 3. ETT sizing and technique of placement 4. Flow loops and flow patterns 5. I:E ratio 6. Sedation and other medications, including nitric oxide 7. Oxygen delivery 8. Barotrauma Hallbrianh (talk) 18:49, 18 March 2008 (UTC)

Ventilator-associated lung injury
I think it is time to create an article or a section called ventilator-associated complications. There is already a separate ventilator-associated lung injury article. Nephron T|C 06:42, 3 April 2008 (UTC)

Dead links and mild confusion
At least ASB is a dead end link, others may be as well but I am a wikipedia rookie and don't have the time to check them all. Some of these terms are very new to me (a medic with 8+ years experience). Perhaps the "old" terms could be listed more clearly in the article? I came to reasearch PSV and only found a reference to it in the links section (which directed me to the dead link). ~wikiRookie 11/8/09 — Preceding unsigned comment added by 65.205.15.46 (talk • contribs) 03:20, 9 November 2009 (UTC)

Copy edit: head section
I've just done a first pass on the article head to fix what I felt were some slightly awkward phrases. I welcome your thoughts on the subject. I placed a note at Wikipedia_talk:WikiProject_Medicine to ask for more experienced eyes than mine. Cheers, Basie (talk) 18:57, 16 January 2009 (UTC)

Galen the first?
I've come across an interesting and relatively new (2006) reference which asserts Galen was the first to describe mechanical ventilation, not Vesalius. "Galen is the first to have described ventilating and animal: 'If you take a dead animal and blow air through its larynx [through a reed], you will fill its bronchi and watch its lungs attain the greatest distention.' He was fascinated by the question of how air could be drawn into the heart. Unfortunately for Galen, this was a question that could not be solved before the development of the microscope and the concept of diffusion. Also unfortunate for Galen was his failure to appreciate how ventilating the lungs could help him in his vivisection work. Galen operated on many living animals but his studies on the function of the heart were limited by the risk of pneumothorax. Opening the thoracic cavity almost certainly resulted in the death of the animal. It was over a thousand years later that Vasalius realized that ventilation could protect animals from pneumothorax. The beating heart would almost stop when Vesalius opened the chest cavity, and the lungs would collapse but could be restarted by inflating the lungs through a reed tied into the trachea. It is unclear whether Vesalius learned this procedure from others or developed the idea directly from Galen's work. A fascinating coincidence is that Paracelsus, a contemporary of Vesalius, is reported to have used a similar technique around 1530 in attempting to resuscitate a human. Did Paracelsus adapt Vesalius's research efforts, or vice versa?'" Ref:

Interesting stuff. I wrote "may have been" in my addition because different sources seem to suggest different things. Colice quotes and references Cheers, Basie (talk) 02:39, 18 January 2009 (UTC)

The Diagram
The Diagram at the start of the article is of the Nasotracheal Suctioning process not Nasotracheal Intubation.

Mohshamy1976 (talk) 19:37, 6 October 2009 (UTC)

terminology section
should the terminology section be split into a sub-article so it can be made bigger with all terminology associated with mechanical ventilation and a brief sentence explaining it? Je.rrt (talk) 03:51, 23 August 2011 (UTC)

Adaptive Support Ventilation
ASV is a type of PC-SIMV with added intelligence, it is not an independent mode type. Removal may be necessary but I moved it to the appropriate section. It may not be appropriate to include here since there is an article for a more detailed look at modes of mechanical ventilation and this section provides an overview of modes. Je.rrt (talk) 14:23, 14 September 2011 (UTC)

This is a citation I found that might be the one you are looking for:

Your statement on this page: http://en.wikipedia.org/wiki/Mechanical_ventilation ''Mechanical ventilation is often a life-saving intervention, but carries many potential complications including pneumothorax, airway injury, alveolar damage, and ventilator-associated pneumonia.  Citation Ref'' Colice, Gene L (2006). "Historical Perspective on the Development of Mechanical Ventilation". In Martin J Tobin. Principles & Practice of Mechanical Ventilation (2 ed.). New York: McGraw-Hill.

74.100.215.47 (talk) 19:32, 4 November 2011 (UTC)

Changes
I noticed that there were a few orphan sections in the article that seemed to be left over from newer edits to the the ventilator mode section. Other parts seemed either factually incorrect, didn't seem to fit, or were redundant considering the more lengthy discussion below regarding ventilator modes. I reworked the breath initiation/termination section into information regarding the phases of breath delivery, but I'm not even sure that it should be included in this main article.

I kept the following in the article, but it doesn't seem to fit where it is, and may even be redundant.


 * Volume ventilation — A predetermined tidal volume (Vt) is set by the clinician, and is delivered to the patient every time a breath is triggered. For example, if the tidal volume is set at 500ml, the ventilator will continue inspiration until 500ml have been delivered to the patient. Upon completion of inspiration, the ventilator will cycle to exhalation. The amount of pressure necessary to deliver the tidal volume is determined by the resistance and compliance of the patient and ventilator circuit, and may vary from breath to breath. Inspiratory pressures must be closely monitored to prevent barotrauma.


 * Pressure ventilation — A predetermined peak inspiratory pressure (PIP) is set by the clinician and delivered to the patient throughout the set inspiratory time (Ti) The tidal volume delivered to the patient is determined by the resistance and compliance of the patient and circuit, and may vary from breath to breath. Inspiratory volumes must be closely monitored to prevent hypoventilation or hyperventilation.

Several manufactures have incorporated features from both of these modes in an attempt to accommodate patients needs.

These modes are flow-variable, volume-targeted, pressure-regulated, time-limited modes (for example, pressure regulated volume control — PRVC). This means that instead of providing an exact tidal volume each breath, a target volume is set and the ventilator will vary the inspiratory flow at each breath to achieve the target volume at the lowest possible peak pressure. The inspiratory time (Ti) limits the length of the inspiratory cycle and therefore the I:E ratio. Pressure regulated modes such as PRVC, Auto-flow (Draeger)or Average Volume Assured Pressure Support (AVAPS) from Philips can most easily be thought of as turning a volume mode into a pressure mode with the added benefit of maintaining more control over tidal volume than with strictly pressure-control.

I removed this portion as it didn't seem to fit with the addition of other sections.

--Ventilation process in conventional mechanical ventilation-- The three traditional categories of ventilators are listed below. As microprocessor technology is incorporated into ventilator design, the distinction among these types has become less clear as ventilators may use combinations of all of these modes as well as flow-sensing, which controls the ventilator breath based on the flow-rate of gas versus a specific volume, pressure, or time. Cglion (talk) 23:50, 24 November 2011 (UTC)

Modes of mechanical ventilation
The modes listed under this heading are a bit of a sprawling mess beyond a brief introduction to the main article modes of mechanical ventilation. Main articles should be linked to wherever possible and introductions to concepts that have main articles should be kept brief. Wrin (talk) 21:36, 9 June 2012 (UTC)

Non-invasive ventilation?
I noticed that [ this edit] removed the entire section on “Non-invasive Positive Pressure Ventilation (NIPPV).” The edit summary suggests the information would be moved to Modes of mechanical ventilation, but as it stands now, “Modes of mechanical ventilation” is a somewhat technical article that lacks the overview found in the removed material; therefore, please provide more details on why the “non-invasive ventilation” section was removed. Thank you. Bwrs (talk) 01:03, 27 July 2013 (UTC)

Non-invasive ventilation - split off?
Numerous articles discuss noninvasive ventilation. The applications of NIV are becoming ever more widespread, and significant numbers of people with COPD, sleep disordered breathing and neuromuscular weakness are receiving home NIV through clinical networks. Unfortunately the evidence base for many interventions has not kept trend with the development of the devices, but I think it's time to split everything off into its own article.

For acute NIV, I think 10.1016/S0140-6736(09)60496-7 is an amazing source. JFW &#124; T@lk  14:46, 9 December 2013 (UTC)
 * Agree, there is clearly enough literature to support NIV as its own article. Yobol (talk) 16:54, 9 December 2013 (UTC)

Non-ARDS
Low tidal volume ventilation is good for non-ARDS cases also 10.1001/jama.2012.13730 JFW &#124; T@lk  16:00, 14 July 2014 (UTC)

A wikibook on Intensive Care Medicine
Dear all, I have linked this page to the wikibook on Intensive Care Medicine under Pulmonary Intensive Care — Preceding unsigned comment added by Balaji.md au (talk • contribs) 11:02, 4 January 2016 (UTC)

Section 'Medical uses'
Do non-medical uses exist? If so, what are they. If not, as I suspect, this section should be called 'Uses', which doesn't imply existence of non-medical uses. Batternut (talk) 10:12, 11 October 2016 (UTC)
 * Article changed - more clearly exclusively medical. Batternut (talk) 10:28, 15 October 2016 (UTC)

Intermittent abdominal pressure ventilator, and article organization
As Intermittent abdominal pressure ventilator is neither a 'Negative pressure machine', nor 'Positive pressure' in the sense of pushing air into the lungs, I have moved it to its own subsection. However I find the organisation of this article rather confusing. Batternut (talk) 00:57, 13 October 2016 (UTC)

Possible typo 'on' instead of 'or'
Under the section 'Uses' in the dot points is this sentence:

"Acute on chronic respiratory acidosis most commonly with Chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome"

I thought acute and chronic were effectively opposites, so shouldn't that second word be or  instead of on?

If so, can someone wiser please fix it?

Thanks.

Mathsgirl (talk) 13:04, 3 November 2017 (UTC)
 * No, in this case "acute on chronic" indicates a patient who has a chronic disease (like emphysema) but then develops an acute illness (like influenza) on top of their usual problems. It could probably be worded more clearly for the layperson, but a lot of WP medical content is written more for the provider than for the layperson. EricEnfermero (Talk) 14:47, 3 November 2017 (UTC)
 * Now that I read more carefully, even though "acute on chronic" is a common phrase, I'm not sure that's the intended meaning here. Ventilation is definitely used in patients who have both acute and chronic acidosis. Someone else should weigh in, but I think you might be right. EricEnfermero (Talk) 14:52, 3 November 2017 (UTC)

I wonder if whose edit introduced "Acute on chronic" last year. To me, considering that edit though, I'd say it should be "Acute or chronic". Batternut (talk) 16:13, 3 November 2017 (UTC)

External links modified (January 2018)
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Dead Space.
Explanations of terms in the formulas, such as V(Dmech), V(t), V(Dphys), etc would be helpful for laypersons (In my case an engineer preparing for an interview with a maker of mechanical ventilators.) — Preceding unsigned comment added by 2600:8801:B000:6950:58F5:352:4A4F:67AF (talk) 14:56, 9 April 2019 (UTC)

Hospital beds by country
Please help list the ventilator per countries. It's becoming a critical informations for COVID19 pandemics !

Yug (talk)  02:30, 27 March 2020 (UTC)

A Commons file used on this page or its Wikidata item has been nominated for speedy deletion
The following Wikimedia Commons file used on this page or its Wikidata item has been nominated for speedy deletion: You can see the reason for deletion at the file description page linked above. —Community Tech bot (talk) 17:22, 1 April 2020 (UTC)
 * Commonly used intensive care ventilators.png

Hyphen or no hyphen
This article refers to the modes of mechanical ventilation as both "positive pressure ventilation" and "positive-pressure ventilation", as well as "negative pressure" and "negative-pressure". I am not an expert in this field, but these are seemingly used interchangeably and I was hoping to standardize the use of the hyphen when referring to these modes of ventilation. Many sources seem to refer to it using a hyphen, but other many other articles on Wikipedia in this field do not use the hyphen. Which spelling variation should we use for this? Utopes (talk / cont) 21:45, 7 April 2020 (UTC)

Mechanism section
This section contains details beyond the scope of the layman and does not offer sufficient basic information. I have written a more basic summary of the mechanism. The original version is here below can be found on edits of this wikipedia page prior to 11/14/2021. — Preceding unsigned comment added by Aparnasankar (talk • contribs) 21:30, 14 November 2021 (UTC)

Peer review
General info

Whose work are you reviewing? Aparnasankar

Evaluate the drafted changes

Lead: The lead has been updated to reflect the contents of the article. The introductory sentence does a good job of defining mechanical ventilation and its role in medicine. The lead provides an overview of most sections. It does not touch on the history or risks/complications, so maybe an additional sentence or phrase could be added to encompass those. The lead does not include information that is not present in the article. The lead has been improved to make it more relevant to the article and to describe the topic in a more accessible way.

Content: Relevant information has been added to the "Uses" and "Risks and complications" sections. The "Mechanism" sections has been cleaned up to remove information that goes into too much depth. Additionally, the "History" section has been expanded upon greatly. All of the updates to the content are relevant to the topic and improve the overall readability of the page. Most of the citations are from the 2000's and seem up-to-date. The page appears to be fairly comprehensive.

Tone and balance: The content added is neutral without biases towards any particular position. The article is neutral without any overrepresentation or underrepresentation of groups. For example, information is provided on infants and adults, and the use of certain medications such as opioids in both populations is presented.The added content is informative but not persuasive in favor of any particular position.

Sources and references: Most of the new content is appropriately cited. There are some areas where additional citations may be appropriate. For example, in the "History section", the third paragraph "With increased... used in the ICU" does not have any citation. Even if the same citation was used as the previous paragraph, it might be worthwhile to cite it again just to make the source of the information clear. The content reflects the cited sources. For the most part, sources are current. The links appear to work.

Organization: The content that has been added is concise and readable. Added content does not have any obvious grammatical or spelling errors. The organization of the page has been improved and the content has been added to relevant sections.

Images and media: The article includes multiple images that make it easier to visualize certain aspects of the topic. Most of the images are well-captioned. Some are more descriptive than others. The images appear to be compliant with copyright regulations. The images are laid out alongside the relevant sections.

Overall impressions: The information added is of good quality and the reorganization of the article has increased its accessibility to readers without much background knowledge in this subject. The removal of information that is too in-depth and the expansion of certain areas of the article have definitely improved the quality of the page. The added content makes it easier to learn about the history of mechanical ventilation and also makes the content on mechanism, uses, and risks more accessible to a reader without a good understanding of the subject. Some areas of the article (particularly "Negative pressure machines" and "Types of ventilators") have been marked as needing citations. Perhaps in future edits, those areas could be improved to ensure that the information is accurate and backed by reliable sources.Vs2022 (talk) 19:30, 15 November 2021 (UTC)

Mechanical ventilator carescape R860
Flow sensor problems... 197.156.77.4 (talk) 01:47, 23 March 2022 (UTC)