Editing Artificial ventilation (section)

==Types==
===Manual methods===
{{Further|Mouth-to-mouth resuscitation}}

Pulmonary ventilation is done by manual insufflation of the lungs either by the rescuer blowing into the patient's lungs ([[mouth-to-mouth resuscitation]]), or by using a mechanical device. Mouth-to-mouth resuscitation is also part of [[cardiopulmonary resuscitation]] (CPR) making it an essential skill for [[first aid]]. In some situations, mouth to mouth is also performed separately, for instance in near-[[drowning]] and [[opiate]] overdoses.<ref>{{Cite journal |last1=Newell |first1=Christopher |last2=Grier |first2=Scott |last3=Soar |first3=Jasmeet |date=2018-08-15 |title=Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation |journal=Critical Care |language=en |volume=22 |issue=1 |pages=190 |doi=10.1186/s13054-018-2121-y |doi-access=free |issn=1364-8535 |pmc=6092791 |pmid=30111343}}</ref> The performance of mouth to mouth on its own is now limited in most protocols to [[Health professional|health professionals]], whereas lay first aiders are advised to undertake full CPR in any case where the patient is not breathing. 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]].<ref>{{cite web|url=http://encarta.msn.com/encyclopedia_761562617/Artificial_Respiration.html |title=Artificial Respiration |publisher=Microsoft Encarta Online Encyclopedia 2007 |access-date=2007-06-15 |archive-url=https://web.archive.org/web/20091030071622/http://encarta.msn.com/encyclopedia_761562617/Artificial_Respiration.html |archive-date=2009-10-30 |url-status=dead }}</ref>

===Mechanical ventilation===
{{Main|Mechanical ventilation}}

Mechanical ventilation is a method to mechanically assist or replace spontaneous [[respiration (physiology)|breathing]].<ref>{{Cite web|url=http://www.nhlbi.nih.gov/health/health-topics/topics/vent|title=What Is a Ventilator? - NHLBI, NIH|website=www.nhlbi.nih.gov|access-date=2016-03-27}}</ref> This involves the use of [[ventilator]] assisted by a [[Nursing|registered nurse]], [[physician]], [[physician assistant]], [[respiratory therapist]], [[paramedic]], or other suitable person compressing a [[bag valve mask]]. Mechanical ventilation is termed "invasive" if it involves any instrument penetrating through the mouth (such as an endo[[tracheal tube]]) or the skin (such as a [[tracheostomy]] tube).<ref>[http://www.hsa.gov.sg/publish/etc/medialib/hsa_library/health_products_regulation/medical_devices/guidance_documents.Par.83962.File.tmp/GN-13-R1%2520Guidance%2520on%2520the%2520Risk%2520Classification%2520of%2520General%2520Medical%2520Devices.pdf GN-13: Guidance on the Risk Classification of General Medical Devices]  {{webarchive|url=https://web.archive.org/web/20140529185327/http://www.hsa.gov.sg/publish/etc/medialib/hsa_library/health_products_regulation/medical_devices/guidance_documents.Par.83962.File.tmp/GN-13-R1%20Guidance%20on%20the%20Risk%20Classification%20of%20General%20Medical%20Devices.pdf |date=May 29, 2014 }}, Revision 1.1. From [[Health Sciences Authority]]. May 2014</ref> There are two main [[modes of mechanical ventilation]] within the two divisions: positive pressure ventilation, where air (or another gas mix) is pushed into the [[Vertebrate trachea|trachea]], and negative pressure ventilation, where air is, in essence, sucked into the lungs.<ref>{{Cite journal |last1=Esteban |first1=Andrés |last2=Ferguson |first2=Niall D. |last3=Meade |first3=Maureen O. |last4=Frutos-Vivar |first4=Fernando |last5=Apezteguia |first5=Carlos |last6=Brochard |first6=Laurent |last7=Raymondos |first7=Konstantinos |last8=Nin |first8=Nicolas |last9=Hurtado |first9=Javier |last10=Tomicic |first10=Vinko |last11=González |first11=Marco |last12=Elizalde |first12=José |last13=Nightingale |first13=Peter |last14=Abroug |first14=Fekri |last15=Pelosi |first15=Paolo |date=2008-01-15 |title=Evolution of Mechanical Ventilation in Response to Clinical Research |url=https://www.atsjournals.org/doi/10.1164/rccm.200706-893OC |journal=American Journal of Respiratory and Critical Care Medicine |language=en |volume=177 |issue=2 |pages=170–177 |doi=10.1164/rccm.200706-893OC |pmid=17962636 |issn=1073-449X|url-access=subscription }}</ref>

[[Tracheal intubation]] is often used for short-term [[mechanical ventilation]]. It's when a tube is inserted through the nose (nasotracheal intubation) or mouth (orotracheal intubation) and advanced into the [[Vertebrate trachea|trachea]]. In most cases tubes with inflatable cuffs are used for protection against leakage and aspiration. Intubation with a cuffed tube is thought to provide the best protection against aspiration. Downside of tracheal tubes is the pain and coughing that follows. Therefore, unless a patient is unconscious or anesthetized, [[sedative]] drugs are usually given to provide tolerance of the tube. Other disadvantages of tracheal intubation include damage to the mucosal lining of the [[nasopharynx]] or [[oropharynx]] and subglottic stenosis.

In an emergency a [[cricothyrotomy]] can be used by health care professionals, where an airway is inserted through a surgical opening in the [[cricothyroid membrane]]. This is similar to a [[tracheostomy]] but a [[cricothyrotomy]] is reserved for emergency access.  This is usually only used when there is a complete blockage of the [[pharynx]] or there is massive maxillofacial injury, preventing other adjuncts being used.<ref name="rsi">{{cite journal |vauthors=Carley SD, Gwinnutt C, Butler J, Sammy I, Driscoll P |title=Rapid sequence induction in the emergency department: a strategy for failure |journal=Emergency Medicine Journal |pmid=11904254 |pmc=1725832 |doi=10.1136/emj.19.2.109 |date=March 2002 |volume=19 |issue=2 |url=http://emj.bmjjournals.com/cgi/content/full/19/2/109 |pages=109–113 |access-date=2007-05-19}}</ref>

===Neurostimulation===
{{Main|Diaphragm pacing}}

A rhythmic pacing of the diaphragm is caused with the help [[Neurostimulation|of electrical impulses]].<ref name="BhimjiDia15">{{cite web |url=http://emedicine.medscape.com/article/1970348-overview#a4 |title=Overview - Indications and Contraindications |work=Medscape - Diaphragm Pacing |author=Bhimji, S. |editor=Mosenifar, Z. |publisher=WebMD LLC |date=16 December 2015 |access-date=19 February 2016}}</ref><ref name="KhannaImp15">{{cite book |chapter-url=https://books.google.com/books?id=lLEvCwAAQBAJ&pg=PA359 |chapter=Chapter 19: Diaphragmatic/Phrenic Nerve Stimulation |title=Implantable Medical Electronics: Prosthetics, Drug Delivery, and Health Monitoring |author=Khanna, V.K. |publisher=Springer International Publishing AG Switzerland |year=2015 |pages=453 |isbn=978-3-319-25448-7 |access-date=19 February 2016}}</ref> Diaphragm pacing is a technique used by persons with spinal cord injuries who are on a mechanical ventilator to aid with breathing, speaking, and overall quality of life. It may be possible to reduce reliance on a mechanical ventilator with diaphragm pacing.<ref>{{Cite journal |last1=Le Pimpec-Barthes |first1=Francoise |last2=Legras |first2=Antoine |last3=Arame |first3=Alex |last4=Pricopi |first4=Ciprian |last5=Boucherie |first5=Jean-Claude |last6=Badia |first6=Alain |last7=Panzini |first7=Capucine Morelot |date=April 2016 |title=Diaphragm pacing: the state of the art |journal=Journal of Thoracic Disease |volume=8 |issue=Suppl 4 |pages=S376–S386 |doi=10.21037/jtd.2016.03.97 |doi-access=free |issn=2072-1439 |pmc=4856845 |pmid=27195135}}</ref> Historically, this has been accomplished through the electrical stimulation of a [[phrenic nerve]] by an implanted receiver/electrode,<ref name="ChenDia05">{{cite journal |title=Diaphragm pacers as a treatment for congenital central hypoventilation syndrome |journal=Expert Review of Medical Devices |author1=Chen, M.L. |author2=Tablizo, M.A. |author3=Kun, S. |author4=Keens, T.G. |volume=2 |issue=5 |pages=577–585 |year=2005 |doi=10.1586/17434440.2.5.577 |pmid=16293069|s2cid=12142444 |url=https://zenodo.org/record/894537 }}</ref> though today an alternative option of attaching [[percutaneous]] wires to the diaphragm exists.<ref name="SynapseUse">{{cite web |url=http://www.synapsebiomedical.com/restricted/PDFs/92-0003-5_A%20Use%20and%20Care%20of%20the%20DPS.pdf |title=Use and Care of the NeuRx Diaphragm Pacing System |publisher=Synapse Biomedical, Inc |access-date=19 February 2016 |archive-date=19 February 2016 |archive-url=https://web.archive.org/web/20160219184729/http://www.synapsebiomedical.com/restricted/PDFs/92-0003-5_A%20Use%20and%20Care%20of%20the%20DPS.pdf |url-status=dead }}</ref>