REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator

Mechanical ventilation requires balancing oxygenation and ventilation to support patients who cannot breathe independently. Oxygenation relies on mean airway pressure, primarily managed through FiO2 and PEEP to maintain alveolar surface area and prevent collapse. Conversely, ventilation focuses on removing metabolic CO2 via minute ventilation—the product of respiratory rate and tidal volume. While increasing the respiratory rate is the standard approach for CO2 clearance, obstructive conditions like COPD and asthma necessitate a different strategy. In these cases, reducing the respiratory rate provides sufficient time for exhalation, preventing air trapping and dangerous increases in intrathoracic pressure. Clinicians must tailor ventilator settings to the patient's specific physiology, prioritizing lung-protective strategies to avoid volume or barotrauma while ensuring adequate gas exchange.