Mechanical ventilation clinical application
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Mechanical Ventilation & Clinical application. กวีวรรณ ลิ้มประยูร หน่วยหออภิบาลผู้ป่วยเด็ก หน่วยโรคระบบทางเดินหายใจ ภาควิชากุมารเวชศสตร์ คณะแพทยศาสตร์ศิริราชพยาบาล. Indication. Indication. Respiratory failure To decrease or support work of breathing To improve oxygenation

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Mechanical Ventilation & Clinical application

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Mechanical ventilation clinical application

Mechanical Ventilation& Clinical application


Indication

Indication


Indication1

Indication

  • Respiratory failure

  • To decrease or support work of breathing

  • To improve oxygenation

  • To recruit the lung

  • To support other organs e.g.: increased ICP, CHF


Normal value

Normal value

  • Tidal volume 10-12 ml/kg in general

    or 6-8 ml/kg in ARDS

  • MV 200-300 ml /kg


Parts and humidifiers

Parts and Humidifiers


How to set in some situations

How to set in some situations

  • post-operative

  • asthma or BPD

  • pneumonia or ARDS

  • increased ICP


Mechanical ventilation clinical application

Guideline (12)

1. mode (adequate oxygenation/ventilation) (reduced work of breathing) (synchrony between patient and ventilator) (12,17) (avoidance of high end-inspiration pressures)

2. FiO2 1.0 (oxygen saturation,SaO2) 92-95% Adult Respiratory Distress Syndrome (ARDS) 88% (12,18)


Mechanical ventilation clinical application

3. tidal volume 8-10 ml 1 10-12 ml 1 neuromuscular disease Adult Respiratory Distress Syndrome (ARDS) 5-8 ml 1 plateau pressure 30 .

4. (17)


Mechanical ventilation clinical application

5. PEEP (diffuse lung injury) PEEP 5- 10 . pressuse-volume curves tidal volume overinflation PEEP (5) barotrauma overinflation

6. trigger (autocycling)

7. air trapping autoPEEP


Mechanical ventilation clinical application

8.

9. Non-conventional mechanical ventilation


Example 1 post operative

Example 1- post operative

Mode: Pressure controlled ventilation

PIP 20 cm H2O

PEEP 5 cm H2O

FiO2 0.5

i Time 1.0 sec

Rate 20 / min


Example 2 asthma

Example 2- asthma

Mode: Time cycled pressure limited

Flow 3 times minute ventilation

(Normal MV = 200-300ml/kg)

PIP 20 cm H2O

PEEP 3 cm H2O

FiO2 0.5

i Time 0.6 sec

Rate 20 / min


Mechanical ventilation clinical application

Mode

/

Assist-control ventilation (AC)

, (work of breathing) (spontaneous breathing)

AC volume ventilation

tidal volume

AC pressure-control ventilation

,

Pressure support ventilation (PSV)

(work of breathing)

Synchronized intermittent mandatory ventilation (SIMV)

Controlled mechanical ventilation (CMV)


Mechanical ventilation clinical application

Mode

/

Assist-control ventilation (AC)

, (inappropriate hyperventilation)

AC volume ventilation

AC pressure-control ventilation

Pressure support ventilation (PSV)

,

Synchronized intermittent mandatory ventilation (SIMV)

(work of breathing) assist-control

Controlled mechanical ventilation (CMV)

/,


Alarms

Alarms


Alarms1

Alarms

  • Usually will set 15% more or less

  • MV 200-300 ml /kg

  • Tidal volume 10-12 ml/kg in general

    or 6-8 ml/kg in ARDS


Alarms2

Alarms

  • Pressure alarm for SIMV or volume mode

  • Expired TV alarm and MV alarm for Pressure mode

  • Apnea alarm or high RR alarm


Noninvasive mechanical ventiation

Noninvasive mechanical ventiation


High frequency mechanical ventilation

High frequency mechanical ventilation


Indication2

Indication

1. To serve as a ventilation mode when conventional ventilation has failed.

2. To provide a mode of ventilation that minimizes barotrauma, or damage, to the delicate tissue in the lungs.


Pediatric indications

Pediatric Indications

  • Neonatal Respiratory Distress Syndrome

  • Persistent Pulmonary Hypertension

  • Neonatal Meconium Aspiration Syndrome

  • Congenital Diaphragmatic Hernia

  • Neonatal Lung Hypoplasia

  • Neonatal Air Leak Syndrome

  • Pediatric ARDS/Pulmonary Interstitial Edema

  • RSV Pneumonia


Monitoring

Monitoring


Bp nibp ibp

BP NIBP/IBP


Mechanical ventilation clinical application

CXR


End tidal co 2

End-tidal CO2


Bedside pulmonary mechanics

Bedside pulmonary mechanics


Weaning

Weaning


Weaning1

Weaning

  • C- Consciousness

  • A- Airway

  • L- Lung

  • M- Muscle strength


Patient ventilator in coordination fight

Patient Ventilator In coordination(Fight)

  • Ventilator Malfunction

  • Inappropriate setting

    Under or Over of Trigger sensitivity

    Under or Over of Peak flow

    Under or Over of inspiratory time

    Inadequate Tidal volume


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