1 / 26

Mechanical Ventilation

Mechanical Ventilation. Khaled Hadeli, M.D. History. Criteria for mechanical ventilation. Clinical Criteria, i.e. A.B.C Profound respiratory failure RR >35 MIF < 25 cm H2O VC < 10-15 cc/kg PaO2 < 60mm Hg with FIO2 > 60% PaCO2 >50 mm Hg with pH < 7.35. Physiology of MV.

shaine-villarreal
Download Presentation

Mechanical Ventilation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mechanical Ventilation Khaled Hadeli, M.D.

  2. History

  3. Criteria for mechanical ventilation • Clinical Criteria, i.e. A.B.C • Profound respiratory failure • RR >35 • MIF < 25 cm H2O • VC < 10-15 cc/kg • PaO2 < 60mm Hg with FIO2 > 60% • PaCO2 >50 mm Hg with pH < 7.35

  4. Physiology of MV • Air moves in and out of the lung according to pressure gradient • -ve pressure ventilation = creating negative intra thoracic pressure, i.e suck air in. • +ve pressure ventilation = providing high pressure at the mouth, i.e push air in

  5. Types of Ventilators • -ve pressure ventilators • Iron lung • Rocking bed • Ventilator vest

  6. Types of Ventilators cont. • +ve pressure ventilators • Pressure triggered (cycled) • Pressure control (PC) • PC/IRV • Volume triggered (cycled) • Asses control (AC) • SIMV • CMV = PC and AC • PS

  7. AC • CMV, all breaths are machine breaths • Back up rate • Decrease work of breathing • Complications: hyperventilation, Auto peep, ptx, patient need Sedation… • You can start MV with this mode but you can’t wean.

  8. SIMV • Patient can breath- on his own- more than the set rate • May boost with PS • Increased work of breathing • You can start MV and wean with this mode

  9. PC • You set the pressure limit • You set the I:E OR TI • Variable Vm achieved • Need to adequately sedate the patient • Be careful how to put the order, “ total pressure v.s. pressure over the peep”

  10. PC/IRV • Normal I:E ratio = 1:2 • IRV= 1:1, 2:1, 3:1 • Use in ARDS when you can’t adequately oxygenate • By trapping air increases the iPeep and improves oxygenation • Heavy Paralysis and /or heavy sedation

  11. PS • Spontaneous breathing but each breath is boosted • If patient don’t “trigger” the ventilator he will not get the breath • Can be used in combination with SIMV

  12. Ventilatory Settings • Mode: PC, SIMV, AC, etc. • Rate • TV • Peep • Fio2 • PS

  13. Mode of Ventilation • PC ventilation is more physiologic • VC ventilation is used more because it is easy to operate • AC ventilation if you want to rest the patient completely • SIMV is an ok mode if added PS

  14. Rate/ TV • Corrects hypercapnea (respiratory alkalosis) • TV 8-10-12 cc/kg • Correct for height/ gender • Be aware of breath “stacking” • Low TV ventilation/ ARDS

  15. Fio2 • Start with 100% • Use peep to augment • Decrease Fio2 to less than 40% ASAP • 40%-60% low risk for ARDS • More than 60% Dangerous zone

  16. Peep • Physiologic peep about 3 cm • Increase as needed up to 25cm • Peep above 10cm may affect CO • Decrease peep no more than 2.5cm at a time

  17. PS ventilation • Can be an effective mode of ventilation if used solo • Other uses include: combination with SIMV, overcome the ETT resistance, • No PS if pt is on CMV or if pt has no spontaneous breathing • Type of weaning

  18. Special issues • Permissive hypercapnea • Recruitment maneuvers • Best Peep • Lung protective ventilation • Triggering the ventilator • Proning

  19. CPAP • Not a mechanical ventilation • Pt provides the work of breathing • Helps to keep air ways open • Rx sleep apnea (proximal air ways) • Improves oxygenation ( distal air ways) • You can add PS to cpap

  20. NIPPV • CPAP wit /without PS • Bilevel ventilation • Neuromuscular diseases • COPD • Pulmonary edema (CPAP) • High maintenance, needs the cooperation of MD, nurse, RT, and the patient

  21. New modes of ventilations • NO proven efficacy.

  22. Weaning • Should be started ASAP • PS wean • SIMV wean • CPAP/T piece trial • Wean to NIPPV

  23. Liberation from MV • Reversal of the primary condition leading to the respiratory failure • Mental status • Adequate strength “MIF” • F/TV index ( rapid-shallow index) • Spontaneous TV, rate, VC, Compliance

  24. Sedation • Adequate sedation, short acting sedatives with/without pain meds. • Optimize the environment. • Improve sleep cycles. • TERN OF THE TV IN PATIENTS ROOM!! • ICU psychosis

  25. Paralytics • Depolarizing (intubation), CI in denervated patients and with hyperkalemia. • Non-depolarizing. Critical illness paralysis vs. steroid induced narcotizing myositis. • Use minimal doses, avoid steroids, always sedate patients.

  26. Care of the ventilated patient • Nutrition • DVT prophylactics • GI prophylactics • Daily* CXR • Cuff leak • Patient/ventilator synchrony ( sedation, paralysis, triggering, PS…)

More Related