SlideShare a Scribd company logo
1 of 23
Download to read offline
Mechanical ventilation and RAD
Dr Satish Deopujari
Prof. K. Chellum Oration / CMC Vellore
26th June 2004
Incidence of M.V. in RAD in India ?
Do we under ventilate these patients.
Aggressive management ………..
Proper oxygenation warmed and humidified
Continuous nebulization what dose ?
Look for hypokalemia
Steroids / Ipatropium bromide / MgSO4
Hydration / Ensure good Hemoglobin level.
Avoiding agitation
Ketamine
Newer modalities
MgSO4
 Mechanism of Action
 Antagonizes translocation of Ca across cell
membrane, leads to SM relaxation and Inhibits
degranulation of mast cells
 Decreases release of ACH (decreases excitability of
muscle fibre membranes)
 Side Effects:
 Facial warmth/flushing, hypotension, nausea, emesis,
muscle weakness, sedation, loss of DTRs, resp
depression
 Dose:
 20-40mg/kg IV over 30 min
• The decision to intubate pt in SA , is made on the basis clinical
deterioration,
• Altered level of consciousness
• Exhaustion / P. paradoxus
• Inability to protect airway
• Increasing arterial PCO2.
• Quiet chest, absence of audible wheezing
• PaO2 < 60 mmHg : not responding to adequate oxygenation
• PaCO2 > 50 mmHg and rising more than 5 mmHg/ hour
• Zimmerman et al, reported that one or
more complications occurred in 46% of
intubated asthmatics.
• More than one-third of all complications
occurred during intubation.
• 47 % of complications during the
intensive care unit stay
• Difficult and esophageal intubations
occurred in about 15% of all patients
Standard preparation for rapid sequence
intubation .
 cardio-respiratory and blood pressure
monitoring
 Assistance
 monitoring of oxygen saturation
 careful aspiration of oropharynx
 bag and mask ventilation with 100% oxygen
 emptying of the stomach by nasogastric tube
 benzodiazepine should be considered (e.g.,
midazolam 0.1 - 0.2 mg/kg) permitting
relaxation during preoxygenation
Ketamine hydrochloride (1 to 3 mg/kg)
Good choice for its sedative and
analgesic effects as well as its
bronchodilating characteristics.
Concomitant use of a benzodiazepine
can suppress the dysphoric effects of
Ketamine.
Ketamine increases laryngeal secretions
but does not block pharyngeal and
laryngeal reflexes, increasing the risk of
laryngospasm and aspiration in the
preintubation period
Endotracheal tube…………….
 largest endotracheal tube…..
lower airflow resistance
Suctioning of thick mucosal secretions
Fiber optic bronchoscopy : facilitated
 A cuffed endotracheal tube
Sometimes useful even in small children
(<5 years)
when insufflation pressures become very
high (Hubert 1996).
Intubation………….
oxygenation
H2 blockers , prokinetics . atropine
Lignocaine 4 % neb. 4mg / kg ( 1ml = 40 mg )
Sedation midazolam + ketamine / cricoid
pressure
Paralysis ( Vecuronium .1 to .2 mg / kg )
Intubation
Suction
Confirmation of tube and proper fixation
Avoid positive pressure V. without cricoid P.
Proper monitoring
Oxygenation & Circulation status
Fluid bolus for circulation
Lt heart pumps what
the
right heart gives it
Ventilatory strategy
Permissive hypercapnia
low rate 50 % for the age
low pressure
Avoiding barotrauma
low pressure
Minimal PEEP
Intrinsic PEEP
Dynamic hyperinflation (DHI)
PEEP
Controversies remain about the role of PEEP in
status asthmaticus.
Majority of cases, no PEEP should be applied
during mechanical ventilation (0 3 cm H2O
maximum)
PEEP
Intrinsic PEEP
Air leak syndrome
A 'rapid sequence' for
extubation is justified
by the risk of further
bronchoconstriction
induced by the
presence of the
endotracheal tube.
• Adding adjuvant therapy despite lack of
evidence is reasonable given the risks
associated with intubation and mechanical
ventilation
• More research is required in childhood status
asthmaticus!
M. Ventilation is a BLEND of Art and science
THANKS
• Adding adjuvant therapy despite lack of
evidence is reasonable given the risks
associated with intubation and
mechanical ventilation
• More research is required in childhood
status asthmaticus!
Mechanical ventilation
• Less than 5% of patients with SA
required intubation and MV, “braman et
al, jama 1990”
• Indications:
• To decrease work of breathing.
• To maintain adequate oxygenation .
• Augment alveolar ventilation in face of airway
edema and diffuse mucus plugging of of the
small airways…
Indications of mechanical ventilation
Not governed by numbers but by the clinical conditions.
PaO2 < 60 mmHg or cyanosis not corrected by oxygen administration
PaCO2 > 50 mmHg and rising more than 5 mmHg/ hour
The decision to intubate and ventilate a child with status asthmaticus
is primarily based on clinical criteria:
respiratory muscle fatigue, obvious exhaustion, disappearance of
pulsus paradoxus
diminution of thoracic amplitude during respiratory movements
diminution of air entry in the lungs : quiet chest, absence of audible
wheezing
pulsus paradoxus > 20 - 40 mmHg (inspiratory decline in systolic
blood pressure)
deterioration of mental status (lethargy, agitation, confusion, coma)
diaphoresis in recumbent position
•ideal ventilator settings reduce dynamic hyperinflation
(DHI): limited minute ventilation (MV) using an
appropriately low but adequate tidal volume (Vt) and
respiratory rate, with an extended expiratory time (TE)

More Related Content

What's hot (20)

Premedication mgmc (1)
Premedication mgmc (1)Premedication mgmc (1)
Premedication mgmc (1)
 
Icu pharm case
Icu pharm caseIcu pharm case
Icu pharm case
 
Preoperative sedation and premedication in pediatrics
Preoperative sedation and premedication in pediatrics Preoperative sedation and premedication in pediatrics
Preoperative sedation and premedication in pediatrics
 
Midazolam in er 1
Midazolam in er 1Midazolam in er 1
Midazolam in er 1
 
Art of sedation in icu
Art of sedation in icuArt of sedation in icu
Art of sedation in icu
 
peadiatric premedication and preparation
peadiatric premedication and preparationpeadiatric premedication and preparation
peadiatric premedication and preparation
 
Premedicant drugs in Anesthesia
Premedicant drugs in AnesthesiaPremedicant drugs in Anesthesia
Premedicant drugs in Anesthesia
 
Sedation and analgesia
Sedation and analgesiaSedation and analgesia
Sedation and analgesia
 
Malik sedation
Malik sedationMalik sedation
Malik sedation
 
Premedication
PremedicationPremedication
Premedication
 
Sedation
SedationSedation
Sedation
 
Icu sedation
Icu sedationIcu sedation
Icu sedation
 
Sedation
SedationSedation
Sedation
 
Anesthetic Drugs
Anesthetic DrugsAnesthetic Drugs
Anesthetic Drugs
 
General Anesthesia
General AnesthesiaGeneral Anesthesia
General Anesthesia
 
Induction Agents - Propofol, Sodium Thiopental, Ketamine,
Induction Agents - Propofol, Sodium Thiopental, Ketamine, Induction Agents - Propofol, Sodium Thiopental, Ketamine,
Induction Agents - Propofol, Sodium Thiopental, Ketamine,
 
Sedation & Paralysis in ICU- DR.RAGHUNATH ALADAKATTI
Sedation & Paralysis in ICU- DR.RAGHUNATH   ALADAKATTISedation & Paralysis in ICU- DR.RAGHUNATH   ALADAKATTI
Sedation & Paralysis in ICU- DR.RAGHUNATH ALADAKATTI
 
Preanaesthetic medication & general anaesthetics
Preanaesthetic medication & general anaestheticsPreanaesthetic medication & general anaesthetics
Preanaesthetic medication & general anaesthetics
 
Preanaesthetics 2003
Preanaesthetics 2003Preanaesthetics 2003
Preanaesthetics 2003
 
Intravenous iv agents umar tariq
Intravenous iv agents umar tariqIntravenous iv agents umar tariq
Intravenous iv agents umar tariq
 

Similar to Mechanical Ventilation and RAD - Prof. K. Chellum Oration / CMC Vellore 26th June 2004

Icu Emergency Airway Management
Icu Emergency Airway ManagementIcu Emergency Airway Management
Icu Emergency Airway ManagementAndrew Ferguson
 
Asthma ppt1 PHARMACY
Asthma ppt1 PHARMACYAsthma ppt1 PHARMACY
Asthma ppt1 PHARMACYSemiyya Semi
 
NEONATAL RESPIRATORY DISTRESS SYNDROME
NEONATAL RESPIRATORY DISTRESS SYNDROMENEONATAL RESPIRATORY DISTRESS SYNDROME
NEONATAL RESPIRATORY DISTRESS SYNDROMESUDESHNA BANERJEE
 
Rapid Sequence Intubation.pptx
Rapid Sequence Intubation.pptxRapid Sequence Intubation.pptx
Rapid Sequence Intubation.pptxssuser35691a
 
pulmonary rehabilitation
pulmonary rehabilitationpulmonary rehabilitation
pulmonary rehabilitationmrinal joshi
 
Extubation from Ventilator
Extubation from VentilatorExtubation from Ventilator
Extubation from VentilatorFarhan Shaikh
 
Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation RamanGhimire3
 
SEMS 2014: Ang Shiang Hu - Life threatening asthma
SEMS 2014: Ang Shiang Hu - Life threatening asthma SEMS 2014: Ang Shiang Hu - Life threatening asthma
SEMS 2014: Ang Shiang Hu - Life threatening asthma Rahul Goswami
 
Meconium Aspiration Syndrome
Meconium Aspiration SyndromeMeconium Aspiration Syndrome
Meconium Aspiration SyndromeReena Bhagat
 
rapidsequenceintubation-160123162517.pdf
rapidsequenceintubation-160123162517.pdfrapidsequenceintubation-160123162517.pdf
rapidsequenceintubation-160123162517.pdfdhanu gaysonsiri
 
Rapid sequence intubation
Rapid sequence intubationRapid sequence intubation
Rapid sequence intubationMurtaza Rashid
 
Meconium aspiration syndrome
Meconium aspiration syndromeMeconium aspiration syndrome
Meconium aspiration syndromeSheelendra Shakya
 
Aspiration prophylaxis in full stomach
Aspiration prophylaxis in full stomach Aspiration prophylaxis in full stomach
Aspiration prophylaxis in full stomach ZIKRULLAH MALLICK
 
rsii-191108120721.pptx
rsii-191108120721.pptxrsii-191108120721.pptx
rsii-191108120721.pptxsyedumair76
 
Atelectasis & nursing care
Atelectasis & nursing care Atelectasis & nursing care
Atelectasis & nursing care V4Veeru25
 
Paediatric respiratory physiology
Paediatric  respiratory physiologyPaediatric  respiratory physiology
Paediatric respiratory physiologyPriyanka Karnik
 

Similar to Mechanical Ventilation and RAD - Prof. K. Chellum Oration / CMC Vellore 26th June 2004 (20)

Icu Emergency Airway Management
Icu Emergency Airway ManagementIcu Emergency Airway Management
Icu Emergency Airway Management
 
Asthma ppt1 PHARMACY
Asthma ppt1 PHARMACYAsthma ppt1 PHARMACY
Asthma ppt1 PHARMACY
 
NEONATAL RESPIRATORY DISTRESS SYNDROME
NEONATAL RESPIRATORY DISTRESS SYNDROMENEONATAL RESPIRATORY DISTRESS SYNDROME
NEONATAL RESPIRATORY DISTRESS SYNDROME
 
Rapid Sequence Intubation.pptx
Rapid Sequence Intubation.pptxRapid Sequence Intubation.pptx
Rapid Sequence Intubation.pptx
 
Atelectasis ppt Nikhil
Atelectasis ppt Nikhil Atelectasis ppt Nikhil
Atelectasis ppt Nikhil
 
Airway Management
Airway ManagementAirway Management
Airway Management
 
pulmonary rehabilitation
pulmonary rehabilitationpulmonary rehabilitation
pulmonary rehabilitation
 
Extubation
Extubation Extubation
Extubation
 
Extubation from Ventilator
Extubation from VentilatorExtubation from Ventilator
Extubation from Ventilator
 
Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation
 
SEMS 2014: Ang Shiang Hu - Life threatening asthma
SEMS 2014: Ang Shiang Hu - Life threatening asthma SEMS 2014: Ang Shiang Hu - Life threatening asthma
SEMS 2014: Ang Shiang Hu - Life threatening asthma
 
Obstructive lung disease
Obstructive lung disease Obstructive lung disease
Obstructive lung disease
 
Meconium Aspiration Syndrome
Meconium Aspiration SyndromeMeconium Aspiration Syndrome
Meconium Aspiration Syndrome
 
rapidsequenceintubation-160123162517.pdf
rapidsequenceintubation-160123162517.pdfrapidsequenceintubation-160123162517.pdf
rapidsequenceintubation-160123162517.pdf
 
Rapid sequence intubation
Rapid sequence intubationRapid sequence intubation
Rapid sequence intubation
 
Meconium aspiration syndrome
Meconium aspiration syndromeMeconium aspiration syndrome
Meconium aspiration syndrome
 
Aspiration prophylaxis in full stomach
Aspiration prophylaxis in full stomach Aspiration prophylaxis in full stomach
Aspiration prophylaxis in full stomach
 
rsii-191108120721.pptx
rsii-191108120721.pptxrsii-191108120721.pptx
rsii-191108120721.pptx
 
Atelectasis & nursing care
Atelectasis & nursing care Atelectasis & nursing care
Atelectasis & nursing care
 
Paediatric respiratory physiology
Paediatric  respiratory physiologyPaediatric  respiratory physiology
Paediatric respiratory physiology
 

More from Creativity Please

Kinetic Gears Company Profile - February 2024
Kinetic Gears Company Profile - February 2024Kinetic Gears Company Profile - February 2024
Kinetic Gears Company Profile - February 2024Creativity Please
 
EC-Letter : Ran Chemical Pvt. Ltd.
EC-Letter : Ran Chemical Pvt. Ltd.EC-Letter : Ran Chemical Pvt. Ltd.
EC-Letter : Ran Chemical Pvt. Ltd.Creativity Please
 
Diwali 2022 Art Presentation.pdf
Diwali 2022 Art Presentation.pdfDiwali 2022 Art Presentation.pdf
Diwali 2022 Art Presentation.pdfCreativity Please
 
Udyog Times - June 2022 - Laghu Udyog Bharati
Udyog Times - June 2022 - Laghu Udyog BharatiUdyog Times - June 2022 - Laghu Udyog Bharati
Udyog Times - June 2022 - Laghu Udyog BharatiCreativity Please
 
Udyog Times - January 2022 - Laghu Udyog Bharati
Udyog Times - January 2022 - Laghu Udyog BharatiUdyog Times - January 2022 - Laghu Udyog Bharati
Udyog Times - January 2022 - Laghu Udyog BharatiCreativity Please
 
Udyog Times - December 2021 - laghu udyog bharati
Udyog Times - December 2021 - laghu udyog bharatiUdyog Times - December 2021 - laghu udyog bharati
Udyog Times - December 2021 - laghu udyog bharatiCreativity Please
 
Udyog times - Laghu udyog Bharati - November 2021
Udyog times  - Laghu udyog Bharati - November 2021Udyog times  - Laghu udyog Bharati - November 2021
Udyog times - Laghu udyog Bharati - November 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - May 2021
Udyog times  - Laghu udyog Bharati - May 2021Udyog times  - Laghu udyog Bharati - May 2021
Udyog times - Laghu udyog Bharati - May 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - March 2021
Udyog times  - Laghu udyog Bharati - March 2021Udyog times  - Laghu udyog Bharati - March 2021
Udyog times - Laghu udyog Bharati - March 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - February 2021
Udyog times  - Laghu udyog Bharati - February 2021Udyog times  - Laghu udyog Bharati - February 2021
Udyog times - Laghu udyog Bharati - February 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - January 2021
Udyog times  - Laghu udyog Bharati - January 2021Udyog times  - Laghu udyog Bharati - January 2021
Udyog times - Laghu udyog Bharati - January 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - April 2021
Udyog times  - Laghu udyog Bharati - April 2021Udyog times  - Laghu udyog Bharati - April 2021
Udyog times - Laghu udyog Bharati - April 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - August 2021
Udyog times  - Laghu udyog Bharati - August 2021Udyog times  - Laghu udyog Bharati - August 2021
Udyog times - Laghu udyog Bharati - August 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - September 2021
Udyog times  - Laghu udyog Bharati - September 2021Udyog times  - Laghu udyog Bharati - September 2021
Udyog times - Laghu udyog Bharati - September 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - June 2021
Udyog times  - Laghu udyog Bharati - June 2021Udyog times  - Laghu udyog Bharati - June 2021
Udyog times - Laghu udyog Bharati - June 2021Creativity Please
 
महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021
महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021
महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021Creativity Please
 
Udyog times - Laghu udyog Bharati - October 2021
Udyog times  - Laghu udyog Bharati - October 2021Udyog times  - Laghu udyog Bharati - October 2021
Udyog times - Laghu udyog Bharati - October 2021Creativity Please
 
Prana Setoo brochure - Non-Invasive Ventilator
Prana Setoo brochure - Non-Invasive VentilatorPrana Setoo brochure - Non-Invasive Ventilator
Prana Setoo brochure - Non-Invasive VentilatorCreativity Please
 
Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti
Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti
Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti Creativity Please
 

More from Creativity Please (20)

Kinetic Gears Company Profile - February 2024
Kinetic Gears Company Profile - February 2024Kinetic Gears Company Profile - February 2024
Kinetic Gears Company Profile - February 2024
 
EC-Letter : Ran Chemical Pvt. Ltd.
EC-Letter : Ran Chemical Pvt. Ltd.EC-Letter : Ran Chemical Pvt. Ltd.
EC-Letter : Ran Chemical Pvt. Ltd.
 
Diwali 2022 Art Presentation.pdf
Diwali 2022 Art Presentation.pdfDiwali 2022 Art Presentation.pdf
Diwali 2022 Art Presentation.pdf
 
Udyog Times - June 2022 - Laghu Udyog Bharati
Udyog Times - June 2022 - Laghu Udyog BharatiUdyog Times - June 2022 - Laghu Udyog Bharati
Udyog Times - June 2022 - Laghu Udyog Bharati
 
Kinetic Gears Profile
Kinetic Gears ProfileKinetic Gears Profile
Kinetic Gears Profile
 
Udyog Times - January 2022 - Laghu Udyog Bharati
Udyog Times - January 2022 - Laghu Udyog BharatiUdyog Times - January 2022 - Laghu Udyog Bharati
Udyog Times - January 2022 - Laghu Udyog Bharati
 
Udyog Times - December 2021 - laghu udyog bharati
Udyog Times - December 2021 - laghu udyog bharatiUdyog Times - December 2021 - laghu udyog bharati
Udyog Times - December 2021 - laghu udyog bharati
 
Udyog times - Laghu udyog Bharati - November 2021
Udyog times  - Laghu udyog Bharati - November 2021Udyog times  - Laghu udyog Bharati - November 2021
Udyog times - Laghu udyog Bharati - November 2021
 
Udyog times - Laghu udyog Bharati - May 2021
Udyog times  - Laghu udyog Bharati - May 2021Udyog times  - Laghu udyog Bharati - May 2021
Udyog times - Laghu udyog Bharati - May 2021
 
Udyog times - Laghu udyog Bharati - March 2021
Udyog times  - Laghu udyog Bharati - March 2021Udyog times  - Laghu udyog Bharati - March 2021
Udyog times - Laghu udyog Bharati - March 2021
 
Udyog times - Laghu udyog Bharati - February 2021
Udyog times  - Laghu udyog Bharati - February 2021Udyog times  - Laghu udyog Bharati - February 2021
Udyog times - Laghu udyog Bharati - February 2021
 
Udyog times - Laghu udyog Bharati - January 2021
Udyog times  - Laghu udyog Bharati - January 2021Udyog times  - Laghu udyog Bharati - January 2021
Udyog times - Laghu udyog Bharati - January 2021
 
Udyog times - Laghu udyog Bharati - April 2021
Udyog times  - Laghu udyog Bharati - April 2021Udyog times  - Laghu udyog Bharati - April 2021
Udyog times - Laghu udyog Bharati - April 2021
 
Udyog times - Laghu udyog Bharati - August 2021
Udyog times  - Laghu udyog Bharati - August 2021Udyog times  - Laghu udyog Bharati - August 2021
Udyog times - Laghu udyog Bharati - August 2021
 
Udyog times - Laghu udyog Bharati - September 2021
Udyog times  - Laghu udyog Bharati - September 2021Udyog times  - Laghu udyog Bharati - September 2021
Udyog times - Laghu udyog Bharati - September 2021
 
Udyog times - Laghu udyog Bharati - June 2021
Udyog times  - Laghu udyog Bharati - June 2021Udyog times  - Laghu udyog Bharati - June 2021
Udyog times - Laghu udyog Bharati - June 2021
 
महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021
महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021
महाराष्ट्र मंडळ फ्रान्स Diwali ank 2021
 
Udyog times - Laghu udyog Bharati - October 2021
Udyog times  - Laghu udyog Bharati - October 2021Udyog times  - Laghu udyog Bharati - October 2021
Udyog times - Laghu udyog Bharati - October 2021
 
Prana Setoo brochure - Non-Invasive Ventilator
Prana Setoo brochure - Non-Invasive VentilatorPrana Setoo brochure - Non-Invasive Ventilator
Prana Setoo brochure - Non-Invasive Ventilator
 
Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti
Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti
Epf circular 14 feb 2020 (1) - Laghu Udyog Bharti
 

Recently uploaded

Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...narwatsonia7
 
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersBook Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersnarwatsonia7
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsMedicoseAcademics
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...rajnisinghkjn
 
Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxDr. Dheeraj Kumar
 
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...narwatsonia7
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAAjennyeacort
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Mohamed Rizk Khodair
 
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi NcrDelhi Call Girls
 
Report Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptxReport Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptxbkling
 
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxNiranjan Chavan
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Timevijaych2041
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 

Recently uploaded (20)

Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
 
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
 
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersBook Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes Functions
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
 
Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptx
 
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)
 
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr
 
Report Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptxReport Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptx
 
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptx
 
Epilepsy
EpilepsyEpilepsy
Epilepsy
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 

Mechanical Ventilation and RAD - Prof. K. Chellum Oration / CMC Vellore 26th June 2004

  • 1. Mechanical ventilation and RAD Dr Satish Deopujari Prof. K. Chellum Oration / CMC Vellore 26th June 2004
  • 2. Incidence of M.V. in RAD in India ? Do we under ventilate these patients.
  • 3. Aggressive management ……….. Proper oxygenation warmed and humidified Continuous nebulization what dose ? Look for hypokalemia Steroids / Ipatropium bromide / MgSO4 Hydration / Ensure good Hemoglobin level. Avoiding agitation Ketamine Newer modalities
  • 4. MgSO4  Mechanism of Action  Antagonizes translocation of Ca across cell membrane, leads to SM relaxation and Inhibits degranulation of mast cells  Decreases release of ACH (decreases excitability of muscle fibre membranes)  Side Effects:  Facial warmth/flushing, hypotension, nausea, emesis, muscle weakness, sedation, loss of DTRs, resp depression  Dose:  20-40mg/kg IV over 30 min
  • 5. • The decision to intubate pt in SA , is made on the basis clinical deterioration, • Altered level of consciousness • Exhaustion / P. paradoxus • Inability to protect airway • Increasing arterial PCO2. • Quiet chest, absence of audible wheezing • PaO2 < 60 mmHg : not responding to adequate oxygenation • PaCO2 > 50 mmHg and rising more than 5 mmHg/ hour
  • 6. • Zimmerman et al, reported that one or more complications occurred in 46% of intubated asthmatics. • More than one-third of all complications occurred during intubation. • 47 % of complications during the intensive care unit stay • Difficult and esophageal intubations occurred in about 15% of all patients
  • 7. Standard preparation for rapid sequence intubation .  cardio-respiratory and blood pressure monitoring  Assistance  monitoring of oxygen saturation  careful aspiration of oropharynx  bag and mask ventilation with 100% oxygen  emptying of the stomach by nasogastric tube  benzodiazepine should be considered (e.g., midazolam 0.1 - 0.2 mg/kg) permitting relaxation during preoxygenation
  • 8. Ketamine hydrochloride (1 to 3 mg/kg) Good choice for its sedative and analgesic effects as well as its bronchodilating characteristics. Concomitant use of a benzodiazepine can suppress the dysphoric effects of Ketamine. Ketamine increases laryngeal secretions but does not block pharyngeal and laryngeal reflexes, increasing the risk of laryngospasm and aspiration in the preintubation period
  • 9. Endotracheal tube…………….  largest endotracheal tube….. lower airflow resistance Suctioning of thick mucosal secretions Fiber optic bronchoscopy : facilitated  A cuffed endotracheal tube Sometimes useful even in small children (<5 years) when insufflation pressures become very high (Hubert 1996).
  • 10. Intubation…………. oxygenation H2 blockers , prokinetics . atropine Lignocaine 4 % neb. 4mg / kg ( 1ml = 40 mg ) Sedation midazolam + ketamine / cricoid pressure Paralysis ( Vecuronium .1 to .2 mg / kg ) Intubation Suction Confirmation of tube and proper fixation Avoid positive pressure V. without cricoid P. Proper monitoring Oxygenation & Circulation status
  • 11. Fluid bolus for circulation Lt heart pumps what the right heart gives it
  • 12. Ventilatory strategy Permissive hypercapnia low rate 50 % for the age low pressure Avoiding barotrauma low pressure Minimal PEEP Intrinsic PEEP Dynamic hyperinflation (DHI)
  • 13. PEEP Controversies remain about the role of PEEP in status asthmaticus. Majority of cases, no PEEP should be applied during mechanical ventilation (0 3 cm H2O maximum)
  • 14.
  • 15. PEEP
  • 17. A 'rapid sequence' for extubation is justified by the risk of further bronchoconstriction induced by the presence of the endotracheal tube.
  • 18. • Adding adjuvant therapy despite lack of evidence is reasonable given the risks associated with intubation and mechanical ventilation • More research is required in childhood status asthmaticus!
  • 19. M. Ventilation is a BLEND of Art and science THANKS
  • 20. • Adding adjuvant therapy despite lack of evidence is reasonable given the risks associated with intubation and mechanical ventilation • More research is required in childhood status asthmaticus!
  • 21. Mechanical ventilation • Less than 5% of patients with SA required intubation and MV, “braman et al, jama 1990” • Indications: • To decrease work of breathing. • To maintain adequate oxygenation . • Augment alveolar ventilation in face of airway edema and diffuse mucus plugging of of the small airways…
  • 22. Indications of mechanical ventilation Not governed by numbers but by the clinical conditions. PaO2 < 60 mmHg or cyanosis not corrected by oxygen administration PaCO2 > 50 mmHg and rising more than 5 mmHg/ hour The decision to intubate and ventilate a child with status asthmaticus is primarily based on clinical criteria: respiratory muscle fatigue, obvious exhaustion, disappearance of pulsus paradoxus diminution of thoracic amplitude during respiratory movements diminution of air entry in the lungs : quiet chest, absence of audible wheezing pulsus paradoxus > 20 - 40 mmHg (inspiratory decline in systolic blood pressure) deterioration of mental status (lethargy, agitation, confusion, coma) diaphoresis in recumbent position
  • 23. •ideal ventilator settings reduce dynamic hyperinflation (DHI): limited minute ventilation (MV) using an appropriately low but adequate tidal volume (Vt) and respiratory rate, with an extended expiratory time (TE)