Hypoxia, Management of hypoxic patient, Improving Mean Airway Pressure, PEEP, Respiratory Rate, Recruitment, Inspiratory Flow

1. How to improve oxygenation
with Conventional Ventilator
Muhammad Asim Rana
BSc, MBBS, MRCP, FCCP, EDIC, SF-CCM
Critical Care Medicine
King Saud Medical City
Riyadh, KSA

2. Patient’s Data
• 37 yrs old alcoholic female with history of
recurrent gall stones.
• Admitted with pancreatitis
• Lipase 1120, Amylase 560.
• 5th day developed SOB, worsened so electively
intubated.
• FiO2 90%, Sat O2 78%, PaO2 48.

3. Chest Radiology

4. You only have Conventional Ventilator!
How can she be helped further to
improve Oxygenation?

5. Modalities to Improve Oxygenation
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Increase Respiratory Rate
Increase PIP
Increase Volume
Increase PEEP
Increase Flow
Increase Inspiratory Time (I:E Ratio)

6. By Increasing MEAN AIRWAY PRESSURE
Can we say it more logically

7. Mean Airway Pressure
Lengthen Inspiratory Time
Increase peak pressure
Increase PEEP
Increase Rate
Increase Flow

8. Increasing Mean Airway Pressure
1. Increase flow
2. Increase peak pressure
3. Lengthen inspiratory time
4. Increase PEEP
5. Increase Rate
Pressure
Time

9. Extra for the Experts

10. • The pt is on PCV with the following settings
PEEP=12, FiO2=1.0, IP=18, PIP=28, Vt=350 ml
(down from 450ml) & Slope is set at the
slowest possible flow delivery.
• ABG’s on these settings are:
• 7.28/49/53 (↓O2 ↑CO2 from previous).
• The RT notices that PIP reaches only
23cmH2O. No leaks are found in the system.
• What recommendations might be made to
improve this patient’s ABG’s?

11. Decrease the Rise Time
Better ventilation is actually accomplished by
adjusting the slope to achieve a faster
pressure delivery and increase the Vt,
The PIP will return to 28 cm H2O and the
patient's ABG values will improve without
further adjustments

12. Thank you