Successfully reported this slideshow.

Mechanical ventilator

167

Share

Loading in …3
×
1 of 67
1 of 67

More Related Content

Related Books

Free with a 14 day trial from Scribd

See all

Related Audiobooks

Free with a 14 day trial from Scribd

See all

Mechanical ventilator

  1. 1. Mechanical ventilationMechanical ventilation
  2. 2. MECHANICALMECHANICAL VENTILATIONVENTILATION ‘‘When you cannot breathe, nothing elseWhen you cannot breathe, nothing else matters.’matters.’
  3. 3. The BASICS!!The BASICS!! AnatomyAnatomy • Upper Respiratory TractUpper Respiratory Tract – Humidifies inhaled gasesHumidifies inhaled gases – Site of most resistance to airflowSite of most resistance to airflow • Lower Respiratory TractLower Respiratory Tract – Conducting zone/airways (Anatomic deadConducting zone/airways (Anatomic dead space)space) – Respiratory zone/ bronchioles and alveoliRespiratory zone/ bronchioles and alveoli (Gas exchange)(Gas exchange)
  4. 4. The BASICS!! (Cont’d)The BASICS!! (Cont’d) PhysiologyPhysiology Negative pressure circuitNegative pressure circuit – Gradient between mouth and pleuralGradient between mouth and pleural space is the driving pressurespace is the driving pressure – need to overcome resistanceneed to overcome resistance – maintain alveolus openmaintain alveolus open
  5. 5. The BASICS!! (Cont’d)The BASICS!! (Cont’d) • Ventilation?Ventilation? • Respiration?Respiration? • External Respiration?External Respiration? • Internal Respiration?Internal Respiration? O2CO2
  6. 6. DefinitionDefinition Mechanical ventilator is anMechanical ventilator is an apparatus which can replaceapparatus which can replace normal mechanism of breathingnormal mechanism of breathing either by providing intermittenteither by providing intermittent or continuous flow of oxygen oror continuous flow of oxygen or air under pressure, which isair under pressure, which is connected to the patient by aconnected to the patient by a tube inserted through mouth,tube inserted through mouth, the nose or an opening in thethe nose or an opening in the trachea.trachea.
  7. 7. Mechanical VentilationMechanical Ventilation 1.1. Indications for Intubation and VentilationIndications for Intubation and Ventilation 2.2. Principles of Mechanical VentilationPrinciples of Mechanical Ventilation 3.3. Modes & Patterns of VentilationModes & Patterns of Ventilation 4.4. Ventilator Dependence: ComplicationsVentilator Dependence: Complications 5.5. Liberation from Mechanical Ventilation: WeaningLiberation from Mechanical Ventilation: Weaning 6.6. TroubleshootingTroubleshooting 7.7. Arterial Blood GasesArterial Blood Gases
  8. 8. Indications for MechanicalIndications for Mechanical VentilationVentilation “….An opening must be attempted in the“….An opening must be attempted in the trunk of the trachea, into which a tube ortrunk of the trachea, into which a tube or cane should be put; You will then blow intocane should be put; You will then blow into this so that lung may rise again….And thethis so that lung may rise again….And the heart becomes strong….”heart becomes strong….” Andreas Vesalius (1555)Andreas Vesalius (1555)
  9. 9. INDICATIONSINDICATIONS • Primary IndicationsPrimary Indications • Prophylactic IndicationsProphylactic Indications • Therapeutic IndicationsTherapeutic Indications
  10. 10. Primary IndicationsPrimary Indications • Acute Respiratory Failure (66%)Acute Respiratory Failure (66%) – Acute Respiratory Distress SyndromeAcute Respiratory Distress Syndrome – Heart Failure (through pulmonary edema/hypertension)Heart Failure (through pulmonary edema/hypertension) – PneumoniaPneumonia – SepsisSepsis – Complications of SurgeryComplications of Surgery – TraumaTrauma • Coma (15%)Coma (15%) • A/c Exacerbation of COPD(13%)A/c Exacerbation of COPD(13%) • Neuromuscular Disease (5%)Neuromuscular Disease (5%)
  11. 11. Prophylactic IndicationsProphylactic Indications • ShockShock • PostoperativelyPostoperatively »Extreme obesityExtreme obesity »Possibility of sepsisPossibility of sepsis »COPD with upper abdominalCOPD with upper abdominal surgerysurgery »Cardiovascular and neurologicalCardiovascular and neurological surgeriessurgeries • Acid aspiration syndromeAcid aspiration syndrome
  12. 12. Therapeutic IndicationsTherapeutic Indications • Resuscitation from cardio respiratoryResuscitation from cardio respiratory arrestarrest • Hypoventilation /ApneaHypoventilation /Apnea • Drug over dosageDrug over dosage • Neurological dysfunctionNeurological dysfunction • Trauma to chest and laceratedTrauma to chest and lacerated diaphragmdiaphragm
  13. 13. Objectives of MechanicalObjectives of Mechanical VentilationVentilation • Improves pulmonary gas exchangeImproves pulmonary gas exchange • Relieves respiratory distressRelieves respiratory distress • Alter pressure-volume relationsAlter pressure-volume relations • Permit lung and airway healingPermit lung and airway healing • Avoid complicationsAvoid complications
  14. 14. TerminologiesTerminologies • Respiratory RateRespiratory Rate • Tidal VolumeTidal Volume • Minute Ventilation (MV=RR x TV)Minute Ventilation (MV=RR x TV) • FiO2FiO2 • Peak PressurePeak Pressure
  15. 15. Main Determinants!!Main Determinants!! • Oxygen inOxygen in ↑↑ FFIIOO22 ↑↑ mean alveolarmean alveolar pressurepressure – PEEPPEEP • Re-open alveoliRe-open alveoli andand ↓↓ shuntshunt • Carbon dioxideCarbon dioxide outout ↑↑ ventilationventilation ∀ ↑↑ RRRR ∀ ↑↑ tidal volumetidal volume
  16. 16. Modes of VentilatorModes of Ventilator • Controlled modeControlled mode RR and TV by VentilatorRR and TV by Ventilator • Assist Control Mode (Mixed Mode)Assist Control Mode (Mixed Mode) Both got their RoleBoth got their Role • Spontaneous modeSpontaneous mode RR and TV by PatientRR and TV by Patient
  17. 17. CONTROLLED MODE VENTILATIONCONTROLLED MODE VENTILATION • Pressure Controlled VentilationPressure Controlled Ventilation • Volume Controlled VentilationVolume Controlled Ventilation • Time Controlled VentilationTime Controlled Ventilation
  18. 18. Pressure Controlled VentilationPressure Controlled Ventilation • Pressure cycled breathing, fully ventilatorPressure cycled breathing, fully ventilator controlledcontrolled • Suited for patients with neuromuscularSuited for patients with neuromuscular diseasesdiseases • Inspiratory phase stops when presetInspiratory phase stops when preset inspiratory pressure is reachedinspiratory pressure is reached
  19. 19. Volume Controlled VentilationVolume Controlled Ventilation • Volume targeted VentilationVolume targeted Ventilation • Inspiratory Cycle ends when TV isInspiratory Cycle ends when TV is delivereddelivered • Ventilator generates sufficient pressure toVentilator generates sufficient pressure to deliver set volumedeliver set volume
  20. 20. Time Controlled VentilationTime Controlled Ventilation • Normal I:E ratio -> 1:2Normal I:E ratio -> 1:2 • Prolonged Expiratory phase according toProlonged Expiratory phase according to the underlying pathology i.e. up to 1:3 orthe underlying pathology i.e. up to 1:3 or 1:41:4 Inverse Ratio VentilationInverse Ratio Ventilation • Helps prevent alveolar collapseHelps prevent alveolar collapse • Hyperinflation, Auto-PEEP and decreasedHyperinflation, Auto-PEEP and decreased cardiac outputcardiac output • Use: ARDS with refractory hypoxemia orUse: ARDS with refractory hypoxemia or hypercapniahypercapnia
  21. 21. ASSIST CONTROL MODE / MIXEDASSIST CONTROL MODE / MIXED MODEMODE • Intermittent Mandatory Ventilation (IMV)Intermittent Mandatory Ventilation (IMV) -- Mandatory Breaths-- Mandatory Breaths • Synchronized Intermittent MandatorySynchronized Intermittent Mandatory Ventilation (SIMV)Ventilation (SIMV) -- Synchronized Breaths-- Synchronized Breaths • SIMV + Pressure SupportSIMV + Pressure Support -- Pressure Support too along with-- Pressure Support too along with
  22. 22. SPONTANEOUS MODESPONTANEOUS MODE • Pressure Support Ventilation (PSV)Pressure Support Ventilation (PSV) -- Spontaneous inspiratory efforts trigger the-- Spontaneous inspiratory efforts trigger the ventilator to provide a variable flow of gas in orderventilator to provide a variable flow of gas in order to attain a preset airway pressure.to attain a preset airway pressure. Machine assistMachine assist and augment the spontaneous breathing efforts ofand augment the spontaneous breathing efforts of patientpatient • Continuous Positive Airway Pressure (CPAP)Continuous Positive Airway Pressure (CPAP) No machine breaths deliveredNo machine breaths delivered Allows spontaneous breathing at elevated baselineAllows spontaneous breathing at elevated baseline pressurepressure Patient controls rate and tidal volumePatient controls rate and tidal volume
  23. 23. CMVCMV
  24. 24. ACV/SIMVACV/SIMV
  25. 25. PSVPSV
  26. 26. Setting a VentilatorSetting a Ventilator Settings vary with Age, WeightSettings vary with Age, Weight and underlying Pathology of theand underlying Pathology of the patientpatient
  27. 27. The required Ventilator settingsThe required Ventilator settings are :-are :- • Tidal volumeTidal volume • FiOFiO22 • Respiratory RateRespiratory Rate • Minute VolumeMinute Volume • I:E RatioI:E Ratio • Pause timePause time • PEEP, ZEEP & NEEPPEEP, ZEEP & NEEP • Trigger sensitivityTrigger sensitivity
  28. 28. Tidal Volume (VTidal Volume (VTT )) Tidal volumeTidal volume 8-10ml/Kg8-10ml/Kg Small tidal volume inSmall tidal volume in ARDSARDS BronchospasmBronchospasm Large tidal volume causesLarge tidal volume causes Increased airway pressureIncreased airway pressure BarotraumasBarotraumas
  29. 29. FiOFiO22 FiOFiO22 (Oxygen concentration)(Oxygen concentration) Expresses as percentage or decimalsExpresses as percentage or decimals Settings from 21% to 100% (0.21 to 1.0)Settings from 21% to 100% (0.21 to 1.0) FiOFiO22 of 0.5 or less –minimize oxygenof 0.5 or less –minimize oxygen toxicitytoxicity Target PaO2 isTarget PaO2 is 60mm of Hg or60mm of Hg or SpO2 90% in ABG ,SpO2 90% in ABG , SpO2 95% in pulse oximeterSpO2 95% in pulse oximeter With minimum possible FiOWith minimum possible FiO22
  30. 30. Respiratory Rate (RR)Respiratory Rate (RR) Respiratory Rate (RR) or FrequencyRespiratory Rate (RR) or Frequency > Set rate depends on age of patient> Set rate depends on age of patient Newborn - 30-40/mtNewborn - 30-40/mt Children - 20-30/mtChildren - 20-30/mt Adult - 10-15/mtAdult - 10-15/mt Reduce rate in patients with COPDReduce rate in patients with COPD
  31. 31. Minute Volume [MV]Minute Volume [MV] Minute volume = Tidal volume X R.R.Minute volume = Tidal volume X R.R.
  32. 32. I:E RatioI:E Ratio Inspiratory time and I:E ratioInspiratory time and I:E ratio • Determines duration of inspirationDetermines duration of inspiration and oxygenationand oxygenation NewbornNewborn 0.3-0.5 sec0.3-0.5 sec Infant and childrenInfant and children 0.5-0.8 sec0.5-0.8 sec AdultAdult up to 1.5up to 1.5 secsec
  33. 33. I:E Ratio (Cont’d)I:E Ratio (Cont’d) Normal I:E - 1:2 (is physiological)Normal I:E - 1:2 (is physiological) COPDCOPD - 1:3 to 1:4- 1:3 to 1:4 1:1 or 2:1 or more is called1:1 or 2:1 or more is called Inverse Ratio VentilationInverse Ratio Ventilation Used in ARDS and inUsed in ARDS and in Refractory HypoxemiaRefractory Hypoxemia
  34. 34. Trigger sensitivityTrigger sensitivity • How does the Ventilator know when to give aHow does the Ventilator know when to give a breath???breath??? “Trigger”“Trigger” – Patient effortPatient effort • The patient’s effort can be “sensed” as aThe patient’s effort can be “sensed” as a change in pressure or a change in flow (in thechange in pressure or a change in flow (in the circuit)circuit) Helps to the initiation of breath by patientHelps to the initiation of breath by patient - Ventilator sense the pressure drop in the- Ventilator sense the pressure drop in the systemsystem - Set between -2 to -20 cm of H- Set between -2 to -20 cm of H22OO - Start from -2, incrementally increase- Start from -2, incrementally increase
  35. 35. Flow rateFlow rate Flow rateFlow rate Speed with which the Tidal Volume isSpeed with which the Tidal Volume is delivereddelivered An important determinant of patientAn important determinant of patient comfortcomfort Normal rateNormal rate - 40-60 L/ Mt- 40-60 L/ Mt - 4X Minute Ventilation- 4X Minute Ventilation
  36. 36. End Expiratory PressuresEnd Expiratory Pressures • PEEP (Positive End ExpiratoryPEEP (Positive End Expiratory Pressure)Pressure) • ZEEP (Zero End Expiratory Pressure)ZEEP (Zero End Expiratory Pressure) • NEEP (Negative End ExpiratoryNEEP (Negative End Expiratory Pressure)Pressure)
  37. 37. Initial Ventilatory settingInitial Ventilatory setting for an adultfor an adult ModeMode PCV/ VCVPCV/ VCV FiO2FiO2 0.7-1 decrease to 0.5 or0.7-1 decrease to 0.5 or lessless Tidal Volume (VT) 10ml/KgTidal Volume (VT) 10ml/Kg RRRR 10-15 breaths/mt10-15 breaths/mt TriggerTrigger -2 cm of H2O-2 cm of H2O Flow rateFlow rate 40-60 L/mt40-60 L/mt I:EI:E 1:2 to 1:31:2 to 1:3 PEEPPEEP 5 cm of H2O5 cm of H2O Analyze Arterial Blood Gas 20 minutes laterAnalyze Arterial Blood Gas 20 minutes later and adjustand adjust
  38. 38. General rules ofGeneral rules of Ventilator ManipulationVentilator Manipulation To improve oxygenationTo improve oxygenation Apply PEEPApply PEEP Increase Insp. TimeIncrease Insp. Time Increase FiOIncrease FiO22 To improve COTo improve CO22 removalremoval Increase RateIncrease Rate Increase Tidal VolumeIncrease Tidal Volume
  39. 39. Care during MechanicalCare during Mechanical VentilationVentilation - Sedation and muscle paralysis- Sedation and muscle paralysis - Humidification- Humidification - Chest physiotherapy- Chest physiotherapy - Suctioning Event- Suctioning Event - Nutritional support- Nutritional support - Other general care- Other general care - Prevention of infection- Prevention of infection
  40. 40. Sedation and MuscleSedation and Muscle paralysisparalysis Sedation and Muscle paralysisSedation and Muscle paralysis • To relieveTo relieve AwarenessAwareness AnxietyAnxiety Pain andPain and Patient discomfortPatient discomfort • Drugs for Analgesia, Sedation, and MuscleDrugs for Analgesia, Sedation, and Muscle relaxationrelaxation
  41. 41. HumidificationHumidification HumidificationHumidification Process of addition of moisture and heat toProcess of addition of moisture and heat to inspiratory gasesinspiratory gases Methods of humidificationMethods of humidification Heated humidifiersHeated humidifiers NebulizersNebulizers Heat and Moist Exchangers (HME’s)Heat and Moist Exchangers (HME’s) In normal breathing humans,In normal breathing humans, Temperature of upper trachea 30-33Temperature of upper trachea 30-33oo CC
  42. 42. Chest PhysiotherapyChest Physiotherapy Chest PhysiotherapyChest Physiotherapy Used to mobilize the secretionUsed to mobilize the secretion Techniques IncludesTechniques Includes Postural drainagePostural drainage PercussionPercussion Rib SpringingRib Springing Vibration etc.Vibration etc.
  43. 43. Suctioning EventSuctioning Event Clearing of secretion (Suctioning)Clearing of secretion (Suctioning) - Most common procedure done in ICU- Most common procedure done in ICU - Should be done when needed, not on time- Should be done when needed, not on time basisbasis Suction cathetersSuction catheters Should be made of clear materialsShould be made of clear materials Size not greater than half the diameter of ETTSize not greater than half the diameter of ETT Should be longer than ETTShould be longer than ETT
  44. 44. Suctioning Event (Cont’d)Suctioning Event (Cont’d) Suction techniquesSuction techniques • OpenOpen Disconnecting the patient from theDisconnecting the patient from the ventilatorsventilators • ClosedClosed Allow the catheter to suck withoutAllow the catheter to suck without disconnecting from ventilatorsdisconnecting from ventilators
  45. 45. Suctioning Event (Cont’d)Suctioning Event (Cont’d) ComplicationsComplications • Cardiac arrhythmiasCardiac arrhythmias • Vagal stimulationVagal stimulation • Cardiac arrestCardiac arrest • Mucosal traumaMucosal trauma • AtelectasisAtelectasis • HypoxemiaHypoxemia • InfectionInfection • Raised Intracranial tensionRaised Intracranial tension
  46. 46. Nutritional supportNutritional support • Nutritional support is very important inNutritional support is very important in ventilator patientsventilator patients • Acute loss of 30-40% Body weight is lethalAcute loss of 30-40% Body weight is lethal • Poor nutrition leads to ventilator musclePoor nutrition leads to ventilator muscle weakness and delay Weaningweakness and delay Weaning
  47. 47. Other General Care –Other General Care – Mobilization of PatientMobilization of Patient • Seven days bed rest leads to loss ofSeven days bed rest leads to loss of muscle bulk up to 30%muscle bulk up to 30% • Patient may require active, assistedPatient may require active, assisted or passive movementor passive movement • The joints should be maintained andThe joints should be maintained and protected in neutral positionprotected in neutral position
  48. 48. Other General Care –Other General Care – Pressure soresPressure sores - Dependent areas of immobile patient- Dependent areas of immobile patient - Tissues over the bony prominence- Tissues over the bony prominence - Trauma, Diabetics Burn patients – High Risk- Trauma, Diabetics Burn patients – High Risk Preventive measuresPreventive measures • Regular turning and repositioning every 2-4Regular turning and repositioning every 2-4 hourshours • Special mattress and beds should be used toSpecial mattress and beds should be used to relieve pressure over susceptible areasrelieve pressure over susceptible areas • Regular inspection of skin integrityRegular inspection of skin integrity • Early nutritional supportEarly nutritional support
  49. 49. Other general care –Other general care – Eyes and mouth careEyes and mouth care - Commonest problems are Dry eyes and- Commonest problems are Dry eyes and Exposure keratopathyExposure keratopathy - Protective mechanisms are lost- Protective mechanisms are lost - Decreased tear production- Decreased tear production - Decreased resistance to infection- Decreased resistance to infection PreventionPrevention Artificial eye drops, hydrogel padsArtificial eye drops, hydrogel pads
  50. 50. Other general care -Other general care - Oral hygieneOral hygiene Oral Ulcers and Infection are commonOral Ulcers and Infection are common Decreased Oral fluid intakeDecreased Oral fluid intake Mucosal DehydrationMucosal Dehydration Decreased saliva productionDecreased saliva production Presence of Orotracheal tubePresence of Orotracheal tube
  51. 51. Prevention of InfectionPrevention of Infection ICU patients are 4 times more prone toICU patients are 4 times more prone to develop to nosocomial infectionsdevelop to nosocomial infections Common sitesCommon sites LungLung Catheter sitesCatheter sites Urinary tractsUrinary tracts WoundWound
  52. 52. Prevention of InfectionPrevention of Infection (Cont’d)(Cont’d) • As many as 40% of infections areAs many as 40% of infections are transmitted by the hands of Hospital stafftransmitted by the hands of Hospital staff • Most important preventive measure againstMost important preventive measure against the spread of infection is Hand Washingthe spread of infection is Hand Washing Infections can be decreased byInfections can be decreased by Using Antibiotics, Isolation techniquesUsing Antibiotics, Isolation techniques Use of Disposable components-Use of Disposable components- ETT, Catheters, Ventilator tubing andETT, Catheters, Ventilator tubing and fittingsfittings
  53. 53. ALARMSALARMS • Look from whereLook from where • Do not switch alarm off until causeDo not switch alarm off until cause of alarm trigger is identified andof alarm trigger is identified and correctedcorrected
  54. 54. Discontinuing MechanicalDiscontinuing Mechanical VentilationVentilation • DeathDeath • WeaningWeaning – Up to 25% of patients have RespiratoryUp to 25% of patients have Respiratory distress severe enough to requiredistress severe enough to require reinstitution of ventilator.reinstitution of ventilator. • ExtubationExtubation – 10 - 20 % of Extubated patients who10 - 20 % of Extubated patients who were successfully weaned requirewere successfully weaned require reintubation.reintubation.
  55. 55. THE WEAN (Liberation fromTHE WEAN (Liberation from MV)MV) Weaning is the gradual withdrawal fromWeaning is the gradual withdrawal from Mechanical Ventilation.Mechanical Ventilation. • Hemodynamically stableHemodynamically stable • Correction of underlying lung diseaseCorrection of underlying lung disease • Correction of acid-base/electrolyte disordersCorrection of acid-base/electrolyte disorders • Adequate nutritionAdequate nutrition • Mentally alertMentally alert • Avoidance of sedationAvoidance of sedation
  56. 56. THE WEAN (Cont’d)THE WEAN (Cont’d) Techniques to Wean!!Techniques to Wean!! • SIMV WeanSIMV Wean • PS WeanPS Wean • T- Piece TrialT- Piece Trial
  57. 57. TroubleshootingTroubleshooting Is it working or not?Is it working or not? – Look at the patient !!Look at the patient !! – Listen to the patient !!Listen to the patient !! – SaOSaO22, ABG, EtCO, ABG, EtCO22 – Chest X rayChest X ray – Look at the Ventilator (PIP; Expired TV;Look at the Ventilator (PIP; Expired TV; Alarms)Alarms)
  58. 58. TroubleshootingTroubleshooting (Cont’d)(Cont’d) • When in doubt, DISCONNECT THE PATIENTWhen in doubt, DISCONNECT THE PATIENT FROM THE VENTILATOR, and begin AMBUFROM THE VENTILATOR, and begin AMBU Bag Ventilation.Bag Ventilation. • Ensure you are bagging with 100% O2.Ensure you are bagging with 100% O2. • This eliminates the Ventilator circuit as theThis eliminates the Ventilator circuit as the source of the problem.source of the problem. • Bagging by hand can also help you gaugeBagging by hand can also help you gauge patient’s compliancepatient’s compliance
  59. 59. TroubleshootingTroubleshooting (Cont’d)(Cont’d) • Airway firstAirway first !!!!!! • Breathing nextBreathing next !!!! • Circulation!Circulation!
  60. 60. COMPLICATIONSCOMPLICATIONS • Ventilator Induced Lung InjuryVentilator Induced Lung Injury – Oxygen toxicityOxygen toxicity – Barotraumas / VolutraumasBarotraumas / Volutraumas • Peak PressurePeak Pressure • Plateau PressurePlateau Pressure • Shear Injury (Tidal Volume)Shear Injury (Tidal Volume) • PEEPPEEP
  61. 61. COMPLICATIONSCOMPLICATIONS (Cont’d)(Cont’d) • Cardiovascular ComplicationsCardiovascular Complications – Impaired venous return to RAImpaired venous return to RA – Bowing of the Interventricular SeptumBowing of the Interventricular Septum – Decreased left sided afterload (good)Decreased left sided afterload (good) – Altered right sided afterloadAltered right sided afterload • Sum Effect…..Sum Effect….. Decreased Cardiac OutputDecreased Cardiac Output (usually, not always and often we don’t(usually, not always and often we don’t even notice)even notice)
  62. 62. COMPLICATIONSCOMPLICATIONS (Cont’d)(Cont’d) • Other ComplicationsOther Complications – Ventilator Associated PneumoniaVentilator Associated Pneumonia (VAP)(VAP) – SinusitisSinusitis – SedationSedation – Risks from associated devicesRisks from associated devices (Central Lines, Arterial Lines)(Central Lines, Arterial Lines) – Unplanned ExtubationUnplanned Extubation
  63. 63. Related TerminologiesRelated Terminologies • Auto PEEPAuto PEEP • Alveolar RecruitmentAlveolar Recruitment • Prone VentilationProne Ventilation
  64. 64. Please DoPlease Do Remember!!Remember!! WHEN IN ANY DOUBT ABOUTWHEN IN ANY DOUBT ABOUT THE ADEQUACY OFTHE ADEQUACY OF MECHANICAL VENTILATION...MECHANICAL VENTILATION... MANUALLY VENTILATE THEMANUALLY VENTILATE THE PATIENT WITH AN AMBU BAG,PATIENT WITH AN AMBU BAG, WITH THE AVAILABLEWITH THE AVAILABLE MAXIMUM OMAXIMUM O22
  65. 65. ?? ?? ?? DOUBTSDOUBTS????

×