Algorithms simplified (1) (1).ppt
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This document provides guidelines for using proportional assist ventilation (PAV) mode on a ventilator based on four conditions of a patient: 1. No respiratory distress. Gradually reduce assist and PEEP over time. 2. Respiratory distress develops. Increase PEEP until compliance no longer increases, then increase assist gradually until distress is resolved. 3. Inefficient gas exchange without distress. Gradually increase PEEP until compliance plateaus and assess blood gases. May need to switch to control modes. 4. Respiratory distress from overassist. Gradually increase assist to maximum 90% and switch mode if breaths become excessively prolonged.
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ards-pocket-card-4.7-qr.pdfrespiratory d
resphe inside of the lips, or on the fingernails may happen when a person is not getting as much oxygen as needed. The color of the skin may also appear pale or gray.
Grunting. A grunting sound can be heard each time the person exhales. This grunting is the body's way of trying to keep air in the lungs so they will stay open.
Nose flaring. The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe.
Retractions. The chest appears to sink in just below the neck and/or under the breastbone with each breath--one way of trying to bring more air into the lungs.
Sweating. There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is very fast.
Wheezing. A tight, whistling or musical sound heard with each breath can indicate that the air passages may be smaller, making it more difficult to breathe.
Stridor. An inspiratory sound heard in the upper airway.
Accessory muscle use. The muscles of the neck appear to be moving when your child breathes in. This can also be seen under the rib cage or even the muscles between the ribs.
Changes in alertness. Low oxygen levels may cause your child to act very tired and may indicate respiratory fatigue.
Body positions. Low oxygen and difficulty breathing may force your child to thrust his or head backwards with the nose up in the air (especially if lying down). Or, your child may lean forward while sitting. A child automatically uses these positions as a last attempt to improve breathing.
The signs of respiratory distress may resemble other problems or medical conditions. Always consult your child's healthcare provider for a diagnosis, but if your child is having difficulty breathing, call 911 or go to the closest emergency room.Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure characterized by diffuse alveolar and endothelial damage. The severe pathophysiological changes in lung parenchyma and pulmonary circulation together with the effects of positive pressure ventilation profoundly affect heart lung interactions in ARDS. The term pulmonary vascular dysfunction (PVD) refers to the specific involvement of the vascular compartment in ARDS and is expressed clinically by an increase in pulmonary arterial (PA) pressure and pulmonary vascular resistance both affecting right ventricular (RV) afterload. When severe, PVD can lead to RV failure which is associated to an increased mortality. The effect of PVD on RV function is not only a consequence of increased pulmonary vascular resistance as afterload is a much more complex phenomenon that includes all factors that oppose efficient ventricular ejection. Impaired pulmonary vascular mechanics including increased arterial elastance and augmented wave-reflection phenomena are commonly seen in ARDS and can additionally affect RV afterload. The use of
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Definition of UNASSISTED BREATHING
(Different from the spontaneous breathing
criteria as PS is not allowed)
1. Extubated with face mask, nasal prong oxygen, or
room air, OR
2. T-tube breathing, OR
3. Tracheostomy mask breathing, OR
4. CPAP less than or equal to 5 cm
H20 without
pressure support or IMV assistance.
Weaning From Mechanical Ventilation
Weaning
Mechanical Ventilation
Weaning Failure
RSBI
SBT
PSV
Criteria of weaning
Extubation
Cuff Leak test
Mechanical Ventilation Weaning From Mechanical Ventilation
- The document discusses various parameters and criteria used to determine when a patient can be safely disconnected from mechanical ventilation, including respiratory muscle strength, gas exchange, respiratory rate and volume.
- Common methods for gradually weaning a patient from mechanical ventilation are described, such as a T-piece trial, pressure support ventilation, and gradually decreasing the rate of support on SIMV.
- Failure criteria are outlined, including rapid shallow breathing, increased heart rate or blood pressure, distress signs. Determining the cause of failure and correcting it is important before subsequent weaning trials.
Basic modes of mechanical ventilation
1. The document discusses various modes of mechanical ventilation including volume control, pressure control, SIMV, and PSV. It describes the settings, parameters, and considerations for each mode.
2. Initial ventilator settings should aim for adequate oxygenation and ventilation while minimizing work of breathing. Settings like tidal volume, respiratory rate, and PEEP are adjusted based on factors like patient size and condition.
3. Weaning from mechanical ventilation involves gradually reducing support through methods like spontaneous breathing trials, decreasing SIMV frequency, and lowering pressure support levels to assess the patient's ability to breathe independently. Readiness criteria and a stepwise protocol are
basicmodesofmechanicalventilation-171010084222.pptx
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Weaning from mechanical ventilator
This document discusses strategies for liberating patients from mechanical ventilation. It outlines key factors that indicate readiness to wean, including improved respiratory function and organ system stability. Two common approaches to weaning are described: gradual weaning using methods like pressure support ventilation or spontaneous breathing trials followed by extubation if tolerated. Protocols using objective criteria can standardize and expedite the weaning process. Factors that may cause weaning failure include respiratory issues, cardiovascular problems, or infection. Readiness is assessed through measurements of ventilatory drive, muscle strength, and breathing patterns.
mechanical ventilation basics.pptx
The document discusses various aspects of mechanical ventilation including:
1. Indications for ventilation include acute ventilatory failure, impending failure, severe hypoxemia, and prophylactic support.
2. Goals of ventilation are to improve gas exchange, relieve respiratory distress, improve pulmonary mechanics, permit airway healing, and avoid complications.
3. Initial modes of ventilation include full support modes where the ventilator does all the work of breathing or partial support modes where the ventilator assists with some work of breathing.
Recommended
ards-pocket-card-4.7-qr.pdfrespiratory d
resphe inside of the lips, or on the fingernails may happen when a person is not getting as much oxygen as needed. The color of the skin may also appear pale or gray.
Grunting. A grunting sound can be heard each time the person exhales. This grunting is the body's way of trying to keep air in the lungs so they will stay open.
Nose flaring. The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe.
Retractions. The chest appears to sink in just below the neck and/or under the breastbone with each breath--one way of trying to bring more air into the lungs.
Sweating. There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is very fast.
Wheezing. A tight, whistling or musical sound heard with each breath can indicate that the air passages may be smaller, making it more difficult to breathe.
Stridor. An inspiratory sound heard in the upper airway.
Accessory muscle use. The muscles of the neck appear to be moving when your child breathes in. This can also be seen under the rib cage or even the muscles between the ribs.
Changes in alertness. Low oxygen levels may cause your child to act very tired and may indicate respiratory fatigue.
Body positions. Low oxygen and difficulty breathing may force your child to thrust his or head backwards with the nose up in the air (especially if lying down). Or, your child may lean forward while sitting. A child automatically uses these positions as a last attempt to improve breathing.
The signs of respiratory distress may resemble other problems or medical conditions. Always consult your child's healthcare provider for a diagnosis, but if your child is having difficulty breathing, call 911 or go to the closest emergency room.Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure characterized by diffuse alveolar and endothelial damage. The severe pathophysiological changes in lung parenchyma and pulmonary circulation together with the effects of positive pressure ventilation profoundly affect heart lung interactions in ARDS. The term pulmonary vascular dysfunction (PVD) refers to the specific involvement of the vascular compartment in ARDS and is expressed clinically by an increase in pulmonary arterial (PA) pressure and pulmonary vascular resistance both affecting right ventricular (RV) afterload. When severe, PVD can lead to RV failure which is associated to an increased mortality. The effect of PVD on RV function is not only a consequence of increased pulmonary vascular resistance as afterload is a much more complex phenomenon that includes all factors that oppose efficient ventricular ejection. Impaired pulmonary vascular mechanics including increased arterial elastance and augmented wave-reflection phenomena are commonly seen in ARDS and can additionally affect RV afterload. The use of
Tutorial tips: Mechanical ventilator protocol from NIH NHLBI ARDS Clinical Ne...
Definition of UNASSISTED BREATHING
(Different from the spontaneous breathing
criteria as PS is not allowed)
1. Extubated with face mask, nasal prong oxygen, or
room air, OR
2. T-tube breathing, OR
3. Tracheostomy mask breathing, OR
4. CPAP less than or equal to 5 cm
H20 without
pressure support or IMV assistance.
Weaning From Mechanical Ventilation
Weaning
Mechanical Ventilation
Weaning Failure
RSBI
SBT
PSV
Criteria of weaning
Extubation
Cuff Leak test
Mechanical Ventilation Weaning From Mechanical Ventilation
- The document discusses various parameters and criteria used to determine when a patient can be safely disconnected from mechanical ventilation, including respiratory muscle strength, gas exchange, respiratory rate and volume.
- Common methods for gradually weaning a patient from mechanical ventilation are described, such as a T-piece trial, pressure support ventilation, and gradually decreasing the rate of support on SIMV.
- Failure criteria are outlined, including rapid shallow breathing, increased heart rate or blood pressure, distress signs. Determining the cause of failure and correcting it is important before subsequent weaning trials.
Basic modes of mechanical ventilation
1. The document discusses various modes of mechanical ventilation including volume control, pressure control, SIMV, and PSV. It describes the settings, parameters, and considerations for each mode.
2. Initial ventilator settings should aim for adequate oxygenation and ventilation while minimizing work of breathing. Settings like tidal volume, respiratory rate, and PEEP are adjusted based on factors like patient size and condition.
3. Weaning from mechanical ventilation involves gradually reducing support through methods like spontaneous breathing trials, decreasing SIMV frequency, and lowering pressure support levels to assess the patient's ability to breathe independently. Readiness criteria and a stepwise protocol are
basicmodesofmechanicalventilation-171010084222.pptx
The document discusses various aspects of mechanical ventilation including indications for use, parts of the ventilator, measurements of ventilatory mechanics, types of ventilation modes including non-invasive and invasive modes, initial ventilator settings, and criteria for weaning patients off the ventilator. It provides details on modes like volume control, pressure control, SIMV, and PSV as well as parameters to monitor and consider when setting up the ventilator for a patient and assessing readiness to wean.
Weaning from mechanical ventilator
This document discusses strategies for liberating patients from mechanical ventilation. It outlines key factors that indicate readiness to wean, including improved respiratory function and organ system stability. Two common approaches to weaning are described: gradual weaning using methods like pressure support ventilation or spontaneous breathing trials followed by extubation if tolerated. Protocols using objective criteria can standardize and expedite the weaning process. Factors that may cause weaning failure include respiratory issues, cardiovascular problems, or infection. Readiness is assessed through measurements of ventilatory drive, muscle strength, and breathing patterns.
mechanical ventilation basics.pptx
The document discusses various aspects of mechanical ventilation including:
1. Indications for ventilation include acute ventilatory failure, impending failure, severe hypoxemia, and prophylactic support.
2. Goals of ventilation are to improve gas exchange, relieve respiratory distress, improve pulmonary mechanics, permit airway healing, and avoid complications.
3. Initial modes of ventilation include full support modes where the ventilator does all the work of breathing or partial support modes where the ventilator assists with some work of breathing.
Ventilator setting
This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
MODES OF VENTILATION detailed ppt presentation.pptx
The document discusses various modes of mechanical ventilation including mandatory minute volume ventilation (MMV). MMV aims to maintain a preset minimum minute ventilation while allowing for spontaneous breathing. It seeks to prevent issues like auto-PEEP and excessive dead space ventilation while fully ventilating in apnea. Adaptive support ventilation (ASV) is an intelligent mode that continually adjusts inspiratory pressure, mandatory breath rate, and inspiratory time on a breath-by-breath basis to adapt to the patient's needs during intubation, weaning, and extubation. Proportional assist ventilation (PAV+) uses software to estimate patient resistance and compliance and provides proportional ventilator support based on a percentage setting.
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Mechanical ventilators generate a controlled flow of gas into a patient's airways using various modes of ventilation. There are both positive and negative pressure machines that can be either invasive or non-invasive. Modes include volume cycled, pressure cycled, time cycled, and flow cycled. Ventilators aim to provide oxygenation through settings like FIO2 and PEEP, and ventilation through tidal volume and respiratory rate. They are indicated for conditions causing respiratory failure and can have complications like lung injury, infection, and decreased blood pressure. Settings must be adjusted based on blood gas results and the patient's condition. Weaning involves gradually reducing support as the patient improves. Non-invasive ventilation
Mechanical ventilation
The document discusses mechanical ventilation settings and principles. It indicates that the goals of ventilation are to facilitate CO2 release and maintain normal PaCO2 levels. Different modes of ventilation are described, including assist-control mode, SIMV, and PSV. Key settings discussed include tidal volume, respiratory rate, I:E ratio, PEEP, and FiO2. The document notes that patients with COPD should aim for controlled hypercapnia to limit high airway pressures. For ARDS patients, a low tidal volume ventilation strategy is recommended based on clinical trial evidence showing lower mortality.
Mechanical ventilation
The document discusses various aspects of mechanical ventilation including:
1) Different ventilator settings such as mode, respiratory rate, tidal volume, and PEEP that can be adjusted for different patient types.
2) Monitoring pressures such as peak pressure and auto-PEEP is important to avoid complications.
3) Specific considerations for ventilating patients with COPD/asthma include permissive hypercapnia to reduce dynamic hyperinflation and work of breathing.
4) Ventilating ARDS patients should use low tidal volumes, as clinical trials have shown this approach reduces mortality compared to traditional higher volumes.
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This document discusses mechanical ventilation strategies and considerations for neonates. It covers:
- Unique challenges in neonatal ventilation compared to older children due to transitional circulation, compliant chest walls, and immature respiratory control.
- Goals of mechanical ventilation including safety, comfort, and liberation from the ventilator.
- Manipulating variables like inspiratory pressure, PEEP, flow rates, and rates to optimize gas exchange and lung volumes while minimizing injury.
- Complications that can arise and how to monitor patients, troubleshoot issues, and wean from the ventilator. Initial strategies are outlined for different clinical scenarios.
difficult weaning from Mechanical ventilator
1) Difficult weaning refers to patients who fail initial weaning attempts or require up to three spontaneous breathing trials (SBTs) over seven days to be successfully weaned.
2) Causes of difficult weaning include imbalance between respiratory muscle strength and load, cardiac dysfunction, neuromuscular impairment, and metabolic or nutritional deficiencies.
3) Management of difficult weaning involves addressing potentially reversible causes, using ventilator modes like pressure support ventilation (PSV) to aid the weaning process, and considering non-invasive ventilation (NIV) in selected patients.
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This document provides an overview of different ventilator modes, including volume control (VC), pressure control (PC), pressure regulated volume control (PRVC), synchronous intermittent mandatory ventilation (SIMV), pressure support (PS), and airway pressure release ventilation (APRV). For each mode, it describes the mode, pros, cons, and major settings. It emphasizes measuring blood gases and oxygen saturation to assess if treatment goals are being achieved and adjusting ventilator settings accordingly. The goals of mechanical ventilation are supporting oxygenation and ventilation while promoting patient comfort and readiness to wean from support.
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This document discusses acute respiratory distress syndrome (ARDS). It defines ARDS according to the Berlin definition and describes its etiology, risk factors, pathogenesis, clinical features, and treatment approaches. Regarding treatment, the main focus is lung protective ventilation with low tidal volumes, optimizing PEEP levels, permissive hypercapnia, and conservative fluid management when possible. Other supportive strategies discussed include prone positioning, neuromuscular blockade, inhaled vasodilators, glucocorticoids, and evaluating patients daily for spontaneous breathing trials to guide weaning from mechanical ventilation.
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Approach to Mechanical ventilation
Mechanical ventilation can be used to support or replace spontaneous breathing in patients unable to maintain adequate ventilation on their own. It aims to facilitate carbon dioxide release and maximize oxygen delivery. Modes include controlled mandatory ventilation where the ventilator controls both tidal volume and rate, and assist-control where the ventilator provides a minimum rate with additional breaths triggered by the patient. Synchronized intermittent mandatory ventilation delivers mandatory breaths at set intervals while allowing spontaneous breathing in between to reduce asynchrony.
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This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
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The document discusses various modes of mechanical ventilation including mandatory minute volume ventilation (MMV). MMV aims to maintain a preset minimum minute ventilation while allowing for spontaneous breathing. It seeks to prevent issues like auto-PEEP and excessive dead space ventilation while fully ventilating in apnea. Adaptive support ventilation (ASV) is an intelligent mode that continually adjusts inspiratory pressure, mandatory breath rate, and inspiratory time on a breath-by-breath basis to adapt to the patient's needs during intubation, weaning, and extubation. Proportional assist ventilation (PAV+) uses software to estimate patient resistance and compliance and provides proportional ventilator support based on a percentage setting.
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The document discusses various aspects of mechanical ventilation including:
1) Different ventilator settings such as mode, respiratory rate, tidal volume, and PEEP that can be adjusted for different patient types.
2) Monitoring pressures such as peak pressure and auto-PEEP is important to avoid complications.
3) Specific considerations for ventilating patients with COPD/asthma include permissive hypercapnia to reduce dynamic hyperinflation and work of breathing.
4) Ventilating ARDS patients should use low tidal volumes, as clinical trials have shown this approach reduces mortality compared to traditional higher volumes.
Invasive ventilation in neonates
This document discusses mechanical ventilation strategies and considerations for neonates. It covers:
- Unique challenges in neonatal ventilation compared to older children due to transitional circulation, compliant chest walls, and immature respiratory control.
- Goals of mechanical ventilation including safety, comfort, and liberation from the ventilator.
- Manipulating variables like inspiratory pressure, PEEP, flow rates, and rates to optimize gas exchange and lung volumes while minimizing injury.
- Complications that can arise and how to monitor patients, troubleshoot issues, and wean from the ventilator. Initial strategies are outlined for different clinical scenarios.
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1) Difficult weaning refers to patients who fail initial weaning attempts or require up to three spontaneous breathing trials (SBTs) over seven days to be successfully weaned.
2) Causes of difficult weaning include imbalance between respiratory muscle strength and load, cardiac dysfunction, neuromuscular impairment, and metabolic or nutritional deficiencies.
3) Management of difficult weaning involves addressing potentially reversible causes, using ventilator modes like pressure support ventilation (PSV) to aid the weaning process, and considering non-invasive ventilation (NIV) in selected patients.
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Introduction.
Indication and Exclusion Criteria.
Technical Aspects.
Initial Controls and Settings.
Monitoring, Assessment, & Adjustment.
Maintaining ABG Goals.
Returning to Conventional Ventilation.
Troubleshooting.
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This document provides an overview of different ventilator modes, including volume control (VC), pressure control (PC), pressure regulated volume control (PRVC), synchronous intermittent mandatory ventilation (SIMV), pressure support (PS), and airway pressure release ventilation (APRV). For each mode, it describes the mode, pros, cons, and major settings. It emphasizes measuring blood gases and oxygen saturation to assess if treatment goals are being achieved and adjusting ventilator settings accordingly. The goals of mechanical ventilation are supporting oxygenation and ventilation while promoting patient comfort and readiness to wean from support.
Dr sami liberation from vent.
Liberation from mechanical ventilation involves gradually reducing ventilatory support as patients regain the ability to breathe spontaneously. There are several key stages in the process: assessing patient readiness using criteria like respiratory rate and oxygen levels; conducting a spontaneous breathing trial to test unsupported breathing; and finally removing the endotracheal tube if breathing is successful. Factors like underlying lung disease, secretions, and respiratory muscle strength can impact weaning outcomes. Close monitoring is needed to identify failures and prevent complications.
ARDS-acute respiratory distress syndrome
This document discusses acute respiratory distress syndrome (ARDS). It defines ARDS according to the Berlin definition and describes its etiology, risk factors, pathogenesis, clinical features, and treatment approaches. Regarding treatment, the main focus is lung protective ventilation with low tidal volumes, optimizing PEEP levels, permissive hypercapnia, and conservative fluid management when possible. Other supportive strategies discussed include prone positioning, neuromuscular blockade, inhaled vasodilators, glucocorticoids, and evaluating patients daily for spontaneous breathing trials to guide weaning from mechanical ventilation.
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The document discusses principles of ventilation including indications for ventilation such as support through illness or reversal of hypoxemia. It describes modes of ventilation including controlled, pressure control, volume control, continuous positive airway pressure, and pressure support. It also discusses patient management considerations for ventilated patients such as monitoring, suctioning, sedation, positioning, nutrition, communication, and readiness to wean from ventilation. Complications of ventilation are also briefly outlined.
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This document outlines the three phases of mechanical ventilation: 1) initiating ventilation by intubating and ventilating a patient in respiratory failure, 2) monitoring the patient and adjusting ventilator controls like PEEP and FiO2 based on ABG results to optimize oxygenation and ventilation, and 3) gradually weaning the patient from the ventilator using methods like a T-piece trial and assessing readiness based on stability of vital signs and ABG values. The goal is to restore the highest level of independence for chronically ventilated patients or provide end of life care through terminal weaning for those with irreversible illness.
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The document discusses various methods for weaning patients off mechanical ventilation, including SIMV, T-piece trials, CPAP/BiPAP, and pressure support. It notes major factors to consider for each patient such as their primary illness, ventilatory support needs, and other medical conditions. Key criteria for determining readiness for weaning trials and extubation include respiratory rate, vital capacity, gas exchange values, hemodynamic stability, and underlying disease improvement. Factors that could lead to weaning or extubation failure are also outlined.
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Approach to Mechanical ventilation
Mechanical ventilation can be used to support or replace spontaneous breathing in patients unable to maintain adequate ventilation on their own. It aims to facilitate carbon dioxide release and maximize oxygen delivery. Modes include controlled mandatory ventilation where the ventilator controls both tidal volume and rate, and assist-control where the ventilator provides a minimum rate with additional breaths triggered by the patient. Synchronized intermittent mandatory ventilation delivers mandatory breaths at set intervals while allowing spontaneous breathing in between to reduce asynchrony.
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- 1. Definition of respiratory distress • At least 2 of the following 1) Heart rate >120% of the usual rate for > 5 min and/or systolic BP >180 or < 90 mmHg and/or systolic BP changes > 20% of the previous value for > 5 min 2) Respiratory rate >40 breaths/min 3) Marked use of accessory muscles 4) Diaphoresis 5) Abdominal paradox 6) Marked complaint of dyspnea
- 2. Initial settings: 70% assist PEEP at least 5 cmH2O FIO2<50%-60% Condition 1 Condition 2 Condition 3 Condition 4 No respiratory distress RR<35 b/min VT>5 ml/Kg SaO2 > 90% No respiratory distress RR>35 b/min and/or VT<5 ml/Kg SaO2 > 90% Respiratory distress Inefficient gas exchange (with no distress) The patient meets criteria for assisted modes (or for starting weaning trial) Set up the ventilator on PAV mode (check that ET tube size and IBW are correct)
- 3. No respiratory distress RR<35 b/min VT>5 ml/Kg SaO2 > 90% Observe for some time (i.e. 2 hours, may be less or more) No respiratory distress Crs: ↔ or ↑ Rrs: ↔ or ↓ Decrease by 10-20% No respiratory distress after 2 hrs RR and VT: ↔ Respiratory distress and/or marked ↑ in RR (>20-30%) and/or marked ↓ in VT (<4 ml/kg) Increase assist to previous value (or slightly higher) Further reductions in assist to be done at less frequent intervals (12-24 hours) 10-20% assist and PEEP ≤5 cmH2O Consider extubation or spontaneous breathing trial PAV- Condition 1
- 4. No respiratory distress RR>35 b/min and/or VT < 5 ml/Kg SaO2 > 90% Close observation for 5-10 min Respiratory distress develops or RR increases further (>15%) or VT decreases further (>15-20%) No respiratory distress RR and VT remains constant Obtain ABGs Inefficient Gas exchange Manage as Condition 3 PAV- Condition 2 Acceptable PaO2 and PaCO2 Manage as Condition 1 Manage as Condition 4
- 5. Respiratory distress at 70% Increase PEEP in steps until Crs no longer increases No respiratory distress Respiratory distress 1) Ensure Pawthershold is 40 cmH2O 2) Check the set-up of the ventilator 3) Check the resistance of the ventilator circuit Proceed as in Condition 1 (Gradual reduction of assist/PEEP) PAV- Condition 3 See next algorithm No respiratory distress Respiratory distress
- 6. Respiratory distress at 70% (after PEEP adjustment and proper set-up of the ventilator) Increase % assist in steps of 5% up to 90% and wait 15-20 breaths between steps Some breaths become stretched out (delayed cycling-off) No Yes No respiratory distress Respiratory distress Proceed as in Condition 1 (Gradual reduction of assist/PEEP) Switch to other mode Stretched out breath PAV- Condition 3 (cont.)
- 7. Inefficient gas exchange* (assist 70% and FIO2 60%) with no distress ↑PEEP until Crs no longer increases ↓PaO2 ↑PaCO2 ↓PaO2 ↑PaO2 Switch to control modes Gradual reduction of assist/PEEP (as in Condition 1) Acidemia (pH <7.35) No significant acidemia (pH>7.35) Manage as Condition 1 *Exclude causes of inefficient gas exchange such as pneumothorax, atelectasis and low cardiac output states Treat accordingly Consider switching to control modes Overassist prior to PAV Metabolic alkalosis (primary or secondary to Chronic Hypercapnia) PAV- Condition 4 Poor respiratory drive: Excessive analgo-sedation CNS disease High CO2 set point