Mechanical ventilation 6- in obstructive airway disease
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This document discusses ventilation challenges in patients with obstructive airway disease. Increased airway resistance from conditions like bronchospasm can lead to inefficient exhalation requiring prolonged expiratory time. This can result in breath stacking where the patient triggers another breath before fully exhaling, and gas trapping where extra air remains in the alveoli at expiration's end, increasing end-expiratory pressure known as auto-PEEP. Diagnosing these issues involves seeing if expiratory flow doesn't reach zero or wheezing persists to the next breath. Managing them includes increasing exhalation time, decreasing tidal volume, adjusting ventilator settings accordingly based on the mode used.
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3) Specific abnormal respiratory patterns discussed include eupnea, tachypnea, bradypnea, polypnea, apnea, hypoventilation, hyperventilation, hyperpnea, and dyspnea.
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Non-Invasive Ventilation
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3. Guidelines for setting pressures on CPAP and BiPAP and troubleshooting persistent hypoxia or hypercapnia by adjusting pressures.
4. Early predictors of NIV failure including a pH <7.3 and lack of acute worsening of chronic respiratory failure.
5. Clinical vignettes describing
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Mechanical ventilation.ppt
Mechanical ventilation is a therapeutic method that uses physical devices to assist or replace spontaneous breathing. There are two main types: negative pressure ventilation which applies pressure lower than atmospheric to the chest, and positive pressure ventilation which applies pressure higher than atmospheric to the lungs. Positive pressure ventilation is more commonly used today. It is important to carefully monitor patients on mechanical ventilation to optimize ventilation and prevent lung injury, through monitoring pressures, volumes, oxygen levels and CO2 levels. The goals are to provide adequate gas exchange while applying the lowest possible pressures and volumes to the lungs.
Principles of mechanical ventilation 2
This document defines key terms and concepts related to mechanical ventilation and interprets blood gas results to guide ventilator adjustments. It describes various ventilator modes, appropriate initial settings, priorities for weaning, and criteria for extubation. Volume control delivers a set tidal volume while pressure control uses a fixed pressure. Pressure-regulated volume control aims for a target minute ventilation. Complications include barotrauma, pneumonia, and cardiac/GI issues. Physical exams and pressure patterns can localize causes of acute deterioration. Neurologic, cardiovascular, and pulmonary status must be optimized before extubation.
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Mechanical ventilation 6- in obstructive airway disease
- 1. Ventilation in Obstructive Airway Disease Ventilation – 6 Fakhir Raza SIUT
- 2. Obstruction in Exhalation • Increased Airway resistance is secondary to • Bronchospasm • Airway inflammation • Collapse • Remodeling • Leads to inefficient exhalation • Require prolonged expiratory time
- 3. Breath Stacking and Auto-PEEP • breath stacking • Patients is not achieving full exhalation prior to the triggering of another breath • gas trapping • additional air remains within the alveoli at the end of expiration • Auto PEEP • Increased air within the alveoli at the end of expiration increases end- expiratory pressure
- 4. Definitions • Breath stacking: triggering another breath before complete exhalation • Gas trapping: retention of extra air in alveoli at end of expiration because of incomplete exhalation • Auto-PEEP: increase in alveolar end-expiratory pressure due to gas trapping
- 7. Identifying breath stacking • Expiratory flow does not reach zero at end of expiration • Wheezing persists right up to initiation of subsequent breath
- 9. How to measure Auto PEEP • Expiratory pause
- 10. Ventilator Management Strategies • Increase the time allowed for exhalation • Decrease tidal volume
- 11. Managing I:E ( I-E ratio)
- 12. Volume-Controlled Ventilation • Ventilator strategies to increase expiratory time in VCV: • Decrease respiratory rate • Decrease tidal volume • Increase flow rate
- 13. Pressure-Controlled Ventilation • Decrease Proximal airway pressure • Decrease inspiratory time • Tidal volume is indirectly decreased by decreasing Proximal airway pressures
Editor's Notes
- Mechanical ventilation is often used in the setting of acute exacerbations of obstructive lung diseases like asthma and chronic obstructive pulmonary disease (COPD). These disorders are characterized by increased airway resistance secondary to bronchospasm and airway inflammation, collapse, and remodeling, often leading to inefficient exhalation and expiratory flow limitation. Patients with obstructive lung disease and inefficient exhalation require a longer expiratory time to achieve full exhalation.
- Mechanical ventilation in patients with inefficient exhalation can be challenging as patients may not achieve full exhalation prior to the triggering of another breath, a phenomenon known as breath stacking. In the setting of breath stacking, because full exhalation has not occurred, additional air remains within the alveoli at the end of expiration, a phenomenon known as gas trapping. Increased air within the alveoli at the end of expiration increases end-expiratory pressure, a phenomenon known as auto-PEEP
- Breath stacking and gas trapping increase end-expiratory alveolar pressure and volume; therefore, inspiration begins at already higher than normal lung volume and pressure. The administration of a set tidal volume (as occurs with volume-controlled ventilation) to lungs that have elevated end-expiratory volume and pressure results in elevated end-inspiratory lung volume and pressure. If breath stacking and gas trapping are severe enough, barotrauma may result from the increased pressure in the airways and the alveoli. Additionally, the increased intrathoracic pressure may compress cardiac structures, decreasing venous return to the heart and ultimately leading to hemodynamic compromise and even obstructive shock.
- The magnitude of auto-PEEP can also be assessed by employing an expiratory pause maneuver on the ventilator (Fig. 6.3). With this maneuver, the expiratory valve is closed at the end of expiration, not allowing any additional air to leave the respiratory system. If, at the end of expiration, alveolar pressure is still higher than proximal airway pressure (PEEP applied at the ventilator), air will continue to flow from the alveoli to the ventilator, raising proximal airway pressure. The amount that proximal airway pressure rises above PEEP applied at the ventilator is referred to as auto-PEEP or intrinsic PEEP. Of note, PEEP applied at the ventilator is often referred to as applied PEEP or extrinsic PEEP. Total PEEP is equal to the sum of intrinsic PEEP and extrinsic PEEP. It is important that the expiratory pause maneuver be performed on a patient who is not making respiratory efforts—patient inspiratory and expiratory efforts will change the measured pressure and will not properly reflect the presence or degree of auto-PEEP.
- The central principle in managing patients on the ventilator with obstructive lung disease and expiratory flow limitation is to increase the time allowed for exhalation and to decrease tidal volume so that less air needs to be exhaled. By increasing the expiratory time, there is a greater chance that expiratory flow will reach zero prior to the subsequent breath, decreasing the degree of gas trapping, auto-PEEP, and hyperinflation
- While low respiratory rate and tidal volume are optimal for managing patients with expiratory flow limitation, utilizing this strategy will often result in hypoventilation and hypercapnia. This permissive hypercapnia is allowed because of the benefits of preventing breath stacking, auto-PEEP, and hyperinflation. Permissive hypercapnia is also utilized in the management of ARDS with low tidal volume ventilation