RT competency at the VA
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This slideshow gives an outlook of what a Respiratory Therapist's duties and functions at the VA hospital in Palo Alto, California and how RT's collaborate with the nursing department to ensure proper treatment to our veterans.
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Protocol for ventilator settings
1. This document provides protocols for ventilator settings for adults, children aged 1-10 years, and neonates/infants. It includes guidelines for initial settings, adjusting settings based on blood gas results, criteria for weaning and extubation.
2. The protocol outlines steps for changing settings from initial pressure-regulated volume control (PRVC) to synchronized intermittent mandatory ventilation (SIMV) and lists criteria for determining readiness for a spontaneous breathing trial.
3. Special considerations are provided for various clinical situations like post-cardiac surgery patients, pulmonary issues, and open sternum cases.
Res 236 ppt.
Based on the clinical presentation, the most likely diagnosis is pneumonia. Key findings supporting this include:
- History of smoking and alcohol use, which are risk factors
- Fever, chills, and chest pain on inspiration, which are common symptoms
- Rust-colored sputum, indicating presence of blood
- Tachypnea and inspiratory crackles on exam, localized to the right lower lobe
The immediate treatments that should be initiated are:
1. Supplemental oxygen via nasal cannula or mask to address his hypoxemia
2. IV fluids for hydration
3. Blood cultures to identify causative organism
4. Broad spectrum IV antibiotics to treat presumed community-acquired pneumonia
5. Chest
Non invasive ventillation...
A 62-year-old female with a history of hypertension, diabetes, and COPD presented with worsening cough, expectoration, and breathlessness over the past 3 days. On examination, she was drowsy with tachycardia, tachypnea, and low oxygen saturation. Tests showed respiratory acidosis and congestive cardiac failure. She was started on non-invasive ventilation (NIV) with initial settings of IPAP 10 cm H2O and EPAP 4 cm H2O, which were gradually increased. NIV was given for decreasing durations over 4 days as her condition improved before being discontinued.
Monitoring in mechanical ventilation main
This document discusses monitoring during mechanical ventilation. There are four key reasons for monitoring: to establish treatment plans, establish trends over time, adjust treatment based on measurements, and set alarms. Various parameters are monitored including vital signs, chest inspection, fluid balance, blood gases, oxygen saturation, end-tidal carbon dioxide, transcutaneous blood gases, and cerebral perfusion pressure. Monitoring provides critical information about a patient's condition and ventilator status to guide care and detect any changes or complications.
Pulmonary function tests for PGs
Pulmonary function tests provide objective assessments of respiratory symptoms and can help diagnose respiratory diseases. Spirometry is the most widely used test and measures volumes like FVC and FEV1. Restrictive diseases reduce total lung capacity while obstructive diseases cause decreased FEV1/FVC ratio. Other tests include lung volume measurements using plethysmography or gas dilution, diffusing capacity to assess gas exchange, and methacholine challenge for asthma diagnosis. Bedside tests can also help evaluate respiratory function.
Donor management with simulation
The document discusses the management of a potential organ donor through interactive simulation. It provides details on the patient's history, initial labs, physical exam findings, and hemodynamic status. It then outlines different treatment options and allows the user to make management decisions. The options cover fluid resuscitation, vasopressor and ventilator management, and next steps to optimize the patient for organ donation.
Pulmonary Function Tests
Pulmonary function tests measure lung volumes and capacities including tidal volume, vital capacity, inspiratory reserve volume, and residual volume. Spirometry evaluates parameters such as FEV1, FVC ratio, and peak expiratory flow. Restrictive patterns show reduced lung volumes while obstructive patterns feature reduced flow rates. Tests assess reversibility, diffusion capacity, and respiratory muscle strength. Interpretation requires considering factors like posture, effort, and medications. Bedside tests include match blowing, breath-holding, and peak flow measurement.
Non Invasive Ventilation (NIV)
NIV, or non-invasive ventilation, is a form of ventilation therapy that is applied non-invasively through a mask rather than an endotracheal tube. It is commonly used to treat conditions like COPD exacerbations, pulmonary edema, and respiratory failure. Key settings that must be adjusted include IPAP, EPAP, Ti min/max, trigger sensitivity, and backup rate. Modes include spontaneous, timed, and bi-level positive airway pressure. Proper mask fitting and troubleshooting issues like leaks are important for ensuring effective ventilation. Regular monitoring of parameters like ABGs, SpO2, and ventilation is needed to optimize NIV therapy.
Recommended
Protocol for ventilator settings
1. This document provides protocols for ventilator settings for adults, children aged 1-10 years, and neonates/infants. It includes guidelines for initial settings, adjusting settings based on blood gas results, criteria for weaning and extubation.
2. The protocol outlines steps for changing settings from initial pressure-regulated volume control (PRVC) to synchronized intermittent mandatory ventilation (SIMV) and lists criteria for determining readiness for a spontaneous breathing trial.
3. Special considerations are provided for various clinical situations like post-cardiac surgery patients, pulmonary issues, and open sternum cases.
Res 236 ppt.
Based on the clinical presentation, the most likely diagnosis is pneumonia. Key findings supporting this include:
- History of smoking and alcohol use, which are risk factors
- Fever, chills, and chest pain on inspiration, which are common symptoms
- Rust-colored sputum, indicating presence of blood
- Tachypnea and inspiratory crackles on exam, localized to the right lower lobe
The immediate treatments that should be initiated are:
1. Supplemental oxygen via nasal cannula or mask to address his hypoxemia
2. IV fluids for hydration
3. Blood cultures to identify causative organism
4. Broad spectrum IV antibiotics to treat presumed community-acquired pneumonia
5. Chest
Non invasive ventillation...
A 62-year-old female with a history of hypertension, diabetes, and COPD presented with worsening cough, expectoration, and breathlessness over the past 3 days. On examination, she was drowsy with tachycardia, tachypnea, and low oxygen saturation. Tests showed respiratory acidosis and congestive cardiac failure. She was started on non-invasive ventilation (NIV) with initial settings of IPAP 10 cm H2O and EPAP 4 cm H2O, which were gradually increased. NIV was given for decreasing durations over 4 days as her condition improved before being discontinued.
Monitoring in mechanical ventilation main
This document discusses monitoring during mechanical ventilation. There are four key reasons for monitoring: to establish treatment plans, establish trends over time, adjust treatment based on measurements, and set alarms. Various parameters are monitored including vital signs, chest inspection, fluid balance, blood gases, oxygen saturation, end-tidal carbon dioxide, transcutaneous blood gases, and cerebral perfusion pressure. Monitoring provides critical information about a patient's condition and ventilator status to guide care and detect any changes or complications.
Pulmonary function tests for PGs
Pulmonary function tests provide objective assessments of respiratory symptoms and can help diagnose respiratory diseases. Spirometry is the most widely used test and measures volumes like FVC and FEV1. Restrictive diseases reduce total lung capacity while obstructive diseases cause decreased FEV1/FVC ratio. Other tests include lung volume measurements using plethysmography or gas dilution, diffusing capacity to assess gas exchange, and methacholine challenge for asthma diagnosis. Bedside tests can also help evaluate respiratory function.
Donor management with simulation
The document discusses the management of a potential organ donor through interactive simulation. It provides details on the patient's history, initial labs, physical exam findings, and hemodynamic status. It then outlines different treatment options and allows the user to make management decisions. The options cover fluid resuscitation, vasopressor and ventilator management, and next steps to optimize the patient for organ donation.
Pulmonary Function Tests
Pulmonary function tests measure lung volumes and capacities including tidal volume, vital capacity, inspiratory reserve volume, and residual volume. Spirometry evaluates parameters such as FEV1, FVC ratio, and peak expiratory flow. Restrictive patterns show reduced lung volumes while obstructive patterns feature reduced flow rates. Tests assess reversibility, diffusion capacity, and respiratory muscle strength. Interpretation requires considering factors like posture, effort, and medications. Bedside tests include match blowing, breath-holding, and peak flow measurement.
Non Invasive Ventilation (NIV)
NIV, or non-invasive ventilation, is a form of ventilation therapy that is applied non-invasively through a mask rather than an endotracheal tube. It is commonly used to treat conditions like COPD exacerbations, pulmonary edema, and respiratory failure. Key settings that must be adjusted include IPAP, EPAP, Ti min/max, trigger sensitivity, and backup rate. Modes include spontaneous, timed, and bi-level positive airway pressure. Proper mask fitting and troubleshooting issues like leaks are important for ensuring effective ventilation. Regular monitoring of parameters like ABGs, SpO2, and ventilation is needed to optimize NIV therapy.
Niv initiation and modes final chandan
this is compiled & created to discuss the basic modes and initiation of NIV
the author is thankful to the previous authors,teachers who helped to conceptualize the NIV .
Final newer modes and facts niv chandan
THIS IS THE BASIC POINTS REGARDING NIV, THIS IS COMPILED AND ARRANGED FROM DIFFERENT BOOKS, JOURNALS AND PPTs.
The author is grateful to the teachers and authors of pulmonology and critical care.
Ventilation Strategy in obstructive Lung disease
1) The document discusses ventilation strategies and goals for patients with obstructive lung disease such as COPD who require non-invasive ventilation (NIV) or mechanical ventilation.
2) Key points addressed include physiology of obstructive lung disease, goals of ventilation including reducing work of breathing and dynamic hyperinflation, settings and troubleshooting for NIV and invasive mechanical ventilation, as well as strategies for weaning and extubation.
3) The case study example illustrates assessing the need for intubation in a COPD patient failing NIV, appropriate ventilation settings, and tips for successful weaning and extubation.
Pulmonary Function Test
Here are 5 examples of spirometry tests with bronchodilator reversibility:
1. No significant reversibility
2. Significant reversibility (>12% and 200ml increase in FEV1)
3. Minimal non-significant reversibility (<12% and 200ml change in FEV1)
4. No reversibility
5. Minimal non-significant reversibility
These examples demonstrate how to interpret bronchodilator reversibility testing based on the criteria of a 12% and 200ml increase in FEV1 to determine if the change is significant or not. The percentage and absolute change in FEV1 with bronchodilator are important to report.
Pulmonary Function Tutorial,Bhutani
The document discusses a clinical case of a 695g male neonate with respiratory distress syndrome who is on ventilatory support. It provides the current ventilator settings and blood gas results, and asks if the baby is a candidate for permissive hypercapnia. It then discusses various strategies for optimizing ventilation and weaning support, including the use of dual weaning by reducing both peak inspiratory pressure and positive end-expiratory pressure concurrently to prevent iatrogenic hypercapnia while allowing permissive hypercapnia.
Cardiopulmonarybypass
CBP is a technique where a machine temporarily takes over the heart and lung functions during surgery, maintaining blood circulation and oxygen delivery. The pump and oxygenator function as the heart and lungs. The perfusionist is responsible for setting up the CPB circuit and equipment, priming it, conducting CPB, and monitoring the patient's parameters such as blood gases, temperature, and flow rates throughout the procedure. After cardiac surgery is completed and the heart is de-aired, the patient is slowly weaned off bypass as their heart regains function and hemodynamic stability is confirmed.
Ventilation in acute heart failure
This document discusses ventilation in acute heart failure. It defines key terms like classification of heart failure and diagnostic criteria. It describes the pathophysiology and goals of treatment. Non-invasive ventilation with CPAP or BiPAP is indicated for cardiogenic pulmonary edema to improve oxygenation and reduce workload. Settings, monitoring, complications and indications for invasive ventilation are reviewed. The effects of weaning and NIV for chronic heart failure are also summarized.
Pulmonary function exam
Pulmonary function tests (PFTs) are used to characterize and monitor pulmonary disease. Common PFTs include spirometry to assess airflow limitation, lung volume measurements to detect restriction, diffusion capacity to evaluate gas exchange, and bronchoprovocation tests to identify airway hyperresponsiveness. Spirometry yields values like FEV1, FVC, and their ratio that are used to classify obstructive and restrictive patterns. Lung volumes are directly measured using techniques like plethysmography and indirectly calculated from spirometry. Diffusion capacity reflects membrane thickness and surface area via carbon monoxide transfer. PFTs provide objective data to diagnose and manage respiratory conditions.
Special perioperative mechanical ventilation modes
This document discusses various modes of mechanical ventilation including non-invasive ventilation, continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), and high frequency oscillatory ventilation (HFOV). It describes how each works, their advantages and disadvantages, appropriate settings and indications for use. Key points include how CPAP and BiPAP can provide respiratory support non-invasively while HFOV aims to reduce ventilator-induced lung injury through smaller tidal volumes and higher frequencies compared to conventional mechanical ventilation.
High frequency oscillatory ventilation
This document provides information about high frequency oscillatory ventilation (HFOV). It begins by explaining what HFOV is and how it differs from conventional ventilation. It then discusses indications for HFOV including failure of conventional ventilation in term/preterm infants and air leak syndromes. It provides details on the types of patients that may receive HFOV as early intervention, proactively, or as a rescue treatment. The document outlines initial settings, monitoring, weaning, and nursing management considerations for babies on HFOV. It emphasizes the importance of frequent assessment and adjustment of settings based on blood gases and chest x-rays to optimize ventilation and oxygenation with this mode of support.
SLE 5000 NEONATAL VENTILATOR, Dr Abid ali Rizvi, NICU Maternity Hospital kUWAIT
This document provides guidance on optimally using a SLE 5000 ventilator. It discusses which readings to record, modes of ventilation including CMV, IMV, PTV, PSV and SIMV+PSV. It explains how to adjust trigger sensitivity and describes complications that can arise from a lack of synchronization. Other topics covered include using targeted tidal volume, addressing high resistance values, and interpreting various measured values like tidal volume, minute volume, compliance, mean airway pressure and the HFO tidal volume. The overall aim is to help users properly configure the ventilator settings for neonates.
Sensormedics HIGH FREQUENCY VENTILATOR
This document provides information and guidelines for using the Sensormedics 3100A High Frequency Oscillatory Ventilator. It indicates the ventilator is used for neonatal respiratory support between 24-43 weeks gestation weighing 0.54-4.6kg. The document outlines initial settings for frequency, inspiratory time, power, mean airway pressure and guidelines for calibration, treatment initiation, patient management, suctioning, and weaning from the ventilator.
Spirometry in practice(1)
This document provides guidance on using spirometry to diagnose chronic obstructive pulmonary disease (COPD) in primary care. It defines COPD and outlines how spirometry can help detect the disease earlier through measurements like FEV1. The document recommends training to properly perform and interpret spirometry. It provides tips for identifying at-risk patients and differentiating COPD from asthma using clinical features and reversibility testing.
Pulmonary function tests
This document provides information on pulmonary function tests (PFTs). It discusses the goals of PFTs which include predicting and assessing pulmonary dysfunction. Various lung volumes, capacities, and flow rates are defined, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). The document outlines indications for preoperative PFTs and categorizes different types of PFTs including mechanical ventilatory tests, gas exchange tests, and tests of cardiopulmonary interaction. Bedside PFTs such as breath-holding tests and cough tests are also summarized.
Bipap
BiPAP (bilevel positive airway pressure) is a non-invasive ventilation therapy used to treat sleep apnea and other respiratory conditions. It delivers pressurized air through a mask at two alternating pressure levels - a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP) that mimic the patient's natural breathing pattern. BiPAP is prescribed for patients with obstructive sleep apnea who have not responded well to CPAP or who have other cardiopulmonary disorders. It provides an alternative to mechanical ventilation for respiratory support in hospitalized patients.
pulmonary function test’s
Pulmonary function tests (PFTs) measure how well the lungs work. There are several types of PFTs: spirometry measures airflow; lung volume measures how much air is in the lungs; and diffusion testing measures how well oxygen moves from the lungs into the bloodstream. PFTs can diagnose lung diseases like asthma, identify causes of shortness of breath, and assess treatment effectiveness. Abnormal PFT results usually mean the subject may have a lung disease if values are less than 80% of predicted normal levels based on factors like age, height and sex. PFT devices precisely measure things like airflow, gas volumes and pressures to evaluate lung function.
pulmonary function tests
Dr. M.MADHU CHAITANYA presented on pulmonary function tests. PFTs are a battery of standardized tests used to evaluate aspects of the respiratory system, including lung mechanics, gas exchange, and cardiopulmonary interaction. Common PFTs include spirometry to measure volumes like FVC and rates like FEV1, lung volume measurements via body plethysmography or other methods, and gas exchange tests. PFTs are used to diagnose and monitor respiratory conditions, and to evaluate patients preoperatively by assessing cardiopulmonary reserve and risk of complications. The presentation covered techniques, normal values, and clinical applications of various PFTs.
PFT
This document provides an overview of pulmonary function tests and lung volumes and capacities. It begins by explaining general principles of respiratory control and breathing including control centers in the brain and chest, respiratory reflexes, and chemoreceptors. It then defines key terms like minute volume, dead space, compliance, airways resistance, and work of breathing. Pressure-volume curves and the clinical significance of various lung volumes and capacities such as tidal volume, vital capacity, and functional residual capacity are also discussed. Factors that influence vital capacity like age, sex, posture, and pulmonary diseases are outlined.
Pulmonary function test
Pulmonary function tests provide objective measurements of lung function through various tests. Spirometry is the most basic and widely used test that measures volumes of air inhaled and exhaled over time through a spirometer. It can detect obstructive or restrictive lung diseases patterns based on evaluations of parameters like FEV1, FVC, FEV1/FVC ratio, and flow-volume loops. Other tests measure lung volumes, diffusion capacity, and assess ventilation/perfusion ratios to further characterize lung abnormalities. Together, pulmonary function tests provide quantifiable data to support diagnoses suggested by symptoms and physical exams.
Nippv
This document provides guidelines for non-invasive positive pressure ventilation (NIPPV) in patients experiencing acute respiratory failure. It lists indications and contraindications for NIPPV, and protocols for its use, including settings for inspiratory and expiratory pressures. The document also describes the ventilator modes and parameters that should be set, including pressures, rates, and alarms. It notes that since SARS, there is hesitation to use NIPPV for community-acquired pneumonias due to infection risk.
Intro to Mechanical Ventilation for Residents
This document provides an overview of mechanical ventilation, including its goals, general principles, types, settings, monitoring, troubleshooting, indications, contraindications and complications. It discusses non-invasive positive pressure ventilation and invasive mechanical ventilation, reviewing various modes, settings, weaning methods and specific management considerations for different patient populations. The key points are monitoring patients on mechanical ventilation for oxygenation and ventilation issues, addressing those issues following the DOPE/SEDOP mnemonic, and carefully considering indications and timing for initiation and discontinuation of mechanical support.
Basics of mechanical ventilation
The document provides an overview of mechanical ventilation, including its history and various modes. It begins with the origins of negative-pressure ventilators like iron lungs and the later development of positive-pressure ventilators. The main goals of ventilation are to facilitate carbon dioxide release and oxygen delivery. Various modes are described that can be used for invasive or non-invasive ventilation. Settings like PEEP, respiratory rate, tidal volume, and FiO2 are outlined that can be adjusted to optimize oxygenation and ventilation. Indications for intubation and criteria for safely extubating patients are also reviewed.
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Niv initiation and modes final chandan
this is compiled & created to discuss the basic modes and initiation of NIV
the author is thankful to the previous authors,teachers who helped to conceptualize the NIV .
Final newer modes and facts niv chandan
THIS IS THE BASIC POINTS REGARDING NIV, THIS IS COMPILED AND ARRANGED FROM DIFFERENT BOOKS, JOURNALS AND PPTs.
The author is grateful to the teachers and authors of pulmonology and critical care.
Ventilation Strategy in obstructive Lung disease
1) The document discusses ventilation strategies and goals for patients with obstructive lung disease such as COPD who require non-invasive ventilation (NIV) or mechanical ventilation.
2) Key points addressed include physiology of obstructive lung disease, goals of ventilation including reducing work of breathing and dynamic hyperinflation, settings and troubleshooting for NIV and invasive mechanical ventilation, as well as strategies for weaning and extubation.
3) The case study example illustrates assessing the need for intubation in a COPD patient failing NIV, appropriate ventilation settings, and tips for successful weaning and extubation.
Pulmonary Function Test
Here are 5 examples of spirometry tests with bronchodilator reversibility:
1. No significant reversibility
2. Significant reversibility (>12% and 200ml increase in FEV1)
3. Minimal non-significant reversibility (<12% and 200ml change in FEV1)
4. No reversibility
5. Minimal non-significant reversibility
These examples demonstrate how to interpret bronchodilator reversibility testing based on the criteria of a 12% and 200ml increase in FEV1 to determine if the change is significant or not. The percentage and absolute change in FEV1 with bronchodilator are important to report.
Pulmonary Function Tutorial,Bhutani
The document discusses a clinical case of a 695g male neonate with respiratory distress syndrome who is on ventilatory support. It provides the current ventilator settings and blood gas results, and asks if the baby is a candidate for permissive hypercapnia. It then discusses various strategies for optimizing ventilation and weaning support, including the use of dual weaning by reducing both peak inspiratory pressure and positive end-expiratory pressure concurrently to prevent iatrogenic hypercapnia while allowing permissive hypercapnia.
Cardiopulmonarybypass
CBP is a technique where a machine temporarily takes over the heart and lung functions during surgery, maintaining blood circulation and oxygen delivery. The pump and oxygenator function as the heart and lungs. The perfusionist is responsible for setting up the CPB circuit and equipment, priming it, conducting CPB, and monitoring the patient's parameters such as blood gases, temperature, and flow rates throughout the procedure. After cardiac surgery is completed and the heart is de-aired, the patient is slowly weaned off bypass as their heart regains function and hemodynamic stability is confirmed.
Ventilation in acute heart failure
This document discusses ventilation in acute heart failure. It defines key terms like classification of heart failure and diagnostic criteria. It describes the pathophysiology and goals of treatment. Non-invasive ventilation with CPAP or BiPAP is indicated for cardiogenic pulmonary edema to improve oxygenation and reduce workload. Settings, monitoring, complications and indications for invasive ventilation are reviewed. The effects of weaning and NIV for chronic heart failure are also summarized.
Pulmonary function exam
Pulmonary function tests (PFTs) are used to characterize and monitor pulmonary disease. Common PFTs include spirometry to assess airflow limitation, lung volume measurements to detect restriction, diffusion capacity to evaluate gas exchange, and bronchoprovocation tests to identify airway hyperresponsiveness. Spirometry yields values like FEV1, FVC, and their ratio that are used to classify obstructive and restrictive patterns. Lung volumes are directly measured using techniques like plethysmography and indirectly calculated from spirometry. Diffusion capacity reflects membrane thickness and surface area via carbon monoxide transfer. PFTs provide objective data to diagnose and manage respiratory conditions.
Special perioperative mechanical ventilation modes
This document discusses various modes of mechanical ventilation including non-invasive ventilation, continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), and high frequency oscillatory ventilation (HFOV). It describes how each works, their advantages and disadvantages, appropriate settings and indications for use. Key points include how CPAP and BiPAP can provide respiratory support non-invasively while HFOV aims to reduce ventilator-induced lung injury through smaller tidal volumes and higher frequencies compared to conventional mechanical ventilation.
High frequency oscillatory ventilation
This document provides information about high frequency oscillatory ventilation (HFOV). It begins by explaining what HFOV is and how it differs from conventional ventilation. It then discusses indications for HFOV including failure of conventional ventilation in term/preterm infants and air leak syndromes. It provides details on the types of patients that may receive HFOV as early intervention, proactively, or as a rescue treatment. The document outlines initial settings, monitoring, weaning, and nursing management considerations for babies on HFOV. It emphasizes the importance of frequent assessment and adjustment of settings based on blood gases and chest x-rays to optimize ventilation and oxygenation with this mode of support.
SLE 5000 NEONATAL VENTILATOR, Dr Abid ali Rizvi, NICU Maternity Hospital kUWAIT
This document provides guidance on optimally using a SLE 5000 ventilator. It discusses which readings to record, modes of ventilation including CMV, IMV, PTV, PSV and SIMV+PSV. It explains how to adjust trigger sensitivity and describes complications that can arise from a lack of synchronization. Other topics covered include using targeted tidal volume, addressing high resistance values, and interpreting various measured values like tidal volume, minute volume, compliance, mean airway pressure and the HFO tidal volume. The overall aim is to help users properly configure the ventilator settings for neonates.
Sensormedics HIGH FREQUENCY VENTILATOR
This document provides information and guidelines for using the Sensormedics 3100A High Frequency Oscillatory Ventilator. It indicates the ventilator is used for neonatal respiratory support between 24-43 weeks gestation weighing 0.54-4.6kg. The document outlines initial settings for frequency, inspiratory time, power, mean airway pressure and guidelines for calibration, treatment initiation, patient management, suctioning, and weaning from the ventilator.
Spirometry in practice(1)
This document provides guidance on using spirometry to diagnose chronic obstructive pulmonary disease (COPD) in primary care. It defines COPD and outlines how spirometry can help detect the disease earlier through measurements like FEV1. The document recommends training to properly perform and interpret spirometry. It provides tips for identifying at-risk patients and differentiating COPD from asthma using clinical features and reversibility testing.
Pulmonary function tests
This document provides information on pulmonary function tests (PFTs). It discusses the goals of PFTs which include predicting and assessing pulmonary dysfunction. Various lung volumes, capacities, and flow rates are defined, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). The document outlines indications for preoperative PFTs and categorizes different types of PFTs including mechanical ventilatory tests, gas exchange tests, and tests of cardiopulmonary interaction. Bedside PFTs such as breath-holding tests and cough tests are also summarized.
Bipap
BiPAP (bilevel positive airway pressure) is a non-invasive ventilation therapy used to treat sleep apnea and other respiratory conditions. It delivers pressurized air through a mask at two alternating pressure levels - a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP) that mimic the patient's natural breathing pattern. BiPAP is prescribed for patients with obstructive sleep apnea who have not responded well to CPAP or who have other cardiopulmonary disorders. It provides an alternative to mechanical ventilation for respiratory support in hospitalized patients.
pulmonary function test’s
Pulmonary function tests (PFTs) measure how well the lungs work. There are several types of PFTs: spirometry measures airflow; lung volume measures how much air is in the lungs; and diffusion testing measures how well oxygen moves from the lungs into the bloodstream. PFTs can diagnose lung diseases like asthma, identify causes of shortness of breath, and assess treatment effectiveness. Abnormal PFT results usually mean the subject may have a lung disease if values are less than 80% of predicted normal levels based on factors like age, height and sex. PFT devices precisely measure things like airflow, gas volumes and pressures to evaluate lung function.
pulmonary function tests
Dr. M.MADHU CHAITANYA presented on pulmonary function tests. PFTs are a battery of standardized tests used to evaluate aspects of the respiratory system, including lung mechanics, gas exchange, and cardiopulmonary interaction. Common PFTs include spirometry to measure volumes like FVC and rates like FEV1, lung volume measurements via body plethysmography or other methods, and gas exchange tests. PFTs are used to diagnose and monitor respiratory conditions, and to evaluate patients preoperatively by assessing cardiopulmonary reserve and risk of complications. The presentation covered techniques, normal values, and clinical applications of various PFTs.
PFT
This document provides an overview of pulmonary function tests and lung volumes and capacities. It begins by explaining general principles of respiratory control and breathing including control centers in the brain and chest, respiratory reflexes, and chemoreceptors. It then defines key terms like minute volume, dead space, compliance, airways resistance, and work of breathing. Pressure-volume curves and the clinical significance of various lung volumes and capacities such as tidal volume, vital capacity, and functional residual capacity are also discussed. Factors that influence vital capacity like age, sex, posture, and pulmonary diseases are outlined.
Pulmonary function test
Pulmonary function tests provide objective measurements of lung function through various tests. Spirometry is the most basic and widely used test that measures volumes of air inhaled and exhaled over time through a spirometer. It can detect obstructive or restrictive lung diseases patterns based on evaluations of parameters like FEV1, FVC, FEV1/FVC ratio, and flow-volume loops. Other tests measure lung volumes, diffusion capacity, and assess ventilation/perfusion ratios to further characterize lung abnormalities. Together, pulmonary function tests provide quantifiable data to support diagnoses suggested by symptoms and physical exams.
Nippv
This document provides guidelines for non-invasive positive pressure ventilation (NIPPV) in patients experiencing acute respiratory failure. It lists indications and contraindications for NIPPV, and protocols for its use, including settings for inspiratory and expiratory pressures. The document also describes the ventilator modes and parameters that should be set, including pressures, rates, and alarms. It notes that since SARS, there is hesitation to use NIPPV for community-acquired pneumonias due to infection risk.
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SLE 5000 NEONATAL VENTILATOR, Dr Abid ali Rizvi, NICU Maternity Hospital kUWAIT
Similar to RT competency at the VA
Intro to Mechanical Ventilation for Residents
This document provides an overview of mechanical ventilation, including its goals, general principles, types, settings, monitoring, troubleshooting, indications, contraindications and complications. It discusses non-invasive positive pressure ventilation and invasive mechanical ventilation, reviewing various modes, settings, weaning methods and specific management considerations for different patient populations. The key points are monitoring patients on mechanical ventilation for oxygenation and ventilation issues, addressing those issues following the DOPE/SEDOP mnemonic, and carefully considering indications and timing for initiation and discontinuation of mechanical support.
Basics of mechanical ventilation
The document provides an overview of mechanical ventilation, including its history and various modes. It begins with the origins of negative-pressure ventilators like iron lungs and the later development of positive-pressure ventilators. The main goals of ventilation are to facilitate carbon dioxide release and oxygen delivery. Various modes are described that can be used for invasive or non-invasive ventilation. Settings like PEEP, respiratory rate, tidal volume, and FiO2 are outlined that can be adjusted to optimize oxygenation and ventilation. Indications for intubation and criteria for safely extubating patients are also reviewed.
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.
Respiratory conditions in Critically ill Surgical patient
للزملاء المتقدمين لامتحانات اجنبية زي MRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينوو العمل فيها
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
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https://youtu.be/gLuRAzmCchI
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.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdf
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdf
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Noninvasive ventilation in COPD
This is a case based discussion about non invasive ventilation in patients with acute exacerbation of COPD
Mechanical Ventilation Settings
This document provides information on settings for mechanical ventilation. It discusses how to improve oxygenation by increasing FIO2, PEEP, and inspiratory time. It also discusses how to manage increased Paco2 by increasing tidal volume and respiratory rate. It then covers the different settings used in volume control and pressure control modes of ventilation. It provides recommendations for tidal volume based on patient condition and formulas for calculating ideal body weight. Other settings discussed include frequency, FIO2, inspiratory flow rate, PEEP, inspiratory time, and inspiratory-to-expiratory ratio. Precautions for different settings are also outlined.
G M C F I N A L
1. Mechanical ventilation can be used to treat respiratory failure in COPD patients by providing respiratory support and avoiding intubation complications. Non-invasive ventilation is preferred over invasive ventilation when possible.
2. Key goals of mechanical ventilation in COPD patients include using low tidal volumes to minimize excessive work of breathing, ensuring synchrony between breaths, and preventing complications like barotrauma and respiratory muscle atrophy.
3. Indications for intubation include when a COPD patient fails conservative management, has severe persistent acidosis or hypoxemia, or has additional illnesses. Close monitoring is needed to optimize ventilator settings and prevent issues in mechanically ventilated COPD patients.
Pphnhfov
Pulmonary hypertension in neonates (PPHN) occurs when the fetal circulation pattern persists after birth, causing right-to-left shunting of blood and hypoxemia. It has a mortality rate of over 50% without ECMO treatment. Current management involves optimizing oxygenation through various ventilation strategies like hyperventilation, high frequency ventilation, inhaled nitric oxide, and ECMO. While outcomes have improved, PPHN still carries risks of mortality and long-term morbidity so careful monitoring and a multimodal approach are important.
Basic Ventilator Setting NIV.pptx
1) This document outlines basic ventilator settings and modes of mechanical ventilation. It discusses indications for ventilation, parameters like tidal volume and PEEP, and modes like volume-controlled, pressure-controlled, and non-invasive ventilation.
2) Key ventilator parameters that are described include tidal volume, respiratory rate, FiO2, PEEP, flow rate, I:E ratio, and triggers. Common modes covered are volume-limited ventilation, pressure-limited ventilation, and pressure support ventilation.
3) Non-invasive ventilation is discussed as well, including indications like COPD exacerbation and cardiogenic pulmonary edema, as well as contraindications and modes like assist-control and PSV
Mechanical ventilation منتدى تمريض مستشفى غزة الاوروب
The document discusses the principles and history of mechanical ventilation. It covers the origins of negative pressure ventilators used during polio outbreaks and the later adoption of positive pressure ventilation. The modern standard involves positive pressure ventilation which began the era of intensive care medicine. Various ventilation modes, settings, and indications for intubation and extubation are outlined.
Protocol and guideline in critical care ppt
This document outlines protocols and guidelines for several aspects of critical care, including:
- Nutrition protocols that estimate daily caloric needs and provide guidelines for enteral and parenteral nutrition.
- Mechanical ventilation protocols that provide guidance on indications, modes, low tidal volume ventilation, weaning, and non-invasive ventilation.
- Guidelines for heating, ventilation and air conditioning systems in intensive care units to maintain indoor air quality and prevent hospital-acquired infections.
- Sepsis management protocols including determining infection source, biomarkers for diagnosis, and defining criteria for severe sepsis.
ARDS - trauma
This document discusses a case of acute respiratory failure in a 300 kg patient who presented with sudden severe hypoxia and unconsciousness. It then provides an overview of acute respiratory failure, distinguishing between hypercapnic and hypoxemic respiratory failure. Various causes of each type are described in detail. The case is specifically focused on acute respiratory distress syndrome (ARDS), explaining its pathogenesis, risk factors, complications, and management including a landmark ARMA clinical trial showing benefit of lower tidal volumes.
BASIC MECHANICAL VENTILATOR cme 2017.pptx
This document provides an overview of mechanical ventilation and strategies for setting a basic ventilator. It discusses respiratory physiology, reasons for needing ventilation, how to set parameters like FiO2, PEEP, tidal volume, and respiratory rate. It also covers topics like lung compliance, ARDS protective strategies, and ventilation in asthma. Two case studies are presented and discussed regarding how to address patients' ventilation needs based on their condition and blood gas results.
MedReg+1 Elkin Respiratory
This document provides an overview of acute respiratory medicine for a returning registrar, covering topics such as pleural disease, respiratory failure, acute asthma, COPD, PE, and haemoptysis. It discusses diagnostic and treatment approaches for various respiratory conditions, including techniques for inserting chest drains to treat pneumothoraces, use of non-invasive ventilation for respiratory failure, management of acute asthma exacerbations, and clinical presentation and diagnosis of pulmonary embolisms. Treatment goals, indications, contraindications, settings, and monitoring for conditions like COPD exacerbations requiring non-invasive ventilation are outlined.
Mechanical ventilation
This document provides an overview of basic concepts and applications of mechanical ventilation. It discusses various ventilation modes including controlled, assisted, assist-control, IMV, and SIMV modes. It also covers settings such as tidal volume, respiratory rate, I:E ratio, and FIO2. Key aspects of setting up and monitoring mechanical ventilation are summarized, including how to initially set parameters based on patient size and desired minute ventilation. Factors that affect oxygenation and ventilation are outlined. Waveforms and pressure-volume loops are presented to illustrate lung mechanics under different conditions. The importance of monitoring airway pressures and compliance is emphasized to optimize ventilation.
H1N1 ARDS Case Presentation
"Best Paper Presentation Award"
Presented at 3rd Annual Critical Care Medicine Conference , Sir Gangaram Hospital, New Delhi
"A Case of H1N1 ARDS - Journey from NIV to Invasive Ventilation to recruitment to proning to ECMO & Nitric Oxide"
For PPT, Check following link
http://www.medicalgeek.com/clinical-cases/36303-h1n1-ards-case-presentation.html
Mech Vent monitoring
This document provides guidelines for mechanical ventilation monitoring and management. It outlines an algorithm for initial intubation settings and adjustments based on oxygen saturation levels. It describes strategies for improving ventilation and oxygenation such as correcting PaCO2 abnormalities by adjusting rate and tidal volume, and using FiO2 and PEEP to optimize oxygenation levels while avoiding lung injury. Key concepts covered include permissive hypercapnia, selecting optimal PEEP, and indications for PEEP therapy.
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Respiratory conditions in Critically ill Surgical patient
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Mechanical ventilation & Pulmonary Rehabilitation -1.pdf
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Mechanical ventilation منتدى تمريض مستشفى غزة الاوروب
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APRV on COVID19 ARDS Presentation.pdf
Let's talk about the advantages, and disadvantages of using Airway Pressure Release Ventilation (APRV) mode on patients in mechanical ventilators who are suffering from COVID19 Pneumonia, and developed ARDS, also known as Acute Respiratory Distress Syndrome,
Based on the studies, 30% of these patients have obesity as a pre-existing condition, followed by hypertension with 26% of the patients, then diabetes at 21%, 12% heart failure (for example, congested heart failure), that’s a total of 89%. The rest or runner-ups, are COPD, dementia, liver DZ, and active Cancer.
Interestingly, respiratory issues are not the top pre-existing condition that puts patients in hospitals. This tells us, that when a patient gets intubated and is placed on a breathing machine, also called mechanical ventilation, is because their case is already so severe, that their pulmonary function had been compromised.
The term ARDS refers to the condition in which the patient’s lungs are unable to expand normally. It is stiffer. We call that less compliant, or it has low compliance.
This happens because of non-cardiogenic pulmonary edema. This is the fluid that goes in the interstitial space, the space between your alveoli (the smallest and end part of your airways). This is where the gas exchange happens when we breathe.
Unfortunately, the fluid is not something that a diuretic can eliminate. Therefore, it prevents proper oxygenation, and the patient suffers from hypoxemia.
So, our patients require supplementary oxygen, flow, and pressure to help them maintain normal oxygenation that their blood can carry to the rest of their body, and organs. This includes the heart, brain, kidneys, liver, etc.
If the body does not get enough oxygen, the patient can die in a matter of minutes.
Most COVID patients in Intensive Care Units simply need a High Flow device. The most common one is with a nasal cannula.
When the patient’s condition deteriorates, and they are in respiratory failure, then they are intubated to allow better oxygenation, ventilation, and decreased WOB.
Both High flow devices and Mechanical Ventilators have their advantages and disadvantages
When the patient is still not oxygenating well, even on the highest high flow settings, that means their condition is getting worst.
Remember, that the point of HF is to prevent the patient from being placed on a vent, but when it fails, this puts them in respiratory failure, which indicates that the patient needs to be intubated and be placed on a mechanical ventilator.
APRV Advantages
Alveolar Recruitment
Better Oxygenation
Less Sedation needed
More Spontaneous Breathing
APRV Disadvantages
Volutrauma
Increase Work of Breathing due to Spontaneous Breathing
Overview and Preparation for the 2020 Clinical Simulation Exam (CSE) Portion ...
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This is an open-source of the course overview for the Respiratory Care Board Exam, preparation, and review with a focus on the Clinical Simulation Exam (CSE) testing.Mechanical vent rules to know while taking the TMC
This presentation includes Mechanical Ventilator Testing tips for NBRC's Therapist Multiple Choice Exam, suitable for the test during or after 2015. License Attribution Creative Commons for ZTC (Zero Textbook Courses)
Infant respiratory distress syndrome PPV guideline <28 weeks
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This case scenario entails a 26 weeks gestation preemie born with presenting IRDS symptoms. The power point shows vital points and course of action to take if such situation presents itself. The flowchart enclosed is a great starting point on what to do after birth with such case. However, every individual case varies; therefore, keep caution with the use of our flowchart and modify treatment route as needed. MetaNeb Slideshow
To provide the respiratory therapist a set of guidelines and therapies specific for volume expansion and prevention/mobilization of secretions. This Slideshow focuses on the MetaNeb Device, it's benefits and procedures; it also highlights its indications and contraindications. Enjoy.
Final aerogen
VMN (vibrating mesh nebulization).
History
Irish company,
founded in Galway, started in 1997
CEO John Power
2015- AARC Zenith Award- 3 million patient world wide
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RT competency at the VA
- 1. RT Competency Review By: Anrey bartoszynski-RRT-accs @ Veterans Affairs, palo alto, CA
- 2. 4 Life Functions Ventilation - RT Oxygenation - RT Circulation - RN Perfusion - RN
- 3. Ventilation PCO2 •TV (Set TV, set pc) •RR *Note: we deliver breath- not take away
- 4. Oxygenation PaO2 •Fio2 •PEEP Fio2 up to 60% then Optimum PEEP Then Fio2 up to 100%
- 5. ABG • pH • PCo2 • Pao2 • HCo3 • SaO2 *SPO2 Metabolic VS Alkalotic H2o + Co2 <> H2CO3 <> H+ + CO2 Saturation goals: •Normal •COPD •ILD/ARDS
- 6. Circulation: Hemodynamics DAM Idea!! •CVP •PAP •PCWP •MAP/ CO Watch those pressors that affects PVR
- 7. Perfusion • Urine Output • BP • CRT • Pulse You Know this!!
- 8. EMERGENCY!! RN intervention if RT is unavailable PATIENT NOT VENTILATING •Resp. arrest •Ventilator malfunction •Obstruction in artificial airway INTERVENTION(s) 1.Disconnect from vent 2.Ambu Bag ventilation •Mask •Artificial airway (ETT vs Trach)- don’t forget the CUFF 3. Suction with Lavage •Mucus plugs
- 9. REMEMBER YOUR ACLS Rescue Breaths Do not wait for that BRAIN to starve from OXYGEN!
- 10. Why RT’s Intervene? Recruit (Alveoli Recruitment) – Lung Expansion Therapy Clear airway – airway clearance Protect airway Medicate- Bronchodilator/anti-inflammatory Oxygenate Ventilate Establish airway
- 11. Recruit Alveoli (Lung Expansion Therapy) • IS • Long I.Time • PEP – EZPAP • Aerobika – combo
- 12. Airway Clearance • IPV • Suction lines 1. Open 2. Close • Cough Assist
- 13. Protect Airway (Cuffed) •ETT (Endotracheal Tube) •Trach DEFLATE CUFF DURING PMV TRIAL!!
- 14. Medicate • Bronchodilator • Corticosteroid (Pulmonary) • Antibiotic (Pulmonary) • Mucolytic
- 16. Oxygenate • Low Flow • High Flow • Ambu Bag
- 18. Cool or Heated Aerosol • Mask • Trach Mask • Face tent • Blow-by Flow will depend on Fio2 Delivered
- 19. Ventilate • Hospital Grade Ventilators • Home Ventilators • V60/VPAP/CPAP
- 20. Establish (Cuffed and uncuffed) • OPA (oropharyngeal airway) • NP (Naso- pharyngeal airway • ETT • Trach
- 21. Paralytics Propofol- SBT’s Presedex - Does not decrease WOB Ketamine – also sedates and increases BP Anectin (Succinylcholine) – Not for TBI or Burn *Watch for Respiratory decline
- 22. Sedatives Morphine – decreases RR/TV Versed – common *Watch for Respiratory decline
- 23. Pressors Increases PVR ( pulmonary vascular resistance) 1. Neo-synephrine Common 1. Levophed Increase PVR = Decrease C.O.
- 24. Prevent VAP (ventilator acquired PNA) HOB> 30 degrees Prevent breaking vent tubing circuit, use Heated wire circuit versus HME Keep Tube cuff inflated Using MLT or MOV technique Continue oral care. ETT with Subglottic suction port Daily sedation interruption during SBT. Don’t Forget!! •Hand Hygiene •PPE
- 25. Modes of Ventilator AC Versus SIMV/PS Note: Every Vent calls their modes differently so don’t sweat remembering the modes, but understand how it works. Other: •APRV/Bi-Level •CPAP/PS VC (Volume Control) Versus PC (Pressure Control)
- 26. Wean/SBT Neuro Cardio Pulmonary Airway ”You Pray” If Ok: Turn off Sedation
- 27. Weaning SBT Qualification/Screen Test 3. Pulmonary •FIo2< 40 •PEEP < 8 • TV • RR •RSBI <106 •SPo2 •Abg •BS •WOB 4. Airway •Secure •Leak •Block1. Neuro •Mental Status •Sedation •Pain 2. Cardio •No pressors •Stable Hemodynamics STOP SBT if not tolerating Resume again in 24 hours
- 28. MISC. Neuro-respiratory- 1. Hypoxic Drive? Renal System’s affect to ABG POP Quiz Questions?
- 29. THE END