This document provides information on the management of patients on mechanical ventilation. It discusses the indications for mechanical ventilation including inadequate oxygenation and ventilation. It then covers the mechanisms of oxygen transport and various causes of inadequate oxygenation and perfusion. The document outlines the purposes of ventilation and procedures for initiation and settings of mechanical ventilation including modes, parameters, and monitoring of patients. It discusses potential problems during ventilation and goals of ventilation. Finally, the document reviews weaning from mechanical ventilation.

1. MANAGEMENT OFPATIENTS ON MECHANICALVENTILATION DR. PINAKI MAZUMDERAssistant Professor , Dept. of Anesthesiology, Calcutta Medical College.

2. INDICATIONS OF MECHANICAL VENTILATION Inadequate tissue oxygenation Inadequate tissue perfusion Inadequate ventilationMECHANISM OF OXYGEN TRANSPORT

3. Inadequate oxygenationBronchospasm Pneumonia Pulmonary edema – ARDS, Heart FailurePneumothoraxInadequate PerfusionShock Haemorrhagic

4. Neurogenic (spinal injury)

5. Septic shock Inadequate ventilation Central cause Head injury

6. CVA

7. Meningitis/ Encephalitis Peripheral causePolyneuritis

8. Neuromuscular weakness

9. Muscle dystrophy

10. Neurotoxic snake bite

11. Organophosphorus poisoningPurpose of ventilation Assist respiration Increase oxygenation Wash out CO2

12. Initiation of mechanical ventilationOral/ Nasal intubation

13. Tracheostomy for long term ventilation

14. Size of endotracheal tube

15. 8.0 to 8.5 mm for adult males

16. 7.0 to 7.5 mm for adult femalesChecklist prior to intubationPillow or 10 cm height block under the headSelf inflating AMBU bag with oxygen supplyFace maskLaryngoscope with different size bladesEndotracheal tubesStylet and Gum elastic bougieOral and nasal airwaysLaryngeal mask airwaySuction apparatusNecessary drugs

17. Oral tubes are secured at

18. 21 to 22 cm mark for males

19. 19 to 20 cm mark for females

20. Nasal tubes require 5 cm additional length.

21. Adhesive tape with counter-traction force for tube fixation

22. Head is kept at neutral position

23. Confirmation of tube position by x ray, capnography.Setting up of Ventilatory parameters Mode of ventilation Volume cycled Pressure cycled Time cycled

24. Volume/ Pressure cycled ventilation Controlled mode ventilation (CMV): delivers fixed volume/ pressure at fixed rate