Examines the utility of both arterial and venous blood gas analysis in critical illness
Edward Omron MD MPH FCCP
Pulmonary, Critical Care, and Internal Medicine
Morgan Hill, CA 95037
www.docomron.com
High frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation that uses a constant distending pressure (mean airway pressure [MAP]) with pressure variations oscillating around the MAP at very high rates (up to 900 cycles per minute). This creates small tidal volumes, often less than the dead space.
Examines the utility of both arterial and venous blood gas analysis in critical illness
Edward Omron MD MPH FCCP
Pulmonary, Critical Care, and Internal Medicine
Morgan Hill, CA 95037
www.docomron.com
High frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation that uses a constant distending pressure (mean airway pressure [MAP]) with pressure variations oscillating around the MAP at very high rates (up to 900 cycles per minute). This creates small tidal volumes, often less than the dead space.
Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
Inadequate respiratory drive
Inability to maintain adequate alveolar ventilation
Hypoxia
Decision to provide MV should be based on clinical examination and assessment of gas exchange by blood gas analysis. The principal goal of MV in the setting of respiratory failure is to support gas exchange while underlying diseased process is reversed.
The “How To” of BiVent
Created by: David Pitts II, RRT
Clinical Applications Specialist, Maquet
Birmingham, Alabama
Sponsored by Maquet, Inc – Servo Ventilators
47. Gas exchange parameters- PaO2. FiO2 periodically recorded.
48. Goal of Ventilation Adequate oxygenation and ventilation Prevent oxygen toxicity by using FiO2 < 0.6 Use PEEP in refractory hypoxia Maintain normal blood volume, pump function, cardiovascular parameters. Adequate Hb concentration Humidification of the inspired gas Frequent aseptic tracheo-bronchial suction Good physiotherapy and Organ support.
49. Problems during Ventilation Asynchrony between patient and ventilator : Reassure the patient , give sedative analgesic. Increase minute ventilation Give higher FiO2 Increase inspiratory flow rate Manually ventilate with 100% oxygen for 5 minutes- if severe resistance felt, change the tube. Rule out associated problems- acidosis, electrolyte disorders, pain, fever , shock, full bladder or stomach. Neuromuscular blocker - as last resort.
65. Weaning from ventilator Patient clinically stable ,underlying disease improved PaO2 > 70 mmHg , PCO2 < 45 mm Hg on FiO2 0.4 , acid base status, electrolytes, blood biochemistry, and chest x ray are near normal Hemodynamically stable No fever or Organ failure or Bleeding Nutritional status is good Neuromuscular function is adequate. bedside test: if respiratory rate > 30 or tidal volume < 300 ml then continue ventilation
66. Modes of weaning Patient connected to ventilator Pressure Support Ventilation (PSV) SIMV with gradual decrease of rate. Patient removed from ventilator Daily T piece trial of 60 mins or initial 15 – 30 mins trial followed by progressive increase in trial duration over the whole day. Extubate if no respiratory distress / clinically stable.
