The document discusses various topics related to mechanical ventilation including: 1. Ventilation strategies for acute respiratory distress syndrome (ARDS) including low tidal volumes, optimal positive end-expiratory pressure, and prone positioning. 2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury. 3. Non-invasive ventilation can be considered for certain patients with COPD or asthma to avoid intubation if criteria are met.

1. Ventilatory support

5. Eddy Fan, JAMA. 2005;294

6. “ baby lung” Eddy Fan, JAMA. 2005;294

10. Clinical relevant information from key papers over the last decade: optimizing care in ALI/ARDS Solid proof – restrictive use of sedation – restrictive use of fluids – restrictive use of SG-catheters – use of lower tidal volumes No proof (yet?) – use of high PEEP – use of corticosteroids Speculative – anticoagulant strategies

12. Restrictive use of fluids ARDS Network. N EnglJ Med.2006; 354:2564

14. Use of lower tidal volumes ARDS Network. N EnglJ Med. 2005;

23. optimal PEEP J J Cordingley, Thorax 2002;57

26. Proven Therapeutic Strategies for ALI/ARDS No solid proof (yet) ARDS Network. N EnglJ Med.2004; 351:

29. Proven–use of prone position GattinoniL. N EnglJ Med.2001; 345:

32. Solid proof –restrictive use of sedation “ daily interruption”shortens duration of MV, also in patients with ALI/ARDS” Kress JP N EnglJ Med.2000; 342:1471

47. Peripheral cyanosis and poor capillary refill indicate failing circulation

60. 37 years old ,75 kg , had been suffered of car accident , intubated and ventilated , Gcs=7 3days later you have been called for consultation Ventilator setting

63. Mode of ventilation

65. Vt

66. F

67. PEEP

68. Flow

69. PIP

70. Recruitment

71. Inspiratory time

72. Spontaneous + PSV =No fight

76. Indications for NIV for AE-COPD GOLD 2005

77. Exclusion criteria GOLD 2005

78. Indications for Invasive Mechanical Ventilation GOLD 2005

84. Asthma

90. • FiO 2 = 1.0 (initially) • Long expiratory time (I:E ratio >1:2) • Low tidal volume 5–7 ml/kg • Low ventilator rate (8–10 breaths/min) • Set inspiratory pressure 30–35 cm H2O on pressure control ventilation or limit peak inspiratory pressure to <40 cm H2O • Minimal PEEP <5 cm H2O

93. Ventilator strategies in Bronchopleural fistula