Mechanical Ventilation
17 important questions on Mechanical Ventilation
What are indication for NPPV?
Oxygenation abnormaltiteis: refractory hpoxemia, need for PEEP
work of breathing alternations: need for decreased work of breathing: shock, severe acidosis, respiratory muscle fatigue.
need for sedation
use of hyperventilation to reduce ICP
Who is a good candidate for NPPV
- Good candidates for NPPV include patients with respiratory distress (including tachypnea or dyspnea), hypercarbia, or hypoxia who are able to protect the airway, tolerate the mask, manage secretions, and are hemodynamically stable.
- NPPV has been shown to be beneficial in moderate to severe COPD with hypercarbia and respiratory acidosis, cardiogenic pulmonary edema, pulmonary infections in immunosuppressed patients, and can be used as a bridge after extubation in COPD patients.
What are indications for NPPV?
Pa02 45-50 <
paco2 >45-50
pH. < 7.32
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Contra indications for NPPV
hemodynamic instability
patients who is unable to cooperate
myocardial ischemia or arrhythmias
inability to protect the airway
high risk for aspiration
severe hypoxemia s
severey encephalopathy
active upper gastrointestinal hemorrhage
What is the maximum inspiratory pressure ?
What are important question to ask in the consideration of switching NPPV to invasive?
Oxygenation, ventilation, work of breathing OK?
Illness is anticipated to progress or ..?
What affects the Pao2?
What affects the PaCO2?
What are the goals of ventilation in COPD and ARDS
ventilator associated lung injury
What are the adverse effects of high (auto)peep?
How can you reduce autopeep?
Decrease Vt
change the waveform ( decelerating to constant ) for a faster inspiration.
What happens in prolonged exposure to high levels of inspired oxygen?
Mechanical intubation is a risk factor for?
gastric stress ulceration
nosocomial pneumonia
What are mechanical goals in ARDS
pplat: <30 cm
VtL 4-6 ML / kg
pH: > 7.15 is acceptable
What are the initiate settings in ARDS?
if Pplat is >30 cm, decresy Vt by 1 until Vt 4 ml/kg is reached, pH 7.15 is acceptable.
Pplat can be 25 cm, if not and Vt < 6 ml / kg you are allowed to increase until one of the variables reached its goal ( max)
How initiate with peep in ARDs
What might be helpful to improve the V/q in asymmetric lung disease?
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