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Treatment for life support is Mechanical Ventilation. A Ventilator is a device that aids in breathing when a person is unable to breathe.
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Carolina Romero-Dapueto (Editor) Servicio Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile Jeronimo Graf Santos (Editor) Medical in Chief Clinica Alemana, Santiago, Chile Series: Emergency and Intensive Care Medicine BISAC: MED108000
Mechanical Ventilation in the ICU: A New Approach and Treatment
Carolina Romero-Dapueto (Editor) Servicio Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
Jeronimo Graf Santos (Editor) Medical in Chief Clinica Alemana, Santiago, Chile
Series: Emergency and Intensive Care Medicine BISAC: MED108000
In the present book, a broad description of the processes carried out in patients with mechanical ventilation in the ICU is made. It covers from an overview of mechanical ventilation and some of its history to the processes of weaning and extubation. The novelty of this publication is that it focuses only on the conditions or complications in which patients are vented, as currently is done with these patients in the ICU: Early mobilization, both cooperative and non-cooperative patients with mechanical ventilation, the use of non-invasive ventilation, the adjunctive treatments of mechanical ventilation (such as inhalation therapy in different types of ventilation), and finally ethical issues in both adult and pediatric patients involved in the use of mechanical ventilation with respect to the end of treatment. Moreover, a categorization system for ICU patients and mechanically for narrowing the care burden and optimizing treatment based on an array of ventilation assessment scales is proposed.
MaxCure Hospitals critical care unit is equipped with state-of-art life-saving equipment.
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Acute Respiratory Disorders
Causes of Hypoxemia:
V/Q Mismatch
-Shunt (o2 not getting in), Dead Space ( Good ventilation, not good perfusion - PNA, Asthma, CHF
Dead space causes: hypovolemia, low cardiac output, pulmonary embolus, high airway pressures
Impaired gas diffusion
Alveolar hypoventilation
High altitude
A-a gradient (Alveolar-arterial O2): Tells you if it’s an issue at the level of the lung or just a ventilation issue
Formula: PAO2 (from formula below) - PaO2 (from ABG) = gradient
PAO2 = [FiO2 x (Pb-47)] - [1.25x PaCO2]
***rough guide to whether there is a significant A-a gradient present: PaO2 should = FiO2 x 500 (e.g. 0.21 x 500 = 105 mmHg)
Normal A-a gradient; 10mmHg - if >10 = V/Q Mismatch, lung issue
Determine if ARDS: Pa02:FI02 ratio; >300 = normal
ARDS Severity PaO2/FiO2 Mild 200 – 300 Moderate 100 – 200 Severe < 100
IPAP/EPAP = Pressure Support/Peep (increases oxygenation)
If you have an O2 issue: increase EPAP to bring it closer to IPAP #, titrate by 2cm increments.
Mechanical Ventilation
Lung Injury / ARDS / COPD: 6-8cc/kg of IDEAL body weight
Normal: 8-10/kg of IDEAL body weight
For every 10mm increase in CO2 = pH change of 0.08
Ventilatory failure: adjust TV, increase difference between IPAP & EPAP
Normal min volume (RR x TV) : 5-10
Plateau Pressure - peak pressure: Normal 5-10
Normal Plateau pressure <30, if higher at risk for barotrauma
Normal Peak pressure <35
Low diff: restrictive process - pneumo, Right main stem, acute pulmonary edema
High diff: obstructive process - biting tube, needs suction, bronchospasm
Auto-PEEP
Interventions to decrease auto-peep:
Decrease respiratory rate
Decrease Tidal volume
Increase gas flow rate or Increase I:E ratio
Determinants of Oxygenation:
FIO2
Mean airway pressure
Tidal volume
I:E ratio
Inspiratory flow rate
PEEP
Auto PEEP
For Obstructive Airway Disease:
Set initial tidal volume 6-8cc/kg
Optimize expiratory time
Be aware of auto-PEEP
Adjust min. ventilation to low normal pH
Bronchodilators
From Eric Strong Videos
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Bird, Hamilton, Draeger, Bennett four second names, four technologies, one purpose. #MechanicalVentilation #IMSS #HEALTH #LUNG
