Basic_Mechanical_Ventilation_-_FINAL

Basic_Mechanical_Ventilation_-_FINAL - Basics of Basics of...

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Unformatted text preview: Basics of Basics of Mechanical Ventilation Mechanical Ventilation Alain Broccard, MD Alain Broccard, MD John Marini, MD John Marini, MD University of Minnesota Regions Hospital St Paul, MN Objectives To understand: How positive pressure ventilation helps Reduce the work of breathing Restore adequate gas exchange The basics of Invasive positive pressure ventilation (IPPV) Noninvasive positive pressure ventilation (NIPPV) The principles of bedside monitoring Pressure and volume alarms Flow and pressure time curves Physiopathology of Respiratory Failure30 Physiopathology of Respiratory Failure30 Resistance AW Compliance R VA/Q Work of Breathing Fatigue Hypercapnia Neuromuscular disorders VE VO 2 VCO 2 pH Hypoxemia AW=Airrway; R=respiratroy system; VE = minute ventilation, VO2 = Oxygen consumption, VCO2=carbon dioxide production Indications and Rationale for Initiating IPPV Indications and Rationale for Initiating IPPV Unprotected and unstable airways (e.g,, coma) Intubation and IPPV allows to-Secure the airways-Reduce the risk of aspiration -Maintain adequate alveolar ventilation Hypercapnic respiratory acidosis IPPV and NIPPV -Reduce the work of breathing and thus prevents respiratory muscle fatigue or speeds recovery when fatigue is already present-Maintain adequate alveolar ventilation (prevent or limit respiratory acidosis as needed) Hypoxic respiratory failure IPPV and NIPPV help correct hypoxemia as it allows to -Deliver a high FiO 2 (100% if needed during IPPV) -Reduce shunt by maintaining flooded or collapsed alveoli open Others Intubation to facilitate procedure (bronchoscopy), bronchial suctioning Important Pitfalls and Problems Associated Important Pitfalls and Problems Associated with PPV with PPV Potential detrimental effects associated with PPV Heart and circulation -Reduced venous return and afterload -Hypotension and reduced cardiac output Lungs -Barotrauma-Ventilator-induced lung injury-Air trapping Gas exchange -May increase dead space (compression of capillaries) -Shunt (e.g., unilateral lung disease - the increase in vascular resistance in the normal lung associated with PPV tends to redirect blood flow in the abnormal lung) Decreased preload Positive alveolar pressure lung volume compression of the heart by the inflated lungs the intramural pressure of the heart cavities rises (e.g., RAP) venous return decreases preload is reduced stroke volume decreases cardiac output and blood pressure may drop. This can be minimized with i.v. fluid, which helps restore adequate venous return and preload. Patients who are very sensitive to change in preload conditions (e.g., presence of hypovolemia, tamponade, PE, severe air trapping) are particularly prone to hypotension when PPV is initiated....
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Basic_Mechanical_Ventilation_-_FINAL - Basics of Basics of...

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