Mechanical ventilation remember that all mv is

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Mechanical Ventilation Ventilator-induced lung injury Remember that all MV is harmful to the lung and may cause “VILI”: 46 © OnCourse Learning Corporation 2015
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MV proves beneficial by: Decreasing systemic or (myocardial oxygen consumption) MVO2 Reducing intracranial pressure 47 © OnCourse Learning Corporation 2015
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Mechanical Ventilation Types of ventilators Positive pressure - Inspiration created by positive pressure - Expiration passive - Classifications: pressure-cycled, volume cycled Negative pressure ventilator: iron lung 48 © OnCourse Learning Corporation 2015
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Goals of Mechanical Ventilation Most important goals of MV are: Reduction in work of breathing Assurance of patient comfort Synchrony with ventilator Adequacy of ventilation and oxygenation Airway protection 49 © OnCourse Learning Corporation 2015
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Improve Oxygenation PEEP: Physiologic 3-5 cm Actions: improves the PaO 2 without increasing FiO 2 , decreases surface tension, decreases intrapulmonary shunt Uses: ARDS (acute respiratory distress syndrome), acute respiratory failure Adverse effects: hemodynamic changes (may decrease cardiac output), barotrauma, increased ICP 50 © OnCourse Learning Corporation 2015
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Removal CO 2 Promoting improved alveolar ventilation Increased frequency (f) Increased tidal volume (Vt) No change in dead space On the test, the answer should be to increase the frequency of respiratory rate to reduce CO 2 . 51 © OnCourse Learning Corporation 2015
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Guidelines: Newly Intubated Patient Ventilator mode: - Goals Initial FiO 2 = 100%, then wean to keep sats above preset %. Initial Vt 5-10ml/kg (ideal body weight: IBW): ARF may require more to satisfy air hunger, ARDS less RR = Target pH and PaCO 2 Add PEEP: diffuse lung injury and reduce FiO 2 52 © OnCourse Learning Corporation 2015
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Assessment of Patient with Mechanical Ventilation Pulmonary assessment of intubated patient Airway: type, size, position, cuff pressure Chest excursion: bilateral and equal Breath sounds: bilateral Ventilatory mechanics: VC, Vt, RR Ventilator parameters: mode, Vt, RR, FiO 2 , PEEP, PIP, MAP (mean airway pressure) alarms Pulse oximetry, ABGs, CXR 53 © OnCourse Learning Corporation 2015
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Assessment of Patient with Mechanical Ventilation Cardiovascular - HR, rhythm (common dysrhythmia on ventilator is PACs and/or at fib), decreased BP, pulse pressure, hemodynamic parameters Neurologic Renal metabolic GI (bowel sounds, abdominal distention) Nutritional Immunologic and psychological 54 © OnCourse Learning Corporation 2015
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Complications on MV Decreased cardiac output Fluid retention Baro-biotrauma Atelectasis Hypercapnia-hypo Oxygen toxicity Aspiration GI effects Infection Asynchrony Anxiety Inability to wean 55 © OnCourse Learning Corporation 2015
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Weaning From MV Improvement of pulmonary condition, such that gradual withdrawal of ventilatory support, is possible. Indications: NIF, VC, VT, RSBI (rapid shallow breathing index) Resolution or improvement of condition
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