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ve insp. Pressure
+ve exp. Pressure
0 at end of insp. And exp.
Iron lung
Allows long-term ventilation without artificial airway
Maintains normal intrathoracic hemodynamics
Uncomfortable, limits access to patient
intermittent
o partially
(IMV)
o
complete (CMV)
Mechanical ventilation
Mechanical ventilation follows on from emergency airway management
and intubation and is needed to support the breathing of a patient in the
emergency situations .
Indications
overdose
intracranial problems.
For provision of anaesthesia before urgent surgery in the multiply
injured trauma patient.
Virtually all patients who have been intubated will be ventilated mechanically as
unassisted spontaneous breathing through an ETT is not appropriate
The patient's wishes (if known) are taken into account along with
background detail including previous admissions to ICU, exercise
capacity and pre-existing quality of life.
passive
Inspiratory phase:
pressure generated (constant pressure)
flow generated (constant flow rate)
Inspiratory to expiratory change over cycling:
volume (T.V) (8-10 ml per kg) = flow rate (ml per sec) mutably insp.Time (sec.)
time cycling
Volume cycled
Volume setting by
Pressure Cycled
Terminates inspiration at preset pressure(15-25 cmH2o)
(tidal volume) increase with increase preselected airway
Pressure and decrease with increase flow rate because early
high pressure occurrence.
Tidal volume(8-10 ml/kg)
(that increased with increase flow rate and insp.Time)
pressure ventilators
Pressure ventilators terminate inspiration when a preset
Pressure is reached and therefore avoid excessive inflating pressures.
The usual pressure in an infant or child is (15-20 cm H2O)
They do not compensate for changes in lung compliance and deliver a
variable amount of gas with each breath
Currently are used predominantly in neonates and young infants.
A volume ventilator
Is delivers a preset volume of gas during each mechanical
inspiration.
This type of ventilator compensates for all changes in resistance.
The danger of volume ventilators is that they generate high airway
pressures, which can result in barotrauma.
The usual tidal volume in an infant or child is (8-10mL/kg)
The rate depends on the patient's age and the clinical condition.
Currently, they are used for children and older infants.
preemie
infant
child
adolescent
RR/min
40
30
20
12
IT sec.
0.4
0.6
0.7
0.9
PIP
cmH2o
16
20
20
20
TV ml/kg
5-10
5-10
5-10
5-10
PEEP
cmH2o
4-5
4-5
4-5
4-5
Fio2
titrate
down
As
tolerate
initiating breaths.
If the patient breathes over the set rate, he or she will receive a fully
Uses:
In neonates or patients with high airway pressures (ARDS) to
avoid barotrauma
.
Contraindications:
Not a friendly mode in the awake patient.
Advantages:
Pressure limited, decreases barotrauma risk.
Disadvantages:
No guaranteed TV.
respiratory effort.
Disadvantages:
Any other breaths during cycle are not supplemented.
All breaths are patient triggered if patient breathing is not detected after
a set time interval (usually 20-30s), the machine alarms and a backup
apnoea mandatory ventilation kicks in.
When used with SIMV , the patient receives mandatory breaths but
of peak)
(PointD ) and airway pressure returns to baseline.
PEEP
5cm H O is typical
10cm H O for lung recruitment as described above, can be
2
higher in
specialized situations
can occur.
Hypotension
VENTILATOR SETTINGS
WHERE TO START: INITIAL VENTILATOR SETTINGS
Obviously, the individual patient and clinical setting will determine
the mechanical ventilation needs, but the following is a good place
to start, realizing that the settings will most likely require adjusting
to achieve the desired effect
Safety checks
Most machines will be left ready to switch on and go but preliminary
checks are always needed before connecting to the patient
VENTILATOR-USER INTERFACE
Primary controls
Mode
Rate
Tidal volume or pressure
Flow or inspiratory time
PEEP
FiO2
Secondary controls
Pause: in volume mode (0.25-2 sec.)
Sigh.: in volume mode that increase volume to tidial volume
Alarms
Monitored parameters
Pressure
Volume
Waveforms.
PEEP 24 cm H2O
Temperature ,Humidity and Sighs adjustments
Set PEEP
Capnography (waveform)
Disconnection
Pressure development outside the pre-set range
Leakage
Reducing compliance
Partial airway obstruction
Gas supply failure
Power failure
Reduction of FiO
Apnoea
Assesse ventilation
How
WEANING CRITERIA
pH >7.3
GUIDELINE OF WEANING
Change mode (CMV TO IMV or SIMV or SMV)
Stop sedition
Decrease vent. rate
Lower oxygen
Switch ventilator to CPAP with (3-4 cmHg) and oxygen to 40-50% in older
children
Extubation
hyper oxygenation with bag through tube immediately before remove tube by
applying pressure and give oxygen with concentration 10% higher than that of
CPAP (50-60%)
And be already for reintubation if detoriatiated
Malfunction or disconnection
Contamination
Pulmonary
O2 toxicity
Patient-ventilator asynchrony
Circulation
Fluid retention due to low cardiac output low renal blood flow
Other
Neuropsychiatric complications
Airway malfunction
Mechanical malfunction
Pulmonary barotrauma
Hemodynamic alterations
Observe for:
Decreased BP
Pallor
Increasing Tachycardia