1. Pt. is over-ventilating-reduce rate/sedate pt. 2. Pt. is under-ventilation-increase rate/help overcome resistance w/PS. 3. Return vol. is inadequate. 4. VD/VT too high (deadspace disease-pulmonary embolism)-diagnosis w/ VQ scan & treat.
What should we do if PaO2 is Low?
1. Raise FIO2 by 5-10% until you reach 60%. 2. Then add/raise PEEP by 5cmH2O.3. If PEEP gets very high (above 20 cm H2O) watch hemodynamics & CO.4. If CO falls then lower PEEP to the last previous value & begin raising FIO2 if hypoxemia persists.
How does Curare (d-Tubocurarine) help?
1. Paralyses muscles and 2.reversed by atropine.
How do you monitor the readiness to wean or to stop Mechanical Ventilation?
Pt. ready to wean if 1.All vitals stable 2. ABGs are good 3.Spontaneous VT > 5 mL/kg 4. VC> 10mL/kg 5. MIP> 20 cmH20 6.QS/QT <20% 7.Vd/VT < 60% 8. Underlying Problem is resolved Infection,Myasthenia gravis & Pneumonia is cleared
What is High Frequency Ventilation (HFPPV) MODE?
Includes High frequency.The main controls are-a.Drive pressure.B.% inspiratory time.C.rate.D.injector line.E. Peep.F. Fio2. *USE the drive pressure, rate and %IT to change ventilation.
What is adding of Pressure support (PS) mean?
PS overcome resistance of circuit tubing during spontaneus breathing. PS is set above normal resistance offer subtle increase in vent pressure. Helps spontaneous breathing pt. accomplish larger vt. Helps to wean pt. keep vt above 5ml/kg.
what is the calculated clinical evidence that supports weaning?
1.VD/VT - <60% 2. QS/QT - <20% 3. A-aDO2 - <300 mmHg If pt. don’t meet these then they wont be permitted to wean.
If return volume is inadequate in PaCO2 how can it be correct this?
1.Ensure set VT.2.Look for leak around an ET cuff&circuits.Look for vol. leak thru a chest tube&drainage system.3.If using pressure-cycled vent.Ensure operating pressure High. If using baby vent. Ensure flow is appropriate. Make sure flow rate is high.
What is ASSIST/CONTROL MODE?
1. provides a set VT @ a set rate. Also, the set VT is delivered even when the pt. spontaneously intiates breaths above the set rate. 2. Good mode - works with most pts. 3.Alert pts. Find it uncomfortable may need sedative &Anxiety controlling medication.
