ç Process where FIO2 is moved into and out of lungs with mechanical ventilator
# >= RA
ç Not curative
# Means of supporting patients until recover ability to breath
# Bridge to long-term mechanical ventilation
¥ Or until decision is made to withdraw
Indications
ç Apnea
ç Impending ability to breathe or protect airway
ç Acute respiratory failure
ç Severe hypoxia
ç Respiratory muscle fatigue
# Encourage all patients, particularly those with chronic illnesses to discuss this
with family and HCP
# Record time and place the results of discussion in advanced directive
# The decision to use, withhold, or withdraw must be made carefully respecting
wishes of patients and caregiver
# When there is a disagreement over plan of care, consult agencyÕs ethics
committee for assistance
Positive Pressure Ventilation (PPV)
# Used in acutely ill patients
# Delivers air into lungs under positive pressure during inspiration
ç Opposite of normal
# Expiration occurs passively
Settings
ç Respiratory rate (f)
# Number of breaths the ventilator delivers per minute
# 12-20 breaths/min
ç Tidal volume (Vt)
# Volume of gas delivered to patient during each ventilator breath
# 6-10 mL/kg
ç Oxygen concentration (FIO2)
# Fraction of inspired oxygen delivered to patient
# Set between (RA) 21%- 100%
# Usually adjusted to maintain PaO2 levels >60 mmHg or SpO2 levels >90%
ç Positive inspiratory pressure (PIP)
ç Positive end-expiratory pressure (PEEP)
# Positive pressure applied at the end of expiration of ventilator breaths
# 5cm H2O
, Modes
ç Methods of what the patient and ventilator interact to deliver effective ventilator
modes
ç Based on how much work of breathing (WOB) the patient should or can perform
ç WOB refers to inspiratory effort needed to overcome the elasticity and viscosity of
the lungs along with airway resistance
ç Determined by PatientÕs
# Ventilatory status
# Respiratory drive
# ABGs
ç Ventilator modes are controlled or assisted
# Controlled
¥ Ventilator does all the WOB
# Assisted
¥ Ventilator and patient share the WOB
PEEP
# Positive end-expiratory pressure
# Positive pressure applied to airway during exhalation preventing alveolar
collapse
oxygenation
# Normally during exhalation, airway pressure drops to zero and exhalation
occurs passively
# With PEEP, exhalation remains passive but pressure falls to a present level of
3-20 cm H2O
# Lung volume during expiration and between breaths is greater than normal
with PEEP
¥ This increases functional residual capacity (FRC)
¥ Improves oxygenation with restoration of lung volume that normally
remains at the end of passive exhalation
# The mechanisms PEEP increased FRC and oxygenation include
¥ Increased aeration of patent alveoli
¥ Aeration of previously collapsed alveoli
¥ Prevention of alveolar collapse throughout the respiratory cycle
# Maintain or improve oxygenation while limiting r/ O2 toxicity
¥ FIO2 can often be reduced when PEEP is used
# Indicated in
¥ All mechanically ventilated patients
¥ Patients with ARDS
¥ Hypovolemia
ç In these cases, adverse effects of PEEP outweighs the benefits
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