Chapter 66: Critical Care Part 2 (Airway
Management & Mechanical Ventilation)
Advantages of PSV - ANS-↑ Patient consolation
↓ WOB
↓ Oxygen intake
↑ Endurance conditioning
Airway Pressure release ventilation (ARPV) - ANS-Permits spontaneous respiration
Preset CPAP with short timed strain releases
VT varies
Patients with ARDS who want excessive pressure ranges
Alveolar hyperventilation - ANS-Rate or VT set too high
Patients with COPD at chance
- Alkalosis develops if lower PaCO2 to conventional regular
Determine cause if spontaneous hyperventilation
Alveolar hypoventilation - ANS-Inappropriate ventilator settings
Leakage of air from ventilator tubing or round ET tube or tracheostomy cuff
Lung secretions or obstruction
Low ventilation/perfusion ratio
ARDS - ANS-Acute Respiratory Distress Syndrome
Artificial Airways - ANS-Placement of a tube into the trachea to bypass higher airway and
laryngeal systems
Endotracheal (ET) intubation
- Via mouth or nose beyond larynx
Tracheostomy
- Via stoma in neck
Aspiration - ANS-Cannot guard airway with ET tube
- Inflate cuff
- Continuous epiglottic suctioning
, ↑ Salivation
- Suction oral hollow space regularly
Prevent vomiting
- Orogastric or NG tube and connect to low, intermittent suction
- HOB ↑ 30 to 45 stages
Assess want for suction - ANS-- Visible secretions in ET tube
- Sudden onset of breathing distress
- Suspected aspiration of secretions
- ↑ Peak airway pressures
- Adventitious breath sounds
- Respiratory fee and/or coughing
↓- in PaO2 and/or SpO2
Assessment of Paralyzed patient - ANS-Train-of-4 (TOF) peripheral nerve stimulation
Physiologic signs of pain or tension
Ventilator synchrony
*** Avoid excessive paralysis***
Assisted ventilatory support - ANS-Ventilator and affected person percentage WOB
Auto-PEEP - ANS-Result of inadequate exhalation time
Additional PEEP over what is about
Results
- ↑ WOB
- Barotrauma
- Hemodynamic instability
Automatic tube repayment (ATC) - ANS-Used to conquer WOB associated with artificial
airway
↑ During concept and ↓ in the course of expiration
Set via coming into inner diameter of patient's airway and preferred % of repayment
Barotrauma - ANS-Air can break out into pleural area from alveoli or interstitium,
accumulate, and come to be trapped pneumothorax
Patients with compliant lungs are at ↑ threat
Chest tubes may be located prophylactically
Benefits of SIMV - ANS-Improved patient-ventilator synchrony
Lower mean airway strain
Prevention of muscle atrophy
Bilevel fine airway stress (Bi-PAP) - ANS-Delivers oxygen and two tiers of + pressure aid
- Higher inspiratory fine airway strain
Management & Mechanical Ventilation)
Advantages of PSV - ANS-↑ Patient consolation
↓ WOB
↓ Oxygen intake
↑ Endurance conditioning
Airway Pressure release ventilation (ARPV) - ANS-Permits spontaneous respiration
Preset CPAP with short timed strain releases
VT varies
Patients with ARDS who want excessive pressure ranges
Alveolar hyperventilation - ANS-Rate or VT set too high
Patients with COPD at chance
- Alkalosis develops if lower PaCO2 to conventional regular
Determine cause if spontaneous hyperventilation
Alveolar hypoventilation - ANS-Inappropriate ventilator settings
Leakage of air from ventilator tubing or round ET tube or tracheostomy cuff
Lung secretions or obstruction
Low ventilation/perfusion ratio
ARDS - ANS-Acute Respiratory Distress Syndrome
Artificial Airways - ANS-Placement of a tube into the trachea to bypass higher airway and
laryngeal systems
Endotracheal (ET) intubation
- Via mouth or nose beyond larynx
Tracheostomy
- Via stoma in neck
Aspiration - ANS-Cannot guard airway with ET tube
- Inflate cuff
- Continuous epiglottic suctioning
, ↑ Salivation
- Suction oral hollow space regularly
Prevent vomiting
- Orogastric or NG tube and connect to low, intermittent suction
- HOB ↑ 30 to 45 stages
Assess want for suction - ANS-- Visible secretions in ET tube
- Sudden onset of breathing distress
- Suspected aspiration of secretions
- ↑ Peak airway pressures
- Adventitious breath sounds
- Respiratory fee and/or coughing
↓- in PaO2 and/or SpO2
Assessment of Paralyzed patient - ANS-Train-of-4 (TOF) peripheral nerve stimulation
Physiologic signs of pain or tension
Ventilator synchrony
*** Avoid excessive paralysis***
Assisted ventilatory support - ANS-Ventilator and affected person percentage WOB
Auto-PEEP - ANS-Result of inadequate exhalation time
Additional PEEP over what is about
Results
- ↑ WOB
- Barotrauma
- Hemodynamic instability
Automatic tube repayment (ATC) - ANS-Used to conquer WOB associated with artificial
airway
↑ During concept and ↓ in the course of expiration
Set via coming into inner diameter of patient's airway and preferred % of repayment
Barotrauma - ANS-Air can break out into pleural area from alveoli or interstitium,
accumulate, and come to be trapped pneumothorax
Patients with compliant lungs are at ↑ threat
Chest tubes may be located prophylactically
Benefits of SIMV - ANS-Improved patient-ventilator synchrony
Lower mean airway strain
Prevention of muscle atrophy
Bilevel fine airway stress (Bi-PAP) - ANS-Delivers oxygen and two tiers of + pressure aid
- Higher inspiratory fine airway strain
