Ventilator high pressures: Difference between revisions
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==High Pressure Alarms== | ==High Pressure Alarms== | ||
=== | *In volume control mode, (high)pressure alarm sounds. In pressure control mode (low) volume alarm sounds--BOTH signify similar problems and troubleshoot with the following 4 maneuvers. | ||
===1-Measure Peak Plateau Pressure=== | |||
*Need to measure peak plateau pressure P(Plat) not only peak airway pressure P(Peak). | *Need to measure peak plateau pressure P(Plat) not only peak airway pressure P(Peak). | ||
**Press and hold the “inspiratory hold” button-waveform shows peak pressure and then lower plateau. | **Press and hold the “inspiratory hold” button-waveform shows peak pressure and then lower plateau. | ||
*P(Plat) >30 thought to be potentially injurious to lung. | *P(Plat) >30 thought to be potentially injurious to lung. | ||
*P(Plat) reflects equilibration of airway pressures without flow, accounts for airway resistance. | *P(Plat) reflects equilibration of airway pressures without flow, accounts for airway resistance. | ||
=== | ===2-Determine Airway Resistance=== | ||
*When airway resistance high, P(Peak)>> P(Plat) | *When airway resistance high, P(Peak)>> P(Plat) | ||
**Normal P(Peak)-P(Plat) about 5cm H2O | **Normal P(Peak)-P(Plat) about 5cm H2O | ||
***Airway resistance increased with: asthma, mucus plugging, small tube, tube kinking, tube obstructed | ***Airway resistance increased with: asthma, mucus plugging, small tube, tube kinking, tube obstructed | ||
=== | ===3-Eval for Dynamic Hyperinflation=== | ||
*Flow at end of expiration has not stopped, ie breath stacking, ie need more time to exhale and each breath adding volume to lungs | *Flow at end of expiration has not stopped, ie breath stacking, ie need more time to exhale and each breath adding volume to lungs | ||
*Consequence of dynamic hyperinflation | *Consequence of dynamic hyperinflation | ||
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*Look to make sure expiratory dlow returns to baseline | *Look to make sure expiratory dlow returns to baseline | ||
*Treat with decreased vent rate and increased expiratory time. | *Treat with decreased vent rate and increased expiratory time. | ||
=== | ===4-Measure Hyperinflation=== | ||
*If you suspect dynamic hyperinflation, perform “expiratory hold”, then PEEP on vent may be higher than PEEP on vent settings | *If you suspect dynamic hyperinflation, perform “expiratory hold”, then PEEP on vent may be higher than PEEP on vent settings | ||
*Differences in PEEP with “expiratory hold” and PEEP set on vent suggest hyperinflation. | *Differences in PEEP with “expiratory hold” and PEEP set on vent suggest hyperinflation. | ||
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**Kinked tube- pass suction catheter? | **Kinked tube- pass suction catheter? | ||
**Mucus plug- pass suction catheter and suction | **Mucus plug- pass suction catheter and suction | ||
**Bronchospasm- | **Bronchospasm- inhaled bronchodilators | ||
**Tube too small- swap tube | **Tube too small- swap tube | ||
=== High P(Peak), Low P(Plat)=== | === High P(Peak), Low P(Plat)=== | ||
| Line 33: | Line 34: | ||
**Atelectasis- bronchoscopy | **Atelectasis- bronchoscopy | ||
**Cardiogenic Pulmonary Edema-diuretics vs inotropes | **Cardiogenic Pulmonary Edema-diuretics vs inotropes | ||
**ARDS- | **ARDS- lower Vt | ||
**Pneumothorax- Chest Tube | **Pneumothorax- Chest Tube | ||
**Pneumonia- Antibiotics | **Pneumonia- Antibiotics | ||
Revision as of 17:29, 9 September 2014
High Pressure Alarms
- In volume control mode, (high)pressure alarm sounds. In pressure control mode (low) volume alarm sounds--BOTH signify similar problems and troubleshoot with the following 4 maneuvers.
1-Measure Peak Plateau Pressure
- Need to measure peak plateau pressure P(Plat) not only peak airway pressure P(Peak).
- Press and hold the “inspiratory hold” button-waveform shows peak pressure and then lower plateau.
- P(Plat) >30 thought to be potentially injurious to lung.
- P(Plat) reflects equilibration of airway pressures without flow, accounts for airway resistance.
2-Determine Airway Resistance
- When airway resistance high, P(Peak)>> P(Plat)
- Normal P(Peak)-P(Plat) about 5cm H2O
- Airway resistance increased with: asthma, mucus plugging, small tube, tube kinking, tube obstructed
- Normal P(Peak)-P(Plat) about 5cm H2O
3-Eval for Dynamic Hyperinflation
- Flow at end of expiration has not stopped, ie breath stacking, ie need more time to exhale and each breath adding volume to lungs
- Consequence of dynamic hyperinflation
- Harder to trigger vent- dys-synchrony
- Increased dead space- hypoxic/hypercapneic
- Elevated intra-thoracic pressures decrease venous return
- Look to make sure expiratory dlow returns to baseline
- Treat with decreased vent rate and increased expiratory time.
4-Measure Hyperinflation
- If you suspect dynamic hyperinflation, perform “expiratory hold”, then PEEP on vent may be higher than PEEP on vent settings
- Differences in PEEP with “expiratory hold” and PEEP set on vent suggest hyperinflation.
Management
High P(Peak), Low P(Plat)
- Suggests increased airway resistance, not compliance problem
- Kinked tube- pass suction catheter?
- Mucus plug- pass suction catheter and suction
- Bronchospasm- inhaled bronchodilators
- Tube too small- swap tube
High P(Peak), Low P(Plat)
- Suggests decreased compliance, not an isolated resistance problem
- Mainstem bronchus- pull back ETT, CXR?
- Atelectasis- bronchoscopy
- Cardiogenic Pulmonary Edema-diuretics vs inotropes
- ARDS- lower Vt
- Pneumothorax- Chest Tube
- Pneumonia- Antibiotics