Mechanical ventilation (main): Difference between revisions

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==Modes==
==Background==
===CPAP===
*Intubation and ventilation typically required for [[respiratory failure]] or airway protection/severe [[altered mental status]]
* needs spont breathing pt
* not for fatiguing pt
* no back up rate


===CONTROL MODE===
===Categories of [[respiratory failure|Respiratory Failure]]===
* only in OR
*Type 1 - [[Hypoxemia]]
* machine initiates and delivers breath
*Type 2 - [[hypercapnia|Hypercarbia]]
* fixed rate and TV
*Type 3 - Perioperative
*Type 4 - [[Shock]]


===ASSIST CONTROL (AC)===
==Patient Positioning<ref>Greenwood J. Good Lung UP or DOWN? Maneuvers to Improve Oxygenation in Acute Respiratory Failure. Updated 7/15/2014. https://umem.org/educational_pearls/2464/.</ref>==
* preset rate and TV
*HOB elevation > 30 degrees
* pt able to trigger additional breaths
*Reverse trendelenberg at 30 degrees in obese hypoventilaters
*Lateral decubitus for severe unilateral lung disease
**'''G'''ood lung to '''G'''round generally
**Good lung UP in these exceptions:
***Massive [[hemoptysis]] - prevent blood into dependent, good lung
***Large [[abscess]] - pus fills up dependent lung
***Unilateral [[emphysema]] - prevent hyperinflation


===SYNCH INTERM MANDATORY VENT (SIMV)===
==See Also==
* preset rate and TV synch to pt effort
{{Mechanical ventilation pages}}
* for each additional breath triggered by pt- vent delivers variable TV depending on pt effort and condition of lung
{{Related Difficult Airway Pages}}
* because of pt effort- not recommended for tired or septic pt
 
===PRESSURE SUPP0RT===
* use with SIMV or PEEP- not AC
* preset boost during inspiration of spont gen breath
 
==MODES==
===A/C = Assist Control===
#(helps instigated breaths, extra breaths all of set TV)
#delivers preset breaths (full assisted tidal volume) in coordination with the respiratory effort
#spontaneous breathing (above rate) is not allowed
#beneficial for patients requiring a high minute-ventilation (reduces oxygen consumption and CO2 production of the respiratory muscles)
#may worsen obstructive airway disease by air trapping or breath stacking


===SIMV = Synchronous Intermittent Mandatory Ventilation===
==External Links==
#(senses not to give with breathing if present, extra breaths of pt's TV)
*Vent basics resource: https://emcrit.org/wp-content/uploads/2010/05/Managing-Initial-Vent-ED.pdf
#preset breaths in coordination with the respiratory effort
#spontaneous breathing allowed between breaths
#synchronization attempts to limit the barotrauma by not delivering a breath when already maximally inhaled (vs. IMV)


===PS = Pressure Support===
==References==
#(controls via pressure, good if pressures getting too high)
<references/>
#limits barotrauma and decreases the work of breathing in the spontaneously breathing patient
#level of pressure set (not TV) to assist spontaneous efforts
#most ventilators allow back-up respiratory rate (in case of apnea)
#mode of choice in patients whose respiratory failure is not severe and who have an adequate respiratory drive (improved patient comfort, reduced cardiovascular effects, reduced risk of barotrauma, and improved distribution of gas)
 
^For the paralyzed patient, there is no difference in minute-ventilation or airway pressures between A/C and SIMV
 
 
==See Also==
*[[Ventilation (Initial & Changes)]]
*[[Ventilation (Weaning)]]
*[[Ventilation (Non-Invasive)]]
*[[Ventilator Management]]


[[Category:Airway/Resus]]
[[Category:Critical Care]]
[[Category:Pulm]]
[[Category:Pulmonary]]

Latest revision as of 21:04, 10 April 2024

Background

Categories of Respiratory Failure

Patient Positioning[1]

  • HOB elevation > 30 degrees
  • Reverse trendelenberg at 30 degrees in obese hypoventilaters
  • Lateral decubitus for severe unilateral lung disease
    • Good lung to Ground generally
    • Good lung UP in these exceptions:
      • Massive hemoptysis - prevent blood into dependent, good lung
      • Large abscess - pus fills up dependent lung
      • Unilateral emphysema - prevent hyperinflation

See Also

Mechanical Ventilation Pages

Airway Pages

External Links

References

  1. ↑ Greenwood J. Good Lung UP or DOWN? Maneuvers to Improve Oxygenation in Acute Respiratory Failure. Updated 7/15/2014. https://umem.org/educational_pearls/2464/.
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