Mechanical ventilation (main): Difference between revisions
(Changed to a main page with modes on a separate page)
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==Modes==
==Sections==
===Assist Control (AC)===
===[[Intubation]]===
*(helps instigated breaths, extra breaths all of set TV)
*Indications
** preset rate and TV
*Absolute Contraindications
** pt able to trigger additional breaths (full assisted tidal volume)
*Relative Contraindications (Mnemonics for Predicting Difficulties)
*spontaneous breathing (above rate) is not allowed
*Mnemonics
*beneficial for patients requiring a high minute-ventilation (reduces oxygen consumption and CO2 production of the respiratory muscles)
*Procedure
*may worsen obstructive airway disease by air trapping or breath stacking
*Complications
*Special Situations


===Synchronous Intermittent Mandatory Ventilation (SIMV)===
===[[Deterioration after intubation]]===
*senses not to give with breathing if present, extra breaths of pt's TV
*Differential and management of deterioration after intubation
*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)
* for each additional breath triggered by pt, vent delivers variable TV depending on pt effort and condition of lung
* because of need for pt effort, not recommended for tired or septic pt


===Pressure Support (PS)===
===[[Ventilation settings]]===
*controls via pressure, good if pressures getting too high
*Initial ventilation settings
*limits barotrauma and decreases the work of breathing in the spontaneously breathing patient
*Lung Injury Strategy
*level of pressure set (not TV) to assist spontaneous efforts
*Obstruction Strategy
*most ventilators allow back-up respiratory rate (in case of apnea)
*Making Setting Changes
*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
===[[Ventilation modes]]===
*Assist Control (AC)
*Synchronous Intermittent Mandatory Ventilation (SIMV)
*Pressure Support (PS)
*Pressure Regulated Volume Control (PRVC)
*CPAP
*Control Mode


===CPAP===
===[[Ventilator high pressures]]===
* needs spont breathing pt
*High pressure alarms
* not for fatiguing pt
*Management
* no back up rate


===Control Mode===
===[[Ventilation weaning]]===
* only in OR
*Weaning parameters
* machine initiates and delivers breath
*Failure to wean
* fixed rate and TV
 
===[[Noninvasive ventilation]]===
*CPAP
*BiPAP


==See Also==
==See Also==

Revision as of 16:31, 26 August 2015

Sections

Intubation

  • Indications
  • Absolute Contraindications
  • Relative Contraindications (Mnemonics for Predicting Difficulties)
  • Mnemonics
  • Procedure
  • Complications
  • Special Situations

Deterioration after intubation

  • Differential and management of deterioration after intubation

Ventilation settings

  • Initial ventilation settings
  • Lung Injury Strategy
  • Obstruction Strategy
  • Making Setting Changes

Ventilation modes

  • Assist Control (AC)
  • Synchronous Intermittent Mandatory Ventilation (SIMV)
  • Pressure Support (PS)
  • Pressure Regulated Volume Control (PRVC)
  • CPAP
  • Control Mode

Ventilator high pressures

  • High pressure alarms
  • Management

Ventilation weaning

  • Weaning parameters
  • Failure to wean

Noninvasive ventilation

  • CPAP
  • BiPAP

See Also

Mechanical Ventilation Pages

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