Mechanical ventilation (main)

Background

Intubation and ventilation typically required for respiratory failure or airway proctection/severe altered mental status

  • Categories of respiratory failure
    • Type 1 - Hypoxemia
    • Type 2 - Hypercarbia
    • Type 3 - Perioperative
    • Type 4 - Shock

Sections

Noninvasive ventilation

  • CPAP
  • BiPAP

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

Recruitment maneuver

  • Techniques for hypoxic ARDS patients

Ventilation weaning

  • Weaning parameters
  • Failure to wean

Extubation

  • Extubating after brief periods on a ventilator (ex. intubation for agitated trauma patient)

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

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/.