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Unit 2


Adaptive Support Ventilation (ASV) - Ventilator looks at the respiratory mechanics (& IBW) to determine the amount of support needed
Mandatory Minute Volume (MMV) - guarantees the delivery of a minimum (set) MV - If the patient’s spontaneous efforts do not meet the set minute volume, the ventilator will increase pressure, rate or volume to meet the set minute volume
Volume Assured Pressure Support (VAPS) - Pressure Support Ventilation (PSV) with a volume guarantee for each breath - Pressure Support (PS) level, tidal volume, respiratory rate and inspiratory flow are set - Patient initiates breath and at a minimum will get the set Vt at the set flow rate
VAPS - Breath is pressure supported as long as target tidal volume is met before set flow is reached - If Vt is not met before set flow is reached, breath switches to volume breath (Instead of pressure) to deliver remainder of tidal volume (Vt)
Automatic Tube Compensation (ATC) - compensates for the flow-dependent pressure decrease across the endotracheal tube during both inspiration and expiration. - reduces WOB and may improve patient comfort. - referred to as electronic Extubation.
Volume Support Ventilation PSV with a target tidal volume -Ventilator uses pressure supported breaths to deliver a target tidal volume PB 840 – SPONT mode, VS breath type -Set target volume, expiratory sensitivity and rise time % -PIP is limited by alarm setting
Proportional Assist Ventilation (PAV) - delivers a pressure assist in response to patient’s desired tidal volume and flow demands
Neurally Adjusted Ventilatory Assist (NAVA) - Responds to changes in diaphragmatic activity - Requires a specially designed nasogastric catheter with a 10-cm length of EMG electrodes
NAVA primary indication Primary indication would be a patient with a significant level of asynchrony
Most important advantage to PAV and NAVA - Improved synchrony
Pressure Regulated Volume Control (PRVC) -PCV with a targeted tidal volume -Ventilator uses pressure control breaths to deliver a target tidal volume -Inspiratory pressure varies breath to breath (< 3 cm H2O) to deliver target tidal volume
PRVC - Set RR, targeted tidal volume, PEEP, FIO2, IT (I:E, ET), rise time - Pressure limit is determined by high PIP alarm
PRVC on an Evita XL Autoflow (CMV or SIMV)
PRVC on a Servo-I PRVC
PRVC on a PB 840 VC+ (AC or SIMV)
Ventilator Induced Lung Injury (VILI) Complications Related to Pressure - Barotrauma Complications Related to Overdistention or inappropriate ventilation strategy - Volutrauma or Atelectrauma
What happens with ventilator associated/induced lung injury? -Increase in permeability of the A-C membrane -Pulmonary edema -Cell damage and necrosis -Diffuse alveolar damage -All a result of inappropriate ventilation strategy (too much pressure/volume or too little volume)
Barotrauma Physical injury sustained as a result of exposure to ambient pressures above normal, most commonly secondary to positive pressure ventilation (for example, pneumothorax and pneumomediastinum, pneumopericardium, and subcutaneous emphysema)
Volutrauma Alveolar overdistention and DAMAGE DUE TO ventilation with EXCESSIVE VOLUMES
Atelectrauma (sheer forces) Damage/injury to the lung due to repeated opening and closing of alveoli at lower lung volumes or inappropriate mechanical ventilation settings
Time Constants - The time necessary for passive inflation and deflation of the lung or lung unit is determined by the product of compliance and resistance - Must overcome critical opening pressure
Time Constants (2) - When Compliance or Resistance increase the time constant increases, when compliance or Resistance decrease the time constant decreases - Different lung units have different Time Constants
Acute Hypoxic Respiratory Failure - Hydrostatic (cardiogenic) - Non- hydrostatic (non-cardiogenic)
Common Causes of Hydrostatic (Cardiogenic) Pulmonary Edema: Cardiac -Left ventricular failure (e.g. myocardial infarction, myocarditis) -Cardiac valvular disease (aortic, mitral)
Common Causes of Hydrostatic (Cardiogenic) Pulmonary Edema: Vascular -Systemic hypertension -Pulmonary embolism
Common Causes of Hydrostatic (Cardiogenic) Pulmonary Edema: Volume overload -Excessive fluid administration -Renal failure -Hepatic failure
Primary (Direct) Risk Factors for ALI and ARDS -Direct Injury Pneumonia (viral, bacterial, fungal) Gastric aspiration Toxic inhalation (phosgene, cocaine, smoke, high concentration of oxygen) Near-drowning Lung contusion
Secondary (Indirect) Risk Factors for ALI and ARDS Indirect Sepsis and prolonged shock Burn injury (chemical or heat induced Multiple trauma Transfusions Pancreatitis Gynecologic (abruptio placentae, amniotic embolism eclampsia Drug effect (trans-retinoic acid for acute leukemia Sickle cell crisis
Clinical Features of CHF/ARDS Features common to CHF and ARDS -Symptoms of anxiety, dyspnea, tachypnea -Reduced lung volumes and decreased compliance -Hypoxemia (mild to severe), often requiring ventilator assistance -Chest radiograph shows diffuse alveolar and interstitial infiltrates
Clinical Features of CHF/ARDS: Features Favoring CHF Clinical history suggestive of CHF Symmetric pulmonary infiltrates Cardiomegaly or pleural effusions on chest radiograph PCWP > 18 mmHg Bronchoalveolar lavage fluid BALF: low protein level and noninflammatory Prompt <12 to 24 hours and lasting respons
Created by: trobin1
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