Intensive Care
Rabin Medical Center
Beilinson Campus
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Basic principles of ventilation in the intensive care unit презентация
Содержание
- 1. Basic principles of ventilation in the intensive care unit
- 2. TYPES OF RESPIRATORY FAILURE HYPOXIC ABNORMALITIES OF
- 3. TREATMENT OF OF RESPIRATORY FAILURE TREAT CAUSE
- 4. INDICATIONS FOR MECHANICAL VENTILATION Acute Respiratory Failure
- 5. COMPLICATIONS OF VENTILATION ENDOTRACHEAL TUBE COMPLICATIONS Tube
- 6. COMPLICATIONS OF VENTILATION MEDICAL COMPLICATIONS Oxygen toxicity
- 7. VENTILATION CAN THEREFORE CAUSE GREAT DAMAGE BOTH TO THE LUNGS AND TO OTHER ORGANS
- 8. HOW TO AVOID THESE PITFALLS Personnel should
- 9. VENTILATION POSITIVE PRESSURE VENTILATION NEGATIVE PRESSURE VENTILATION
- 10. Negative pressure ventilation Negative pressure ventilation Non invasive ventilation Invasive ventilation
- 11. INVASIVE VENTILATION Ventilators = Husband Have to
- 12. Ventilators can measure 4 parameters
- 13. Ventilators need to know 5 basic
- 14. Normal spontaneous breathing baseline inspiration expiration One breath
- 15. TIME INSPIRATION EXPIRATION Ventilator breath Start inspiration End inspiration Start next breath
- 16. TRIGGER BASELINE CYCLE BASELINE LIMIT TIME INSPIRATION EXPIRATION
- 17. TRIGGER Time – RATE or Pressure
- 18. MODE OF VENTILATION DETERMINED BY LIMIT AND
- 19. Pressure Limited Flow Cycled Ventilation (PSV) -operator
- 20. Pressure Limited Time Cycled Ventilation (PCV) -operator
- 21. Flow Limited Volume Cycled Ventilation (VCV) -operator
- 22. Pressure- limited, flow-cycled ventilation (PSV) ADVANTAGES improved
- 23. PRESSURE LIMITED TIME CYCLED(PCV) ADVANTAGES ? less
- 24. FLOW LIMITED VOLUME CYCLED(VCV) ADVANTAGES ensures minute
- 25. IF CHOOSE VCV OR PCV must make
- 26. Pressure Limited Time Cycled Ventilation (PCV) CONTROLLED
- 27. Pressure Limited Time Cycled Ventilation (PCV) ASSIST
- 28. Flow Limited Volume Cycled Ventilation SYNCHRONIZED INTERMIITENT
- 29. Mode pressure flow
- 30. MONITORING Ventilator-patient synchrony Saturation > 90% PaCO2
- 31. ALARMS OXYGEN PRESSURE Max 35cmH2O Min 10cmH2O
- 32. SUMMARY TYPES OF RESPIRATORY FAILURE HYPOXIC HYPERCAPNIC COMBINED
- 33. SUMMARY TREATMENT OF RESP. FAILURE ALWAYS TREAT CAUSE
- 34. SUMMARY TREATMENT OF HYPOXIC RESP. FAILURE OXYGEN CPAP / PEEP
- 35. SUMMARY Rx OF VENTILATORY RESP. FAILURE VENTILATION
- 36. SUMMARY All ventilated patients need intensive monitoring
- 37. SUMMARY ADJUNCT TREATMENT OPTIMAL FLUID BALANCE NUTRITION BRONCHODILATOR THERAPY PHYSIOTHERAPY POSITIONAL ADJUSTMENTS NITRIC OXIDE
TYPES OF RESPIRATORY FAILURE HYPOXIC ABNORMALITIES OF OXYGENATION HYPERCAPNIC ALVEOLAR HYPOVENTILATION INCREASED DEAD SPACE(VD) EXCESSIVE CO2 PRODUCTION COMBINED
Слайд 2TYPES OF RESPIRATORY FAILURE
HYPOXIC
ABNORMALITIES OF OXYGENATION
HYPERCAPNIC
ALVEOLAR HYPOVENTILATION
INCREASED DEAD SPACE(VD)
EXCESSIVE CO2 PRODUCTION
COMBINED
Слайд 3TREATMENT OF OF RESPIRATORY FAILURE
TREAT CAUSE
HYPOXIC RESPIRATORY FAILURE
OXYGEN
PEEP / CPAP
HYPERCAPNIC RESPIRATORY
FAILURE
VENTILATE
ADJUNCT THERAPY
OPTIMAL FLUID BALANCE
NUTRITION
BRONCHODILATOR THERAPY
PHYSIOTHERAPY
PRONE POSITION
Nitric Oxide
etc.
VENTILATE
ADJUNCT THERAPY
OPTIMAL FLUID BALANCE
NUTRITION
BRONCHODILATOR THERAPY
PHYSIOTHERAPY
PRONE POSITION
Nitric Oxide
etc.
Слайд 4INDICATIONS FOR MECHANICAL VENTILATION
Acute Respiratory Failure (66%)
ARDS
Heart failure
Pneumonia
Sepsis
Complications of surgery
Trauma
Coma
(15%)
Acute COPD exacerbation (13%)
Neuromuscular disorders (5%)
Acute COPD exacerbation (13%)
Neuromuscular disorders (5%)
Esterban Am J Respir Crit Care Med 2000
Слайд 5COMPLICATIONS OF VENTILATION
ENDOTRACHEAL TUBE COMPLICATIONS
Tube not in place
Oropharynx or esophagus
One lung
intubation
Tube blocked
Cuff air leak
VENTILATOR FAILURE
Machine failure
Alarm failure
Alarms off
Inadequately set alarms
Tube blocked
Cuff air leak
VENTILATOR FAILURE
Machine failure
Alarm failure
Alarms off
Inadequately set alarms
Слайд 6COMPLICATIONS OF VENTILATION
MEDICAL COMPLICATIONS
Oxygen toxicity
Barotrauma
Pneumothorax
Pneumomediastinum
Parenchymal interstitial emphysemia
Volutrauma
Biotrauma
Atelectasis
Infection
Hypoventilation
Hyperventilation
Hypotension
GI hypomotility
Stress gastropathy
Arrhythmias
Salt + water
retention
Gastric dilatation
Gastric dilatation
Слайд 8HOW TO AVOID THESE PITFALLS
Personnel should
have basic understanding of ventilators
and ventilatory principles.
Understand the safe limits of ventilation
Lowest FIO2 and PEEP to maintain oxygen saturation > 90%
Maintain plateau pressure < 35cmH2O
Maintain sterile techniques
Understand the safe limits of ventilation
Lowest FIO2 and PEEP to maintain oxygen saturation > 90%
Maintain plateau pressure < 35cmH2O
Maintain sterile techniques
Слайд 9VENTILATION
POSITIVE PRESSURE
VENTILATION
NEGATIVE PRESSURE
VENTILATION
NON INVASIVE
VENTILATION
INVASIVE
VENTILATION
CONVENTIONAL VENTILATION
NON CONVENTIONAL VENTILATION
High frequency jet
High frequency oscillations
Liquid
ventilation
APRV
APRV
Слайд 10Negative pressure ventilation
Negative pressure ventilation
Non invasive ventilation
Invasive ventilation
Слайд 11INVASIVE VENTILATION
Ventilators = Husband
Have to tell it exactly what to do.
Sometimes
it malfunctions therefore require warnings and backup.
Слайд 12
Ventilators can measure 4 parameters
TIME
PRESSURE
FLOW
VOLUME
We can use these parameters to
tell the ventilator when to start pushing air/oxygen into patient and when to stop.
Слайд 13
Ventilators need to know 5 basic things:
The amount of oxygen to
provide – FIO2
What is the baseline pressure
PEEP
When to start pushing air/O2 into patient
TRIGGER
How quickly to push the air/O2 in
LIMIT
When to stop pushing air/O2 in
CYCLE
What is the baseline pressure
PEEP
When to start pushing air/O2 into patient
TRIGGER
How quickly to push the air/O2 in
LIMIT
When to stop pushing air/O2 in
CYCLE
Слайд 17TRIGGER
Time – RATE
or
Pressure
or
flow
BASELINE
PEEP
ZEEP
NEEP
CYCLE
Volume
or
Time
or
Flow
BASELINE
PEEP,ZEEP,NEEP
LIMIT
Flow
or
Pressure
INSPIRATION
EXPIRATION
TIME
Слайд 18MODE OF VENTILATION DETERMINED BY LIMIT AND CYCLE
Pressure Limited Flow Cycled
PRESSURE
SUPPORT VENTILATION
Flow Limited Volume Cycled
VOLUME CONTROLLED VENTILATION
Pressure Limited Time Cycled
PRESSURE CONTROLLED VENTILATION
Flow Limited Volume Cycled
VOLUME CONTROLLED VENTILATION
Pressure Limited Time Cycled
PRESSURE CONTROLLED VENTILATION
Слайд 19Pressure Limited Flow Cycled Ventilation (PSV) -operator selects FIO2, pressure, PEEP
Operator
chooses
Factory determined
Слайд 20Pressure Limited Time Cycled Ventilation (PCV) -operator selects FIO2, pressure, insp
time (I:E ratio), rate, PEEP
Operator chooses
Слайд 21Flow Limited Volume Cycled Ventilation (VCV) -operator selects FIO2, flow, tidal
volume, rate, PEEP
Operator chooses
Operator chooses
Flow 45L/min
Слайд 22Pressure- limited, flow-cycled ventilation (PSV)
ADVANTAGES
improved patient comfort
patient controls initiation of ventilator
supported breath
patient partially controls cessation of ventilator supported breath
DISADVANTAGES
no back up
patient partially controls cessation of ventilator supported breath
DISADVANTAGES
no back up
Слайд 23PRESSURE LIMITED
TIME CYCLED(PCV)
ADVANTAGES
? less barotrauma
improved patient comfort
DISADVANTAGES
minute volume not guaranteed
Слайд 24FLOW LIMITED
VOLUME CYCLED(VCV)
ADVANTAGES
ensures minute volume
easy to use
DISADVANTAGES
may result in high inspiratory
pressures
barotrauma
may be uncomfortable to patient
flow limit
barotrauma
may be uncomfortable to patient
flow limit
Слайд 25IF CHOOSE VCV OR PCV must make additional choice - the character
of additional spontaneous breaths
Controlled Mechanical Ventilation
CMV
Assist Controlled Ventilation
A/C
Synchronized Intermittent Mandatory Ventilation
SIMV
Слайд 26Pressure Limited Time Cycled Ventilation (PCV) CONTROLLED MECHANICAL VENTILATION(CMV) -operator selects FIO2,
pressure, insp time (I:E ratio),rate, PEEP
Operator chooses
Слайд 27Pressure Limited Time Cycled Ventilation (PCV) ASSIST CONTROL VENTILATION (A/C) -operator selects
FIO2, pressure, insp time (I:E ratio),rate, PEEP
Operator chooses
Слайд 28Flow Limited Volume Cycled Ventilation SYNCHRONIZED INTERMIITENT MANDATORY VENTILATION (SIMV) -operator selects
FIO2, flow, tidal volume, rate, PEEP
Слайд 29Mode pressure flow volume Ti
rate other alarms
PSV yes volume- max & min
PCV yes yes yes CMV;A/C;SIMV volume-min & max
VCV yes yes yes CMV;A/C;SIMV pressure
PSV or PCV or VCV must set 1) FIO2
2)PEEP
3)trigger:pressure or flow
The secret to a happy operator-ventilator relationship is to understand the abilities of the ventilator.
What must I set on the ventilator?
Слайд 30MONITORING
Ventilator-patient synchrony
Saturation > 90%
PaCO2
Normal only if does not require high pressure
Peak
pressure < 35cmH2O
Tidal volume 5 – 7cc/kg
Rate 8 -30 breaths/min
Tidal volume 5 – 7cc/kg
Rate 8 -30 breaths/min
Слайд 31ALARMS
OXYGEN
PRESSURE
Max 35cmH2O
Min 10cmH2O
Tidal volume
Max 7cc/kg
Min 3cc/kg
Rate
Max 30 breaths/min
Min 8 breaths/min
BACK UP
Apnea
time
Apnea parameters
Apnea parameters
Слайд 35SUMMARY
Rx OF VENTILATORY RESP. FAILURE
VENTILATION
NIPPV
INVASIVE VENTILATION
PSV
PCV or VCV
CMV
A/C
SIMV +PSV
Слайд 36SUMMARY
All ventilated patients need intensive monitoring for:
improvement
synchrony between patient and
ventilator
complications
complications
Слайд 37SUMMARY
ADJUNCT TREATMENT
OPTIMAL FLUID BALANCE
NUTRITION
BRONCHODILATOR THERAPY
PHYSIOTHERAPY
POSITIONAL ADJUSTMENTS
NITRIC OXIDE
