2.6 Respiratory Failure

Question 1

CIP?

Answer 1

Critically-ill polyneuropathy
ICUAW…

Typically dx by imp muscle weakness and paresis, unexplained difficulty in weaning form mechanical ventilation.

Can reverse!

Question 2

What is the goal of intubation and mechanical ventilation?

Answer 2

Support breathing by providing an airway and adequate alveolar ventilation and is based on ABGs.

Question 3

What is established and maintained with mechanical ventilation?

Answer 3

Tidal volume (normally exhale and inhale, 500mL) and RR
- satisfactory blood gas & pH

Question 4

Patients on mechanical ventilation should be at what position in bed?

Answer 4

30 degrees HOB!

Due to aspiration possibility!

Question 5

Systems review in ICU

Answer 5

Musculoskeletal:
- PROM
- no gross strength assessed...
Neuromuscular:
- Balance: EOB
- no transfers
Communication:
- one-step commands
- sedated, lethargic, but arousable

Question 6

With PT how much O2 demand is used?

Answer 6

25%!
Makes sure we don’t over demand them!

Check vitals!
Never silence alarms unless you know the meaning of it, have a rationale!

Question 7

Is 20-30 ppm increasing from resting to sitting appropriate?

Answer 7

May be… They are working hard. Check S&S.

Question 8

When is BP hypo adaptive?

Answer 8

> 10-20 mmHg drop. Check S&S.

Question 9

What is normal PIP?

Answer 9

25-35 cm H2O

Question 10

What is normal min ventilation?

Answer 10

at rest: 5-8L/min, should come up with exercise

Question 11

Ways to wean mechanical ventilation: (5)

Answer 11

1) Reduction of PS wean
2) Reduction of machine assisted breaths (SIMV)
3) Spontaneous of breathing trial
4) Progression of time spent w/ less ventilatory support coordinated w/ periods of rest
5) Rapid extubation