acute resp failure + sedation Flashcards
when to avoid HFNC
- high risk extubation failure
- hypercapnic resp failure
benefit of bipap over cpap
increase alveolar vfentilation better
avoid NIV in resp failure
tx of post extutbation resp failure (would reintubate)
prevention of post extub resp. failure if NOT high risk
hypercapnic but not acidotic
when to use NIV
BiPAP for mild-severe acidotic COPD patients (RR >20-24, pH≤7.35, and PaCO2>45)
BiPAP/CPAP for Cardiogenic pulmonary edema* (not cardiogenic shock and acute MI)
*Also in pre-hospital setting / EMS
CONTRAINDDICATION TO NIV
- Facial surgery, facial trauma, airway obstruction
- Decreased LOC (*relative)
- Inability to clear secretions
- Respiratory arrest
- Hemodynamic instability (reduces preload)
- Other Indication for intubation
(e.g. airway protection)
stopping pulmo vasodilator like nitroprusside , does it increase or decrease sp02 ?
increase sp02
VT we aim for ardds ?
6ml/kg
ARDS definition
- severity regarding hypoxemia
<1 cliinical insult or resp deterioration
no pulmonary edema or volume overload
evidence of bilat infiltrates on CXR/CT/Lung ultrasound by trained professional ( not explained by nodules, pleural effusions or atelectasis)
severity ( hypoxemia pao2/fio2)
- severe : 100
-mod : 100-200
- mild : 200-300 , HFNC 30
severity ( hypoxemia spo2/fio2) <315 with spo2 <97%
ards ventilation setting control
mode : volume control
volume : 6ml/kg bw
plateau : <30 ml
driving pressure : <15
peep : <5 , target high peep in mod/severe ards
target spo2 88-93% , paO2 55-80mmhg
permissive hypercapnea pH >7.25
prone position: what’s the mortality benefit if what ?
if p/f <150
CI to ECMO
Disseminated malignancy
* Known severe brain injury
* Prolonged CPR without adequate tissue perfusion
* Severe chronic organ dysfunction
* Severe chronic pulmonary hypertension
* Non-recoverable advanced comorbidity (ie. CNS
damage or terminal malignancy)
call for ecmo if ..
*P/F<80mmHgfor>6hoursORP/F<50mmHgfor>3hours
* PaCO2 > 60 mmHg for > 6 hours (despite optimization of vent)
* Mechanically ventilated < 7 days
* BMI<40orweight<125kg
* Age18-65
who should you perform a cuff leak on ? what if she fails ?
if high risk ( traumatic intubation, intubated >6days, re-intubation, female, large ETT) of post-extubation stridor –> perform cuff leak
if fails –> give steroids minimum 4hrs before extubation (±24H before)
risk of dexmedetomidine ?
hypota and bradycardia
prefered sedsation agents to benzo and why
prop and dexmetomidine
Reduced LOS, duration of IMV, delirium
compaed to propofol and benzo, why is dexometasone better
decrease delirium
decrease MV duratio
decrease ICU LOS
caveat : increased bradycardia and hypotension
whuch vent setting should you promote in icu to promote sleep
assist control over pressure support to impove sleep in appropriate ventilate dpatient
