Initiation of Mech. Vent. Flashcards
Indication for Initiation of Mechanical Ventilation:
Reason why we need to put a patient on mechanical ventilation
- Acute Ventilatory failure.
- Acute Oxygenation Failure
- Impending Respiratory Failure
- Prophylactic Ventilatory Support
- Apnea.
What does it mean Acute Respiratory Failure?
Mean unable to remove PaCO2 normally.
- PH <7.25*
- PaCO2 > 50 mm Hg*
- COPD patients
- Head trauma patient
- Drug over dose patients
- Chest trauma patients ( all these condiction are common on ER and it will take the patient to ARF)
When you assess an Acute Ventilatory failure Patient, what you expect to see?
Rapid Shallow Breathing Index
- RSBI = RR/VT *
- Normal value is < 100*
- Abnormal value: RR40/0.25ml = 160 (>100) (*The faster is the breathing, the lower the volume will get)
Tecnically when we consider Hypoxemia?
When PaO2 decreases < 60 mm Hg
P/F ratio is used to:
Calculate the worsenesses of Hypoxemia, the lower the ratio is the worse the Hypoxemia will be.
Example: 100 PaO2 at 0.21 %
100/0.21 = 476 (>200 is normal)
What is P/F ratio?
PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure to fractional inspired oxygen. It is a widely used clinical indicator of hypoxaemia.
What impending Respiratory Falirure?
- A gradual ↑ of PaCO2
- ↑ WOB to mantain normal gas exchange.
- Progressive Acidosis and Hypoventilation, PH <7.35, PaCO2 >50 mm Hg
- Progressive Hypoxemia <60 mmHg
Assessment Parameters Suggesting IRF?
(IRF= Impending Respiratory Failure)
- VT : <3-5 mL/Kg IBW
- RR : >25/min
- VE : >10 L/min
- VC : <15 mL/Kg IBW
- MIP : >-25 cm H2O
- PaCO2 trend: ↑ to >50 mm hg
- PaO2 trend: ↓ to <60 mm Hg
- VS : ↑RR, ↑HR, ↑BP, ↓ SpO2
VT of <3-5 mL/Kg IBW, this numers suggest what?
Impending Respiratory failure
RR has to be more than what number in orden to be Impending Respiratory Failure?
>25 breaths per minute, if the patient continues to breath like that por a long period of time eventually will get into RF.
VE >10 L/m and VC of <15 mL/Kg IBW, What indicate on patient assessment parameters?
Impemding Respiratory Failure
(Patient must be connected to a ventilator)
How PaCO2 and PaO2 trend has to be for a patient to go on Respiratory Failure?
- PaCO2 ↑ >50 mmHg
- PaO2 ↓ <60 mmHg
In a patient that is getting into RF, RR will:
a. Decrease
b. Increase
c. No change will occurs
b. Increase
In a patient that is getting into respiratory failure HR will be:
- Normal
- Decreased
- Increased
3. Increased
How BP will be on a patient that is getting into RF?
Increased