Intensive care for the critically ill adult

Question 1

Types of respiratory failure

Answer 1

Type 1: hypoxaemia without CO2 retention (lung collapse/consolidation, asthma, pneumonia, pulmonary oedema and pulmonary embolism)

Type 2: hypoxaemia with CO2 retention (chronic bronchitis, chest injuries, drug overdose, postoperative hypoxaemia and neuromuscular disease)

Hypoxaemia = PaO2 <60 mmHg with FiO2 >0.5

Question 2

Problem identification and PT interventions in ICU

Answer 2

> ↓ lung volumes / compliance
> ↓ gas exchange
> ↓ mucociliary clearance
> weakness of peripheral and respiratory muscles
> ↑ WOB

Question 3

Evidence for hyperinflation techniques

Answer 3

MHI has been demonstrated to result in reversal of atelectasis, improvement in tidal volumes, improvement in chest Rx scores, improvements in static and dynamic compliance, and increased yield of secretions.

Question 4

Suggested guidelines for extubation

Answer 4

Pt readiness for weaning:
> FiO2 <0.50
> PEEP ≤5 cmH2O
> No vasopressor agents
> Able to follow simple commands

Then pt undergoes a breathing trial of CPAP for 30-90’

If pt fails...
> SaO2 <90%
> Resp rate >35 bpm
> Variation in heart rate or blood pressure >20%
> Agitation

…then mechanical vent is often reinstituted.