INVASIVE POSITIVE PRESSURE VENTILATION Flashcards
GENERAL
INDICATIONS
Hypoxemic (inadequate oxygenation) respiratory failure (eg, pneumonia, congestive heart failure).
Hypercapnic (inadequate ventilation) respiratory failure (eg, COPD).
Inability to maintain a patent airway (eg, burns, trauma, stroke, overdose).
Anticipated deterioration of clinical status.
Effects of PPV on right vs. left cardiac dynamics:
Worsens Right-Side Dynamice: Decreases RV Preload, Increases RV Afterload
Improves Left-Side Dynamics: Decreases LV Preload, Decreases LV Afterload
2 effects of PEEP on cardiopulmonary physiology:
Higher PEEP improves oxygenation and decreases work when above the alveolar closing capacity
Higher PEEP decreases preload
Variables affecting Minute Ventilation:
Tidal Volule (Vt)
Respiratory Rate (RR)
Variables affecting oxygenation:
Fraction of Inspires 02 (Fi02)
PEEP
MANAGEMENT
COPD / OBSTRUCTIVE
Volume Assist Control
Vt: 6-8 mL / kg
RR: 8-10 bpm
Fi02: 40%
PEEP: 0-5 cm H20
Prolonged Inspiratory to Expiratory Time (I:E ratio) with permissive hypercapnia
ACUTE CARDIOGENIC PULMONARY EDEMA
Volume Assist Control
RR: 15-18 bpm
Tidal volume: 6-8 mL/kg
FiO2: 100%
PEEP 5 cm H2O
Titrate per ARDSnet protocol
ARDS / PNEUMONIA / SEPSIS / LUNG PROTECTIVE STRATEGY
Based on the ARDSNet ARMA study, which demonstrated the mortality benefit of lower tidal volume.
Initial tidal volume: 8 mL/kg of predicted body weight.
Inspiratory flow rate (IFR): 60 L/min as a starting point; can increase to 80-100 L/min and titrate as needed based on patient comfort.
RR: Titrate to manage patient’s ventilation (PaCO2).
PEEP and FiO2: Titrate to manage oxygenation.
If FiO2 >50%, patient may benefit from PEEP.
Plateau Pressure Target and strategy to decrease:
If PP > 30, decreased VTE by 1 ml/kg
POST-INTUBATION CARE
Initiate quantitative end-tidal CO2 monitoring.
Elevate the head of the bed to 30° if there is no contraindication.
Measure the patient to obtain the predicted body weight, if not previously done.
Check the arterial blood gas (ABG) approximately 30 min after initiation of IPPV.
Order analgesia and sedation.
Titrate FiO2 to maintain oxygen saturation >94%.
Maintain plateau pressure <30 cm H2O.
MONITOR FOR COMPLICATIONS: DOPE
DDx: MECHANICAL VENTILATION AND HYPOTENSION
DDx for SHOCK
Vent Specific:
Tension PTX
Auto-PEEP / Dynamic Hyperinflation
Relative Dehydration
Sedation Medications / Post-intubation meds
