Lecture 5 - Effects of Intubation and Mechanical Ventilation Flashcards
1
Q
Reasons for intubation?
A
- MAINTAIN patent upper airway
- PROTECT lower resp tract
- TRACHEOBRONCHIAL TOILET (enable suctioning)
- SUPPORT ventilation (if pt sedated/paralysed/resp mm’s need a rest)
2
Q
Side effects of intubation
5
A
D.A.I.T.S
- D - deadspace increased
- A - airway resistance (tube longer+narrower)
- I - infection (higher risk of nosocomial pneumonia)
- T - trauma (foreign body being inserted (stenosis/fistula)
- S - secretion movement impaired
3
Q
Pulmonary Effects of Mech Ventilation
A
- Decreased compliance in lung (d/t monotonous breathing -therefore less sighs - less stretch - less surfactant
- Reduced FRC - body position; address with CPAP/PEEP to recruit more alveoli - in mech ventilated - air goes anteriorly (path of least resistance) to non dependent; in normal awake pts - air goes posteriorly to dependent regions
- Barotrauma (damage d/t pressure; shearing forces from opening and closing alveoli)
- Volutrauma (damage d/t volume
- O2 toxicity
- Distribution on ventilation - ventilation to non-dependent regions
4
Q
Why is CPAP used in mech ventilated pts?
A
To increase the alveoli recruited/address SA loss/reduced FRC
5
Q
Cardiovascular effects of mech ventilation
A
SPONTANEOUS breathing - the sucking in effect increases venous return
POSITIVE PRESSURE breathing - the positive pressure squeezes the the venous channels and reduces venous return - therefore reduces BP and Q
6
Q
Effects on resp mm’s
A
SIGNIFICANT when >48hrs of mech ventilation
- dec diaphragm strength
- dec resp mm endurance
7
Q
ICU - effects on other systems? MS, CVS, psycho
A
MS - deconditioning (mm wasting, bone demineralization, joint stiffening)
CVS - reduced BV, Hb
Psycho - sleep deprivation, anxiety
8
Q
Aims of Mechanical ventilation
A
- optimize gas exchange
- decrease WOB
- avoid resp complications
- lung recovery
