Treatments and protective strategies

Question 1

What are lung protective strategies (on mechanical ventilation)

Answer 1

• Low Vt and low PIPs
• Allow higher PaCO2 (permissive hypercapnia)
• Lower SpO2 goals (85-90) ->controversial tho

Question 2

What pH goals would fall under permissive hypercapnia?

Answer 2

pH 7.20 or 7.25

• as long as a acceptable pH is maintained = good

Question 3

How do you treat BPD? (3)

Answer 3

• Low protective strategies if ventilated
• iNO
• Lower oxygenation goals (risk of pphn)

Question 4

Ventilation goals for TTNB?

Answer 4

Supportive care

• oxygen therapy < fiO2 0.4
• CPAP 3-5 w/higher fio2

Question 5

What should you consider if neonates rapidly deteriorate (suddenly)?

Answer 5

Air leak syndromes (i.e pneumothorax, emphysema etc.etc.)

Question 6

What are 4 management conditions for Cyanotic Heart Disease?

Answer 6

1. Dependent on keeping PDA open
2. Rule of 40 (pH,PaCO2,PaO2 @40)
3. Target SpO2 70-80
4. minimal suction and handling

Question 7

When would Permissive hypothermia be used?

Answer 7

Used in the acute phase of severe TBI to optimize cerebral perfusion and reduce ICP. used to mitigate brain injury following trauma

• Decreases cerebral metabolic rate
• Reduces cerebral blood flood
• Reduces inflammatory response in brain

Question 8

What is optimal PEEP?

Answer 8

Value associated with the best oxygen delivery and dead space reduction (via PEEP occupying the space)

• generally; (best compliance + 2)
• Monitor driving pressure basically, see if compliance is improving and where we see diminishing returns

Question 9

How can you determine if current settings on a vent are appropriate?

Answer 9

Perform a optimal peep study

• can be performed qd or whenever the pts getting better/worse

Question 10

What should you monitor during a optimal peep study?

Answer 10

Pay attention PEEP affects the plat, ensure driving pressure <15

• Driving pressure
• Plat
• SpO2

Question 11

What is driving pressure

Answer 11

Plat-Peep

• Driving pressure is the amount of pressure needed to open up the lungs (aka compliance) to provide whatever SpO2 goals you’re achieving

Question 12

Indicators of worsening EtCO2 to CO2 with better oxygenation and RR?

Answer 12

• Worsening v/q
• CO2 not crossing the membrane

Question 13

How often is proning done?

Answer 13

Every 18 hours

Question 14

What do dips on inspiration on the flow scalar mean?

Answer 14

patient is air hungry, we’re not providing enough