VENTILATORY SUPPORT STRATEGIES FOR DIFFERENT CAUSES OF RESPIRATORY FAILURE

Question 1

Occurs when the respiratory system cannot maintain adequate gas exchange, leading to insufficient oxygen levels in the blood or elevated carbon dioxide levels, or both.

This failure may arise from issues in the lungs, respiratory muscles, or the central nervous system.

Answer 1

Respiratory Failure

Question 2

2 Main Goals of Ventilatory Support:

Answer 2

Restore adequate gas exchange and Reduce work of breathing

Question 3

Restoring Adequate Gas Exchange:
- Achieving sufficient oxygenation (PaO2 > ______
or SpO2 > ____) to prevent _______.
- Reducing PaCO2 to within a normal or target range in __________.

Answer 3

• 60 mmHg ;
• 90%
• hypoxic injury
• hypercapnic failure

Question 4

Reducing Work of Breathing:
- Assisting or replacing the effort of breathing to prevent ________.
- Supporting weakened or compromised respiratory muscles, especially in _________.

Answer 4

• respiratory muscle fatigue
• neuromuscular conditions

Question 5

1. Failure due to insufficient oxygenation despite normal
   ventilation; often results from ______ or _____.
2. Causes:

Answer 5

1. Type 1 Respiratory Failure
   - (V/Q mismatch or diffusion defects)
2. ARDS
   Pneumonia
   Pulmonary embolism
   Pulmonary edema

Question 6

1. Target: Maintain oxygenation while minimizing ventilator induced lung injury (VILI).
2. Approach:
   * Low Tidal Volume Ventilation (LTVV): _____ ideal body weight to
   prevent overdistension.
   * PEEP Optimization: Prevent alveolar collapse; may adjust based on ARDS severity.
   * Prone Positioning: Improves oxygenation by redistributing lung perfusion/improve gas distribution.
   * FiO2/PEEP Titration: Adjust to maintain PaO2 >____ mmHg or SpO2 > ___.
   * Consider ECMO: For severe, ______.

Answer 6

1. ARDS
2. • 4–6 mL/kg
     
     • 55 mmHg
   • 88%
   • refractory hypoxemia

Question 7

1. Target: Restore oxygenation and reduce patient work of breathing.
2. Approach:
   * Non-invasive Positive Pressure Ventilation (NIPPV): Use CPAP
   or BiPAP if patient is ______.
   PEEP: 5-10 cm H2O to prevent alveolar collapse.
   Higher FiO2: To ensure PaO2 > ______ or SpO2 >_____.
   Monitor for Hypercapnia: If severe, switch to invasive
   ventilation.

Answer 7

1. Pneumonia
2. • hemodynamically stable
     
     • 60 mmHg
   • 92%

Question 8

1. Target: Improve oxygenation, manage ventilation, and reduce the workload on the heart.
2. Approach:
   - Low tidal volumes.
   - Set moderate PEEP ______ (if the PEEP increases it can compromise the hemodynamic of the px)

Answer 8

1. Pulmonary Embolism
2. • (5-10 cm H2O

Question 9

1. Target: Improve oxygenation and reduce work of breathing.
2. Approach:
   * CPAP or BiPAP: Immediate intervention for__________; relieves dyspnea and reduces intubation need.
   * PEEP: Helps recruit alveoli and redistributes fluid in lungs.
   * _________: Key to preventing worsening edema.
   * Diuretics and Vasodilators: Part of overall management.
3. It will expel the excess fluisd in the form of urine

Answer 9

1. Pulmonary edema
2. • cardiogenic pulmonary edema
   • Fluid Management
3. Diuretics

Question 10

1. Results from inadequate alveolar ventilation, leading to CO2 retention.
2. ## Causes:-
   -

Answer 10

1. Type II Respiratory Failure
2. COPD
   Asthma exacerbations
   Neuromuscular diseases

Question 11

1. Target: correct hypercapnia and relieve respiratory distress without over-distending lungs.
2. Approach:
   * Non-invasive Ventilation (NIV):
   Preferred Mode: ____ because it has 2 pressure support which is the inspiratory and expiratory.
   * Low Tidal Volume:
   - to avoid exacerbating AUTO-
   PEEP or air trapping
   Purpose: Avoids exacerbating
   auto-PEEP
   * PEEP:
   Use: Applied carefully and typically at lower levels to prevent exacerbation of auto-PEEP.
   * FiO2:
   Setting: Start low, titrate based on SpO2 or PaO2 to avoid ______.

Answer 11

1. COPD
2. • BiPAP
     - hyperoxia- induced hypercapnia

Question 12

1. Target: Minimize barotrauma and avoid dynamic hyperinflation.
2. Approach:
   * Permissive Hypercapnia: To prevent _______.
   * Low Respiratory Rate: Allows prolonged expiration.
   * Monitor Peak Inspiratory Pressure (PIP): Limit to prevent
   _____.
   * Avoid High PEEP: Can worsen air trapping in severe bronchospasm.

Answer 12

1. Asthma Exacerbation
2. • high airway pressures
   • lung injury

Question 13

1. Target: Minimize barotrauma and avoid dynamic hyperinflation.
2. Approach:
   * NIV for Early Intervention: ____ to support weakened
   muscles.
   * Invasive Ventilation for Severe Cases: If patient cannot maintain
   spontaneous breaths.
   * Tidal Volume: Adjust based on individual’s lung compliance and
   avoid over-distension.
   * Use of Cough Assist: For secretion clearance in patients with weak
   cough.

Answer 13

1. Neuromuscular Disorder
2. • CPAP or BiPAP