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Mechanical Ventilation 101: An Introduction To Ventilatory Support

Here are the recommended ventilator settings based on the information provided: - Mode: Assist-control (AC) to help control ventilation and oxygenation initially - Tidal volume: 7-8 mL/kg based on ideal body weight of 70 kg is 490-560 mL - Respiratory rate: Start at 16 breaths/min to help lower PaCO2 - FiO2: Increase to 50% to help raise PaO2 - PEEP: Initiate 5 cm H2O PEEP to recruit alveoli and improve oxygenation Monitor ABGs and ventilator waveforms to evaluate response to changes in settings and adjust as needed. Goal is normal acid-

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Øsama Ālareke
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58 views16 pages

Mechanical Ventilation 101: An Introduction To Ventilatory Support

Here are the recommended ventilator settings based on the information provided: - Mode: Assist-control (AC) to help control ventilation and oxygenation initially - Tidal volume: 7-8 mL/kg based on ideal body weight of 70 kg is 490-560 mL - Respiratory rate: Start at 16 breaths/min to help lower PaCO2 - FiO2: Increase to 50% to help raise PaO2 - PEEP: Initiate 5 cm H2O PEEP to recruit alveoli and improve oxygenation Monitor ABGs and ventilator waveforms to evaluate response to changes in settings and adjust as needed. Goal is normal acid-

Uploaded by

Øsama Ālareke
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Mechanical Ventilation 101

An Introduction to Ventilatory Support


OBJECTIVES
 The student will be able to:

– State the two purposes of mechanical ventilation.


– List three indications for mechanical ventilation.
– State the primary reason for oxygenation failure.
– List three complications of mechanical ventilation.
– Differentiate between positive and negative pressure
ventilation.
– Differentiate between invasive and non-invasive
ventilation.
– Differentiate between pressure- and volume-based
breaths.
– Describe how the mode of ventilation is related to patient-
ventilation interaction.
– Differentiate between minute ventilation and alveolar
ventilation.
– Describe the relationship between alveolar ventilation and
PaCO2.
OBJECTIVES
 The student will be able to:

 State the two purposes of mechanical ventilation.


 List three indications for mechanical ventilation.
 State the primary reason for oxygenation failure.
 List three complications of mechanical ventilation.
 Differentiate between positive and negative pressure
ventilation.
 Differentiate between invasive and non-invasive ventilation.
 Differentiate between pressure- and volume-based breaths.
 Describe how the mode of ventilation is related to patient-
ventilation interaction.
 Differentiate between minute ventilation and alveolar
ventilation.
OBJECTIVES
 The student will be able to:

 Describe the relationship between alveolar


ventilation and PaCO2.
 State the two primary methods for controlling
alveolar minute ventilation.
 State the normal range for spontaneous tidal
volume.
 State the normal range for tidal volume during
mechanical ventilation.
 List the four primary causes of hypoxemia.
 State two methods for improving PaO2.
 Describe how PaCO2 is managed in patients with
chronic airflow obstruction.
 Describe how PaO2 is managed in patients with
chronic airflow obstruction.
Purposes of Mechanical
Ventilators
 TWO FUNCTIONS:
– Remove Carbon Dioxide
– Deliver Oxygen
 Ventilate (Decrease PaCO2)
– WOB is excessive
• Increased airway resistance
• Reduced lung compliance
– Defect with neuromuscular control
– Post-operative support
 Oxygenate (Increase PaO2 [SaO2])
– Shunt
Effects of Positive
Pressure Ventilation
 Increased airway pressures
– Reduction in venous return/cardiac output.
– Reduced renal blood flow.
– Cerebral blood flow issues.
 Airway related issues
Ventilator Settings
 Positive vs. Negative Pressure
 Invasive vs. Non-Invasive
 Breath Type
– What is our focus: Volume or Pressure
 Mode
– Who is in control: Patient or Ventilator
– Is support full or partial?
– A/C, SIMV, Spontaneous
 Control of Alveolar Minute Ventilation
Alveolar Minute Ventilation
.

PaCO2 levels are inversely related to VA
– Increase minute volume, decrease PaCO2.
– Decrease minute volume, increase PaCO2.
.

Minute Volume (VA) is (Tidal Volume minus
Deadspace Volume) x respiratory rate.
– (Vt – Vd) x f
– Deadspace includes anatomic (doesn’t change),
mechanical (stuff we add), and alveolar ( without ).
 We can control alveolar minute ventilation by:
– Changing Respiratory Rate (f)
– Changing Tidal Volume
Tidal Volume
 Spontaneous tidal volume is 5-8 mL/kg.
 Set tidal volume on ventilator is patient
dependent:
– Higher tidal volumes may lead to higher
delivery pressures and lung damage.
• Use as small of a tidal volume as possible to reduce
the PaCO2 to desired levels.
– A setting of 7-10 mL/kg of Ideal Body Weight
(IBW) is considered a safe place to start.
• ARDS: 6-7 mL/kg
• Some simulations “like” 10-12 mL/kg
– Evaluate CST to determine if setting is
appropriate.
Oxygenation Issues
 Causes of Hypoxemia
– Reduced barometric pressure (move)
– Hypoventilation
. .
(ventilate)
– V/Q imbalance (responds to increased FiO2)
– Diffusion Defect (find cause and correct?)
– Intrapulmonary Shunt
• RECRUIT COLLAPSED ALVEOLI
Steps in Correcting PaO2

 Increase FiO2
 Increase Mean Airway Pressure
– “Space under the table”
– Increase starting pressure (PEEP)
– Increase delivery (ending) pressure (PIP)
– Lengthen inspiratory time (tI)
tI
PIP

PEEP
Mechanical Ventilation:
COPD & Asthma
 Treat increased PaCO2 (and low pH)
– Use caution with increasing tidal volume.
• Increased RV leads to overdistension.
• Extend expiratory time.
– Auto PEEP
• Shorten inspiratory time (increase inspiratory flow rate).
– Use respiratory rate to control PaCO2.
– Control patient (?) pharmacologically.
– Permissive hypercapnia and acidosis.
 Treat reduced PaO2 . .
– Usually a result of hypoventilation and V/Q imbalance.
– Responds well to increase in FiO2.
 5’10” male admitted to ICU.
 Determine Ventilator settings
– Mode
– Tidal Volume
– Respiratory Rate
– FIO2
– PEEP
 ABG
– pH: 7.31, PaCO2: 50, PaO2: 60, HCO3: 26
 ABG:
– pH: 7.38, PaCO2: 38, PaO2: 62, HCO3: 27

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