Nuts and Bolts of Mechanical Ventilation

Size: px
Start display at page:

Download "Nuts and Bolts of Mechanical Ventilation"

Transcription

1 Nuts and Bolts of Mechanical Ventilation National Conference for Nurse Practitioners Eric Magaña, M.D. Give me facts but above all give me understanding Solomon Misconceptions are Barriers to Understanding Very little education is devoted to Vents Personal habits are billed as facts not born out by physics Dogma is rarely accurate Always is rarely true Use the same terms for different things and different terms for the same things Ventilator terms are abstract, not concrete Outline Discuss Modes Control Variables Peak, Mean and Plateau pressures ARDS Weaning If you don t understand it, you can t troubleshoot it. If you can t troubleshoot it, you shouldn t use it. Craig Jensen 3 1

2 Respiratory Failure Most common organ failure 100% of cardiac output goes to lungs Lungs see raw inflammatory mediators Requires supplemental oxygen Severe failure causes need for mechanical ventilation Goals of Mechanical Ventilation Avoid Lung Injury Blow air in the patient Exhalation is passive 6 2

3 Modern ventilators are confusing Use the same terms for different things Use different terms for the same thing The more sophisticated the machine, the more sophisticated a person has to be to use it. Case 1 A 25 yr female has been intubated in the field after being found down, unresponsive with an empty valium bottle at her side. Exam unremarkable. She is 5 4, 70 kg. Make initial ventilator settings for this patient. 3

4 Initial Ventilator Settings There are no standard vent settings Individualize to the patient s needs Why they need mechanical ventilation Take into consideration pathophysiology Patient ventilator interactions Game plan CNS and respiratory depression due to drug overdose. Do not suspect lung disease. Game plan: Until her brain function improves, we must breath for her. Minute Ventilation (V E ) Ventilation is the act of moving air in and out of the lungs. The amount of ventilation is quantified as Minute ventilation (V E ) Liters breathed in per minute V E is inversely proportional to pco 2 Increase V E, pco 2 goes down Decrease V E, pco 2 goes up 4

5 How much Minute Ventilation (V E ) is needed? Patient without lung disease Negative History Negative Chest X-ray Lungs are functioning normally, patient is just without a respiratory drive Probably needs a normal V E Normal (rest) V E 5-8 l/m Minute Ventilation (V E ) V E = RR X V T Need to determine a V T Then determine a RR 5

6 Tidal Volume (V T ) cc/kg 8-10 cc/kg 4-7 cc/kg Predicted Body Weight (kg) P bw =50+91 X (ht cm-152) male P bw =45+91 X (ht cm-152) female P bw = X (ht inches- 60) male P bw = X (ht inches- 60) female Predicted Body Weight (kg) female P bw = * (ht inches- 60) P bw = * (64-60) P bw = X (4) P bw = P bw =55.27 kg Actual body weight=70 kg 6

7 19 Tidal Volume (V T ) 55 kg pt 8-10 cc/kg 55 X (8 to 10)= cc We will choose a V T of 480 ml Minute Ventilation (V E ) Set up V E 6 l/m Normal (rest) V E 5-8 l/m V E =RR X V T V T =480 ml 6=RR X 480 ml RR=12 7

8 Ventilator Settings Doctor A Volume Control A/C (Assist/Control), Rate=12, V T =480 ml, FiO 2 =100% V E =RR X V T V E =12 X 480 ml=5.7 l/m Volume Control A/C Rate=12, V T =480 ml Minimum number of breaths is 12 Patient can have as many breaths beyond 12 as she desires Each breath will be 480 ml 24 8

9 Pressure Ventilator Settings Doctor B Pressure Control A/C, rate=10, P=14 cm H 2 O, T insp =1.0 sec, FiO 2 =100% yiedling V T 600 ml V E =RR X V T V E =10 X 600 ml=6 l/m Delta P ΔP Driving Pressure Change in pressure (ΔP) Rise of pressure above baseline (PEEP) during inspiration Inspiratory Pressure PEEP + ΔP PEEP ΔP values ΔP=8 cm H 2 O-overcomes the resistance of the ETT ΔP=20 cm H 2 O-fairly high If ΔP of 20 cm H 2 O gives a 300 ml V T, the Respiratory system is pretty stiff If ΔP of 20 cm H 2 O gives a 1300 ml V T, the Respiratory system is pretty compliant or the patient is helping a lot 27 9

10 Pressure Control A/C Rate=10, P=14, T insp =1.0 s, yielding V T 600 ml Minimum number of breaths is 10 Patient can have as many breaths beyond 10 as she desires Each breath will be P=14 for 1.0 s PC AC Pressure-Volume Curve (Compliance) What does Volume Ventilation do to the lungs that Pressure Ventilation does not? What does Pressure Ventilation do to the lungs that Volume Ventilation does not? Which is safer: Pressure or Volume? 10

11 Pressure-Volume Curve Add a Volume to the System Add a Pressure to the System Review What is the P? What is Pressure A/C? Do Pressure and Volume coexist? Which is safer? 11

12 Evaluate the Settings Patients appears comfortable Venous blood gas (VBG) 7.40/42/37 ph=7.4 pco 2 =42 po 2 =37 Oxygen saturation=73% 34 Outcome Patient gradually starts over breathing the vent Patient wakes up Follows commands Normal vitals and saturations Pt is extubated and transferred Review What is V E? What is Normal V E? How do we achieve a V E? How do we determine V T? What is Volume A/C? ABG vs VBG 12

13 Case 2 58 yr male presents with decreased LOC Pt is intubated with versed/fentanyl 90/50 on 15 µ/kg/min Dopamine, RR=30, P=124, 38, 94% on 100% Lungs scattered rhonchi throuhout, CXR diffuse pulm infiltrates Lab: creat=3.5, HCO 3 =14, K+=5.6 Vent: Volume A/C 500 ml, PEEP=5, 100%, Rate=15/30 Pt is agitated 100 mg of Rocuronium is given 10 min later: pt starts runs of V-tach associated with worsened hypotension What is going on? Pt has septic shock due to Pneumonia complicated by Acute Renal Failure and Metabolic Acidosis. Elevated V E is needed to compensate for metabolic acidosis and inefficiency of lung ventilation 13

14 Paralytic reduces patient s V E by 50% Set Rate=15, was breathing 30 Doubles pco 2 ph goes from 7.29 to 7.03 K+ increases due to cellular shifts to buffer ph (K+ was 5.6) How Could This be Prevented? Anticipate effect of paralytic on respiratory rate and V E Increase Vent rate to meet patient needs Increase rate to 30 Results in no net change in pco 2 or ph End-Tidal CO 2 (ETCO 2 ) Measures exhaled CO 2 level Uses absorption of infra-red waves ETCO 2 pco 2 ETCO 2 25 might correspond to pco 2 of 40 Gradient exists from blood stream to alveoli to eliminate CO 2 Gradient varies according to clinical state Gradient in non-diseased state is around 5 In severe pulmonary disease, gradient 14

15 Review Do we need to pay attention to V E? What happens to pco 2 and ph when the V E is inadequate? Case 4 58 y, 80 kg male presents with pneumonia and respiratory failure Game Plan The patient is septic and has an increased load placed on respiratory system. We want to unload the respiratory muscles and calm the patient, so he can better interface with our therapy and decrease oxygen utilization. 15

16 Minute Ventilation (V E ) V E =RR X V T Patient has significant lung disease Pneumonia gives an increased respiratory load Sepsis has fatigued the patient Probably needs a higher V E than normal (5-8 l/m) due to inefficiency of ventilation from pneumonia (V/Q mismatch) How much increased? Desired V E 9 l/m Educated guess In What other situation does the patient needs an increased V E? Metabolic acidosis CNS injury Increased metabolic activity PE Tidal Volume (V T ) 80 kg pt 8-10 cc/kg 80 X (8 to 10)= cc 16

17 What Respiratory Rate does it take to get a V E 9 l/m? Desired V E 9 l/m V E =RR X V T V T =640 ml (8 ml/kg) 9=RR X 640 ml RR=14 Initial Ventilator Settings Doctor A Volume Control A/C (Assist/Control), Rate=14, V T =640 ml, FiO 2 =100% V E =RR X V T V E =14 X 640 ml=9 l/m Volume Control A/C Rate=14, V T =640 ml Minimum number of breaths is 14 Patient can have as many breaths beyond 14 as she desires Each breath will be 640 ml 17

18 Evaluate the Settings Look at the Patient ABG=7.18/55/136 Respiratory Acidosis pco 2 too high Make adjustments to improve the gas Increase the V E Minute Ventilation (V E ) V E =RR X V T V E is inversely proportional to pco 2 Increase V E the, the pco 2 goes down Decrease V E the, the pco 2 goes up Respiratory Acidosis pco 2 too high Increase the V E By how much? Boyle s Law p 1 V 1 =p 2 V 2 (pco 2 ) (V E )= (pco 2 ) (V E ) (55)(9)=(40)(V E ) V E =12.4 L/M Current V E =9 L/M with pco 2 =55 We want a pco 2 =40 18

19 Initial settings: Volume Control A/C (Assist/Control), Rate=14, V T =640 ml, FiO 2 =100%, V E =9 l/m We need to increase V E to 12.4 How can this be accomplished? Increase rate Increase the volume V E =RR X V T Initial settings: Volume Control A/C Rate=14, V T =640 ml, V E =9 l/m Increase rate to 19 with a V T =640 ml gives a V E =12.2 l/m Keep rate of 14, increase V T to 880 ml (11 cc/kg) gives a V E =12.3 l/m V E =RR X V T Before ventilator changes can be made, Shift change: Doctor B comes on Changes pt to: Pressure Control A/C, Rate=14, P=14 cm H 2 O, T insp =1.0 sec, FiO 2 =100% yiedling V T 640 ml V E =RR X V T V E =14 X 640 ml=9 l/m 19

20 Pressure Control A/C Rate=14, P=14, T insp =1.0 s, yielding V T 640 ml Minimum number of breaths is 14 Patient can have as many breaths beyond 14 as she desires Each breath will be P=14 for 1.0 s This patient still has pneumonia and reduced efficiency of ventilation If with Volume Ventilation, a V E of 9 l/m gives a pco 2 of 55, what do you think the pco 2 will be with Pressure Ventilation and a V E =9 l/m? Hint: V E is inversly proportional to pco 2 The V E of 9 l/m will give this patient a pco 2 =55 regardless of if the patient is in Pressure or Volume Ventilation 20

21 V E Adjustment Calculation Current V E =9 L/M with pco 2 =55 We want a pco 2 =40 What V E do we need? p 1 V 1 =p 2 V 2 (pco 2 ) (V E )= (pco 2 ) (V E ) (55)(9)=(40)(V E ) V E =12.4 L/M Initial Settings Doctor B Pressure Control A/C, Rate=14, P=14 cm H 2 O, T insp =1.0 sec, yielding V T 640 ml We need to increase V E to 12.4 How can this be accomplished? Increase rate Increase the volume How to Increase V T in Pressure Ventilation? Increase P Increase T insp 21

22 Delta P ΔP Driving Pressure Change in pressure (ΔP) Rise of pressure above baseline (PEEP) during inspiration Inspiratory Pressure PEEP + ΔP PEEP Inspiratory Time Flow P V Initial settings: Pressure Control A/C, Rate=14, P=14 cm H 2 O, T insp =1.0 sec, yielding V T 640 ml V E =9 l/m Increase rate to 19 with a V T =640 ml gives a V E =12.2 l/m 12.4 l/m 640 ml = Rate Keep rate of 14, increase P=18 cm H 2 O with gives V T 880 ml (11 cc/kg) gives a V E =12.3 l/m 12.4l/m 14= 886 ml V E =RR X V T 22

23 Volume A/C vs Pressure A/C Doctor A-Volume Control Volume Control A/C, Rate=14, V T =640 ml, FiO 2 =100% V E =14 X 640 ml=8.96 l/m Doctor B-Pressure Control Pressure Control A/C, Rate=14, P=14 cm H 2 O, T insp =1.0 sec, FiO 2 =100% yiedling V T 640 ml V E =14 X 640 ml=8.96 l/m Assist/Control=patient will get a minimum number of breaths based on set rate, but can have as many additional breaths of the same type as she wants Positive Pressure Ventilation Every Breath has Pressure, Flow and Volume Air pressure Lung Air Flow Air Flow 5 68 Flow or Flow Rate The speed at which the breath is delivered Units of liters per minute or per second Similar to IV fluid bolus 1 L bolus over 2 hours Usually set by Respiratory Therapist 23

24 Flow Patient Flow needs vary according to patient demand Varies within a breath and with levels of agitation and anxiety Inadequate Flow leaves the patient struggling Excessive Flow overwhelms the patient 71 Volume Ventilation Volume and flow are set and pressure varies based on system compliance 24

25 Flow Patterns Pressure Control Pressure is set, volume and flow vary based on system compliance Every breath has Pressure, Flow, Volume and Time Can control Volume and Flow Pressure is variable Volume Control Ventilation Can control Pressure Volume and Flow are variable Pressure Control Ventilation Volume Control Can NOT control Pressure, Flow and Volume all at the same time Pressure Control 25

26 Control Variable Pressure Control Pressure Targeted Pressure Limited Pressure Ventilation Volume Control Volume Targeted Volume Limited Volume Ventilation Volume and Flow control can not be distinguished clinically Term Volume Control is used for both Review Can the same patient goals can be achieved in either Pressure or Volume ventilation? Every breath has Pressure, Flow and Volume. What is the Control Variable? What is set and what is variable in Pressure Ventilation? What is set and what is variable in Volume Ventilation? Case 5 VA is a 66yo, 90 kg male Several days of progressive dyspnea PMHX: CHF, CAD, COPD Pt has labored breathing EKG shows nonspecific ST changes 26

27 Pt is intubated and placed on mechanical ventilation to decrease work of breathing Volume A/C V T =480, RR=16/20, Flow=60 l/m, FIO 2 =60% Pt appears very agitated and uncomfortable Accessory muscles of respiration What Have You Done For This Patient? NOTHING 27

28 Review Are patients on vents necessarily doing less work than spontaneously breathing patients? In Volume ventilation, Flow and V T are set, Pressure is variable What is outstripping flow? Case 6 16 yr, 60 kg male presents with chills/sweats/fever, sore throat and stridor Labored respirations, retractions, / % on 2 L NC Intubated with Fentanyl/versed for epiglotitis Make initial vent settings 28

29 Game Plan Patient has upper airway obstruction causing respiratory distress. Lungs and gas exchange are normal. Once obstruction has been overcome by ET tube, we need to support patient until treatment has decreased swelling and inflammation of epiglottis. Minute Ventilation (V E ) Patient has no lung disease Epiglotitis effects upper airway Probably needs a near normal V E (5-8 l/m) Desired V E 7 l/m Educated guess Minute Ventilation (V E ) Desired V E 7 l/m V E =RR X V T V T =640 ml (8 ml/kg) 7=RR X 640 ml RR=11 29

30 Initial Ventilator Settings Volume Control A/C (Assist/Control), Rate=11, V T =480 ml, FiO 2 =100% Pt is breathing 26 bpm with retractions, sats OK, BP=145/78 Patient is changed to PSV Pt immediately looks better CPAP PSV CPAP PSV 30

31 PSV (Pressure support + PEEP) CPAP (Continuous Positive Airway Pressure) Set basal pressure Inflates the lung Recruits alveoli No support of V T No augmentation of ventilation 31

32 Inspiration Expiration Inspiration Expiration Pressure Support PEEP Pressure Support CPAP CPAP CPAP PEEP CPAP PEEP=Positive End-Expiratory Pressure CPAP=Continuous Positive Airway Pressure Pressure Support Patient initiates breath, but not doing all the work alone Patient controls: duration of breath size of breath speed of breath Level of PS or P is set No Set Rate Solutions for Outstripping Flow Increase Flow setting on ventilator Sedate the patient Switch to a flow variable setting (Pressure ventilation) 32

33 Cycling How the breath terminates Volume breath-volume cycled Pressure Control-Time cycled Pressure Support-Flow cycled PSV Flow Cycling Flow cycling in Pressure Support (PSV) Breath terminates (cycles off) at a percentage of maximum liter flow for that breath Percentage can be adjusted 33

34 Pressure A/C vs Pressure Support Both have Set Pressure with variable Flow and Volume Pressure A/C Has a set or minimum Rate Breath is terminated after Tinsp is reached Time cycled Pressure Support No minimum Rate Breath is terminated by drop in Flow Flow cycled Case 7 42 yr, 80 kg male is intubated in the ER for respiratory failure with Fentanyl and versed Vent settings: Pressure Control A/C, Rate=20/20, P=14 cm H 2 O, T insp =1.0 sec, FiO 2 =100% yiedling V T 640 ml V E = 20 X 640ml=12.8 l/m ABG=7.38/41/136 1 hr later, the patient is very agitated Propofol infusion is initiated and titrated up to 40 µg/kg/min Pt appears very calm V T is now around 330 ml V E = 20 X 330 ml=6.6 l/m ABG=7.08/80/90 34

35 Why did this happen? ABG=7.08/80/90 V T dropped from 640 ml to 330 ml V E dropped from 12.8 l/m to 6.6 l/m V E is inversly proportional to pco 2 Increase V E the, the pco 2 goes down Decrease V E the, the pco 2 goes up Pressure Ventilation V T determined by both P mus and P appl Same pressure for each breath Increase in inspiratory effort results in an increase in V T but at expense of patient effort As P decreases, patient effort increases to maintain V T 35

36 Remedy Increase P Set Low V T alarm to detect drops in V T Assist/Control (A/C) Volume Ventilation Pressure Ventilation Pressure Ventilation ADVANTAGES Airway pressure is limited (protective?) Flow varies according to patient demand Volume varies by patient demand DISADVANTAGES Volume is not guaranteed Decreased volume with decreased compliance, secretions or kinked tubing 36

37 Volume Ventilation ADVANTAGES Guaranteed volume Breath can be terminated early if excessive airway pressure is detected DISADVANTAGES No Variable flow Flow Pattern set Volume not variable Review Which is better -Pressure or Volume ventilation? In Pressure Ventilation, can the V T be affected without touching the ventilator? Case 8 65 yr female on vent for respiratory failure VC+ A/C Rate=12/20 V T =450 ml, T insp =.9 s 37

38 Volume Control+ (VC+) Dual control mode Features of both Pressure and Volume Pressure based breath (variable flow/volume) with volume as feedback to determine P for next breath Can be done in A/C or SIMV BULLSEYE 113 Dual-Control Breath to breath VC+ (PB 840) PRVC (Servo I) Pressure Regulated Volume Control Adaptive Pressure Ventilation (Hamilton Galileo) Auto-flow (Evita 4) Variable Pressure Control (Venturi) Volume Support (Servo I) 38

39 Pressure Ventilation ADVANTAGES Airway pressure is limited (protective?) Flow varies according to patient demand Volume varies by patient demand DISADVANTAGES Volume is not guaranteed Decreased volume with decreased compliance, secretions or kinked tubing Volume Ventilation ADVANTAGES Guaranteed volume Breath can be terminated early if excessive airway pressure is detected DISADVANTAGES No Variable flow Flow Pattern set Volume not variable VC+ Has variable flow More comfortable Volume is not guarenteed Will decrease support if pt repeatedly takes more than feedback volume 39

40 Review What can affect V T in Pressure Ventilation? What is VC+ or PRVC? Non-Invasive Positive Pressure Ventilation (NIPPV) aka BiPAP Uses a Mask interface instead of endotracheal tube Masks often leak around edges Activates Low Exhaled Volume alarms Vent may alarm as a disconnect NIPPV Respironics developed a new machine that essentially provided PSV and PEEP No Low exhaled volume alarms To deal with mask leak New machine was called BiPAP Bilevel Positive Airway Pressure Term is trademarked Used terms IPAP and EPAP for settings Confused people as to what machine is doing 40

41 PSV and BiPAP Ai 20 r w a y P re s s ur e 5 0 Time IPAP Pressure Support PEEP EPAP IPAP=Inspiratory Positive Airway Pressure EPAP=Expiratory Positive Airway Pressure BiPAP vs PSV IPAP=15 Inspiratory Positive Airway Pressure EPAP=5 Expiratory Positive Airway Pressure Pressure Support=10 PEEP=5 Total Inspiratory Pressure (peak)=15 NIPPV Many manufactures have BiPAP machines Many use IPAP and EPAP terms Many vents have a Non-Invasive option Turns off Low exhaled volume alarm All vent modes are available for use 41

42 NIPPV Settings 12/6 IPAP of 12 and EPAP of 6? Effect Pressure support of 6 Review What is set and what is variable in Pressure ventilation? How is PSV cycled? How is Volume ventilation cycled? How is Pressure A/C cycled? What is the difference between PSV and BiPAP? Case 9 66 y male post-op 4 vessel CABG Volume targeted SIMV, V T =640 ml, Rate=10/19 PSV=10 yielding V T 120 ml, FiO 2 =75%, V E =7.05 l/m 42

43 What changes will correct this gas? ABG=7.2/50/120 Respiratory acidosis Need to increase V E How? V E Adjustment Calculation Current V E =7.05 L/M with pco 2 =50 We want a pco 2 =40 What V E do we need? p 1 V 1 =p 2 V 2 (pco 2 ) (V E )= (pco 2 ) (V E ) (50)(7.05)=(40)(V E ) V E =8.8 L/M Synchronized Intermittent Mechanical Ventilation (SIMV) 43

44 SIMV vs SIMV + PS SIMV SIMV + PSV Volume SIMV Some breaths will have a set Flow and set Volume Some breaths have a set Pressure with variable Flow and Volume

45 Pressure SIMV Some breaths are Pressure targeted (variable Flow and Volume)- Time cycled Some breaths are Pressure targeted (variable Flow and Volume)- Flow cycled Case 9 66 y male post-op 4 vessel CABG Volume targeted SIMV, V T =640 ml, Rate=10/19 PSV=10 yielding V T 120 ml, FiO 2 =75%, V E =7.05 l/m ABG=7.2/50/120 We want V E =8.8 l/m Case 9 Increase the Rate to 14 Volume targeted SIMV, V T =640 ml, Rate=14/14 PSV=10 PSV breaths would probably decrease to zero ABG=7.41/39/125 We want V E =9 l/m 45

46 Case 9 Increase PSV Volume targeted SIMV, V T =640 ml, Rate=10/14 PSV=15 yielding V T 640 ml We want V E =9 l/m Why do we have so many Modes? They were developed to solve the limitations (characteristics) with other modes. New modes have different characteristic but still have limitations. There is no perfect or best mode. If you understand which of the control variables are set or variable and how the breath is cycled, you can understand what the machine is doing. 46

47 PEEP (Positive End-Expiratory Pressure) PEEP = 0 cm H 2 O PEEP = 5 cm H 2 O Inspiration Expiration Inspiration Expiration Pressure Support PEEP Pressure Support CPAP CPAP CPAP PEEP CPAP PEEP=Positive End-Expiratory Pressure CPAP=Continuous Positive Airway Pressure Why do we use PEEP? PEEP restores Functional Residual Capacity (FRC) 0 PEEP 5 PEEP IR IR IC Inspiratory capacity TLC V T TLC V T ERV RV FRC RV ERV FRC 47

48 400 ml tidal volume V o l u m e Pressure 142 PEEP values PEEP 5 cm H 2 O normal PEEP cm H 2 O high 143 Bagpipe Effect Bag is filled with air Noise is made even when player is not blowing Bag serves as a reservoir of air 48

49 Bagpipe Effect FRC serves as a reservoir of air to blunt changes in po 2 and pco 2 between breaths TLC V T IR Inspiratory capacity ERV FRC RV Alveolar Volume during Breaths

50 Effect of PEEP Recruits alveoli for gas exchange open lung strategy of ventilation Prevents opening and closing of alveoli between breaths Decreases shearing forces Adding PEEP Increases Peak and Mean Pressures Peak Pressure MAP Case yr male is intubated for exacerbation of COPD, difficult intubation, size 6.5 ET Volume A/C V T =600, Rate=14/16, PEEP=5, 96% on 50% FiO 2 P Peak = 50 cm H 2 O 50

51 Peak Pressure Reflective of Upper airway Resistance and compliance Airway Resistance Compliance Peak Airway Pressure (Pp) Flow BP=CO X Resistance P=Flow X Resistance Affected by ET tube size Upper airway resistance Bronchospasm Secretions Tidal Volume PEEP Pneumothorax Mainstem intubation Static C & R Maneuver Peak pressure reflects both resistance and compliance Peak Pressure Resistance Flow is stopped at end inspiration (plateau) which allows the lung and alveolar pressure to equilibrate. The pressure above plateau pressure equals resistance The difference between PEEP and Plateau pressure represents compliance. Plateau Pressure PEEP Compliance R = (PIP-Pplat)/ Flow C = dvolume / Pplat-PEEP 51

52 Plateau Pressure Surrogate for alveolar pressure End-inspiratory pause Plateau Pressure Plateau Pressure A=15 B=? Plateau Pressure A Pressure at A is only equal to Pressure at B when Flow is 0 B Similar to wedge measurement with a Swan-Ganz catheter 52

53 Plateau Pressure A=15 B=? Plateau Pressure End-inspiratory pause Equilibration of airway pressures Reflects alveolar pressure No safe number acceptable <28 cm H2O P Peak = 50 cm H 2 O P plat =20 cm H 2 O Pt has small ET tube Partially occluded by secretions 53

54 High Airway Resistance and normal lung Compliance Low lung Compliance and normal airway Resistance 160 Airway Pressures Peak Pressure Involves both airway resistance, alveolar distension and flow Mean Airway Pressure Most affected by PEEP Often affects oxygenation Plateau Pressue Surrogate for alveolar distension Inspiratory pause PEEP Peak Pressure MAP Case yr 50 kg female intubated for respiratory failure from pancreatitis Volume SIMV V T =600 ml, Rate=20/20, PSV=14, PEEP=6, FiO 2 =80% 54

55 ARDS definition 164 PF ratio PaO 2 /FiO 2 Patient PaO 2 =60 FiO 2 =80% 60.8=75 Less than 200 Pt has ARDS Normal PaO 2 =70 FiO 2 =21% 70.21=333 more than 200 not ARDS 55

56 Causes of ARDS Sepsis Aspiration Infectious pneumonia Severe trauma Surface burns Multiple blood transfusions Leukoagglutin reactions Pancreatitis Drug overdose Near drowning Smoke inhalation Cardiopulmonary bypass Pulmonary contusion Multiple Fractures Following upper airway obstruction Following bone marrow transplantation Drug reaction Venous air embolism Amniotic fluid embolism Neurogenic pulmonary edema Acute eosinophilic pneumonia* Bronchiolitis obliterans organizing pneumonia (BOOP) *Miliary tuberculosis* Baby Lung Lung available for oxygenation is reduced Collapsed alveoli Surfactant dysfunction Filling with debris Use smaller tidal volumes ARDS Net Compared 6 cc/kg vs 12 cc/kg Volume A/C Available on the most ventilators 31% vs 40% mortality Plateau Pressures <30 cm H 2 O associated with less volu/barotrauma N Engl J Med 2000 May 4;342(18):

57 Case yr 50 kg female intubated for respiratory failure from pancreatitis Volume SIMV V T =600 ml, Rate=20/20, PSV=14, PEEP=6, FiO 2 =80% P Peak = 42cm H 2 O P plat =34 cm H 2 O 7.28/45/60 sat=88% P PL =34 cm H 2 O Too high? 7.28/45/60 sat=88% V E =12 L/M Need to decrease alveolar pressures and maintain V E Volume A/C V T =600 ml, Rate=18/18, PEEP=6 P Peak = 42 cm H 2 O P plat =34 cm H 2 O 7.28/45/60 sat=88% V E =11 L/M Alveoli are overdistended Need to decrease V T Currently at 11 ml/kg What effect will dropping V T have on V E? 57

58 Case Reduce V T to 6 cc/kg (300 cc) Lowers alveolar pressures Want to keep the same V E (11 L/M) Need to double RR to 40 A little fast I limit RR to around 35 Permissive Hypercapnea Allow pco 2 to rise as long as oxygenation adequate To maintain ph, bicarb drip may be needed Ai 20 r w a y P re s s ur e 5 0 Time Ai 20 r w a y P re s s ur e 5 0 PEEP EPAP CPAP Expiratory Release Pressure Time PEEP: Positive End-Expiratory Pressure EPAP: Expiratory Positive Airway Pressure CPAP: Continuous Positive Airway Pressure 58

59 Ai 20 r w a y P re s s ur e 5 0 Inspiratory Pressure (I P ) Pressure P (P P ) PEEP H IPAP Time PEEP H : High PEEP Pressure P : Peak Pressure IPAP: Inspiratory Positive Airway Pressure Ai 20 r w a y P re s s ur e 5 P Driving Pressure Pressure Support 0 Time P: Change in Pressure Case yr male with abd pain of 2 days duration, distended Alert, severe distress 75% on NRB, 7.35/40/40 CXR: diffuse infiltrates

60 Game plan Improve oxygenation Patient is alert and awake Try NIPPV 178 NIPPV PEEP/EPAP to recruit more alveoli and increase oxygenation How much? Guess 5 cm H 2 O is not much 10 cm H 2 O? 179 Case continued Saturations improve to 94% on 100% O 2 and 10 cm H 2 O PEEP

61 Patient is becoming more agitated and confused, fighting mask and machine Sedated with Fentanyl/ativan 7.20/55 sat=91% Respiratory acidosis Need to increase V E 181 Want to increase V E and decrease WOB PS/IPAP 10 cm H 2 O 20 cm H 2 O IPAP/10 cm H 2 O EPAP Tidal volume increases, V E increases 7.35/42 Sat=94% 182 Patient is becoming more agitated and confused, fighting mask and machine Decreased LOC 7.20/55 sat=86% Respiratory acidosis

62 Can use meds Now with decreased LOC Airway is uncertain Intubation Etomidate/Rocuronium followed by propofol/ativan =/- Fentanyl to improve comfort 184 Vent Settings Game plan Improve oxygenation Decrease WOB, improve respiratory acidosis V E =12 l/m V T = 500 ml RR= Volume A/C V T = 500 ml RR=24 V E =12 l/m PEEP=10 cm H 2 O Pressure A/C ΔP=16, T insp =.96 Yielding V T = 500 ml RR=24 V E =12 l/m PEEP=10 cm H 2 O

63 Volume SIMV with PSV Pressure SIMV with PSV VC+ A/C VC+ SIMV with PSV not PSV until paralytic has worn off 187 Volume A/C V E =12 l/m V T = 500 ml RR=24 PEEP=10 cm H 2 O Plateau=32 cm H 2 O Over distended alveoli 188 Volume A/C V E =12 l/m V T = 500 ml RR=24 PEEP=10 cm H 2 O Plateau=32 cm H 2 O Over distended alveoli V E =12 l/m V T = 400 ml RR=30 PEEP=10 cm H 2 O Plateau=26 cm H 2 O

64 Volume A/C Levophed at 30 μg/min, Vasopressin.4 u/hr Ativan 5 mg/hr, fent 100 μg/hr, systolic 85 Pt is outstripping flow with increased WOB 190 Pressure A/C Allows variable Flow and Volume Solves outstripping and decreases WOB ΔP=14 cm H 2 O, T insp =.96 sec Yielding V T = 400 ml RR=30 V E =12 l/m PEEP=10 cm H 2 O 191 Case 15, continued Patient eventually went to the OR for perforated bowel, developed shock and ARDS Day 7: 40%, PEEP=5 cm H 2 O, Volume SIMV 450 cc, Rate=18/20 Patient arousable to verbal stimulation, follows simple commands Hemodynamically stable 64

65 How Do you decide if a patient no longer needs the vent? Underlying process must be significantly improved Hemodynamically stable Able to cough and maintain airway FiO 2 < 50% & PEEP< 8 cm H 2 O We want to impose a work of breathing on the patient similar to what he would do off the ventilator Weaning Parameters Rapid Shallow Breathing Index (RSBI) Yang 1991 RR/VT<105 Highly predictive of successful extubation 194 Spontaneous Breathing Trials (SBT) No rate is set Patient is allowed to breath on his own T-Piece CPAP PSV Watch patient for signs of intolerance Tachycardia, hypotension, agitation, distress, drop in tidal volumes, increase in respiratory rate, retractions 65

66 T-Piece Trials Humidified O 2 Pt disconnected from vent because work to overcome demand valves was high (before PSV) Pt breaths for minutes CPAP Trials Zero rate, PEEP=5 PSV=0 Have use of alarms, less hassle, quickly return to full support PSV=8 to overcome resistance of tubing Can no longer call it CPAP-now PSV Pt breaths for minutes Pressure Support Trials Patient is placed in Pressure Support Mode-no rate Pressure Support is set at 4-8 cm H 2 O Pt breaths for minutes 66

67 How do you wean from Volume A/C 12/14 V T =450? Decreasing the rate has little effect Breaths are Assisted and Controlled Work to trigger is minimal Use SBT Some people switch to SIMV to wean. Weaning Strategies Recondition respiratory muscles Similar to increasing exercise capacity in normals Which weaning method is best Daily T-piece trials, multiple daily T-piece trials, Decrease SIMV rate, PSV Weaning Literature 76% extubate at first t-piece trial Does every patient need to be weaned? Weaning concept is replaced with Liberation concept. PSV and t-piece trials are equal and both faster than SIMV weans 67

68 Wean Volume targeted SIMV with PSV Rate decreased to 20 Rate decreased to 18 Rate decreased to 10 Rate decreased to 2 Is the patient ready to extubate? Volume targeted SIMV with PSV Rate 20/20-100% volume breaths 18/20-90% volume/10% PSV 10/20-50% volume/50% PSV 2/20-10% volume/90% PSV PSV of 10 may significantly support a patient SIMV Wean (no PSV) Rate 20/20-100% volume breaths 18/20-90% volume/10% Patient 10/20-50% volume/50% Patient 2/20-10% volume/90% Patient Ends in T-Piece or CPAP trial This gradually demonstrates patient s ability to handle Work of Breathing 68

69 Sample Liberation Protocol Any patient with FiO 2 50%, PEEP 6 Hemodynamically stable (no pressors) Initiated by RT-No physician order required Coordinate with nurse optimal sedation SBT with T-piece, PSV 4-8, CPAP or TC RSBI calculated REVIEW 206 Volume ventilation Volume set, Flow set, Pressure variable PTX results in a rise in Peak pressure High P peak : consider upper airway resistance (ETT size, bronchospasm, biting tube) and alveolar distension (decreasing tidal volume or PEEP, mainstem intubation)

70 Pressure ventilation Pressure set, Volume and Flow variable PTX results in drop in tidal volume V T is increased by increasing P or increasing T insp T insp can be set directly or from I:E For a rate=15, Resp cycle length is 4 sec (60 sec/15=4 sec) 1:3 with means T insp =1sec Normal T insp for adults is 1 secondish Infants.3 seconds 208 Normal V E is 6-8 L/M Needs to be higher in lung disease and metabolic acidosis p 1 V 1 =p 2 V 2 (Boyle s Law) (pco 2 ) (V E )= (pco 2 ) (V E ) 209 A/C: gives a minimum number of breaths and as many of those same breaths above the set rate as the patient wants. SIMV: gives a set number of set breaths and PSV breaths in between set breaths

71 NIPPV case-use peep for oxygenation, use PS for augemtation of ventilation

Indications for Mechanical Ventilation. Mechanical Ventilation. Indications for Mechanical Ventilation. Modes. Modes: Volume cycled

Indications for Mechanical Ventilation. Mechanical Ventilation. Indications for Mechanical Ventilation. Modes. Modes: Volume cycled Mechanical Ventilation Eric A. Libré, MD VCU School of Medicine Inova Fairfax Hospital and VHC Indications for Mechanical Ventilation Inadequate ventilatory effort Rising pco2 with resp acidosis (7.25)

More information

Mechanical Ventilation. Mechanical Ventilation is a Drug!!! is a drug. MV: Indications for use. MV as a Drug: Outline. MV: Indications for use

Mechanical Ventilation. Mechanical Ventilation is a Drug!!! is a drug. MV: Indications for use. MV as a Drug: Outline. MV: Indications for use Mechanical Ventilation is a Drug!!! Mechanical Ventilation is a drug I am an employee of Philips Healthcare Hospital Respiratory Care Group and they help me pay for my kids education Jim Laging, RRT, RCP

More information

Basics of Mechanical Ventilation. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity

Basics of Mechanical Ventilation. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Basics of Mechanical Ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Overview of topics 1. Goals 2. Settings 3. Modes 4. Advantages and disadvantages

More information

Objectives. Respiratory Failure : Challenging Cases in Mechanical Ventilation. EM Knows Respiratory Failure!

Objectives. Respiratory Failure : Challenging Cases in Mechanical Ventilation. EM Knows Respiratory Failure! Respiratory Failure : Challenging Cases in Mechanical Ventilation Peter DeBlieux, MD, FAAEM, FACEP LSUHSC University Hospital Pulmonary and Critical Care Medicine Emergency Medicine pdebli@lsuhsc.edu Objectives

More information

Mechanical Ventilation. Which of the following is true regarding ventilation? Basics of Ventilation

Mechanical Ventilation. Which of the following is true regarding ventilation? Basics of Ventilation Mechanical Ventilation Jeffrey L. Wilt, MD, FACP, FCCP Associate Professor of Medicine Michigan State University Associate Program Director MSU-Grand Rapids Internal Medicine Residency Which of the following

More information

Mechanical Ventilation. Flow-Triggering. Flow-Triggering. Advanced Concepts. Advanced Concepts in Mechanical Ventilation

Mechanical Ventilation. Flow-Triggering. Flow-Triggering. Advanced Concepts. Advanced Concepts in Mechanical Ventilation Mechanical Ventilation Advanced Concepts in Mechanical Ventilation Flow-Triggering Trigger = the variable that causes the vent to begin the inspiratory phase Common triggers 1-2- 3- Effort required to

More information

PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: INSTRUCTOR:

PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: INSTRUCTOR: PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: 1. **Identify and name the filters on the 7200ae. 2. **Explain how each filter is sterilized. 3. **Trace the gas flow through the ventilator

More information

Selecting the Ventilator and the Mode. Chapter 6

Selecting the Ventilator and the Mode. Chapter 6 Selecting the Ventilator and the Mode Chapter 6 Criteria for Ventilator Selection Why does the patient need ventilatory support? Does the ventilation problem require a special mode? What therapeutic goals

More information

VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL

VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya Senior Specialist and Director ED Training Clinical Lecturer, Australian National

More information

Using Common Ventilator Graphics to Provide Optimal Ventilation

Using Common Ventilator Graphics to Provide Optimal Ventilation Using Common Ventilator Graphics to Provide Optimal Ventilation David Vines, MHS, RRT, FAARC Associate Professor Chair / Program Director Department of Respiratory Care RUSH UNIVERSITY MEDICAL CENTER Disclosure

More information

ONLINE DATA SUPPLEMENT. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg

ONLINE DATA SUPPLEMENT. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg APPENDIX 1 Appendix 1. Complete respiratory protocol. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg predicted body weight (PBW)) (NEJM 2000; 342

More information

4/2/2017. Sophisticated Modes of Mechanical Ventilation - When and How to Use Them. Case Study 1. Case Study 1. ph 7.17 PCO 2 55 PO 2 62 HCO 3

4/2/2017. Sophisticated Modes of Mechanical Ventilation - When and How to Use Them. Case Study 1. Case Study 1. ph 7.17 PCO 2 55 PO 2 62 HCO 3 Sophisticated Modes of Mechanical entilation - When and How to Use Them Dr. Leanna R. Miller DNP, RN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP LRM Consulting Nashville, TN Case Study 1 A 55 year-old man

More information

Mechanical Ventilation

Mechanical Ventilation Mechanical Ventilation Chapter 4 Mechanical Ventilation Equipment When providing mechanical ventilation for pediatric casualties, it is important to select the appropriately sized bag-valve mask or endotracheal

More information

Mechanical Ventilation

Mechanical Ventilation Mechanical Ventilation Understanding Modes Rob Chatburn, RRT-NPS, FAARC Research Manager Respiratory Therapy Cleveland Clinic Associate Professor Case Western Reserve University 1 Overview Characteristics

More information

The Basics of Ventilator Management. Overview. How we breath 3/23/2019

The Basics of Ventilator Management. Overview. How we breath 3/23/2019 The Basics of Ventilator Management What are we really trying to do here Peter Lutz, MD Pulmonary and Critical Care Medicine Pulmonary Associates, Mobile, Al Overview Approach to the physiology of the

More information

MEDICAL EQUIPMENT IV MECHANICAL VENTILATORS. Prof. Yasser Mostafa Kadah

MEDICAL EQUIPMENT IV MECHANICAL VENTILATORS. Prof. Yasser Mostafa Kadah MEDICAL EQUIPMENT IV - 2013 MECHANICAL VENTILATORS Prof. Yasser Mostafa Kadah Mechanical Ventilator A ventilator is a machine, a system of related elements designed to alter, transmit, and direct energy

More information

Pressure Controlled Modes of Mechanical Ventilation

Pressure Controlled Modes of Mechanical Ventilation Pressure Controlled Modes of Mechanical Ventilation Christopher Junker Department of Anesthesiology & Critical Care Medicine George Washington University Saturday, August 20, 2011 Assist Control Hypoxemic

More information

VENTILATORS PURPOSE OBJECTIVES

VENTILATORS PURPOSE OBJECTIVES VENTILATORS PURPOSE To familiarize and acquaint the transfer Paramedic with the skills and knowledge necessary to adequately maintain a ventilator in the interfacility transfer environment. COGNITIVE OBJECTIVES

More information

Notes on BIPAP/CPAP. M.Berry Emergency physician St Vincent s Hospital, Sydney

Notes on BIPAP/CPAP. M.Berry Emergency physician St Vincent s Hospital, Sydney Notes on BIPAP/CPAP M.Berry Emergency physician St Vincent s Hospital, Sydney 2 DEFINITIONS Non-Invasive Positive Pressure Ventilation (NIPPV) Encompasses both CPAP and BiPAP Offers ventilation support

More information

APRV: Moving beyond ARDSnet

APRV: Moving beyond ARDSnet APRV: Moving beyond ARDSnet Matthew Lissauer, MD Associate Professor of Surgery Medical Director, Surgical Critical Care Rutgers, The State University of New Jersey What is APRV? APRV is different from

More information

RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE

RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Pulmonary Function and

More information

Principles of mechanical ventilation. Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands

Principles of mechanical ventilation. Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands Principles of mechanical ventilation Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands Disclosure Research grant Chiesi Pharmaceuticals Research grant CareFusion GA: 27 weeks,

More information

INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES

INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES PROVIDE THE DEFINITION FOR BI-VENT EXPLAIN THE BENEFITS OF BI-VENT EXPLAIN SET PARAMETERS IDENTIFY RECRUITMENT IN APRV USING

More information

Initiation and Management of Airway Pressure Release Ventilation (APRV)

Initiation and Management of Airway Pressure Release Ventilation (APRV) Initiation and Management of Airway Pressure Release Ventilation (APRV) Eric Kriner RRT Pulmonary Critical Care Clinical Specialist Pulmonary Services Department Medstar Washington Hospital Center Disclosures

More information

Author: Thomas Sisson, MD, 2009

Author: Thomas Sisson, MD, 2009 Author: Thomas Sisson, MD, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/

More information

NOTE: If not used, provider must document reason(s) for deferring mechanical ventilation in a patient with an advanced airway

NOTE: If not used, provider must document reason(s) for deferring mechanical ventilation in a patient with an advanced airway APPENDIX: TITLE: Mechanical Ventilator Use REVISED: November 1, 2017 I. Introduction: Mechanical Ventilation is the use of an automated device to deliver positive pressure ventilation to a patient. Proper

More information

Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo

Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo Link full download: http://testbankcollection.com/download/pilbeams-mechanicalventilation-physiological-and-clinical-applications-5th-edition-test-bank-cairo

More information

Invasive mechanical ventilation:

Invasive mechanical ventilation: Invasive mechanical ventilation definition mechanical ventilation: using an apparatus to facilitate transport of oxygen and CO2 between the atmosphere and the alveoli for the purpose of enhancing pulmonary

More information

EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES

EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES GENERAL PROVISIONS: EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES Individuals providing Inter-facility transport with Mechanical Ventilator must have successfully completed

More information

Advanced Ventilator Modes. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine

Advanced Ventilator Modes. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Advanced Ventilator Modes Shekhar T. Venkataraman M.D. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Advanced modes Pressure-Regulated

More information

Guide to Understand Mechanical Ventilation Waveforms

Guide to Understand Mechanical Ventilation Waveforms Do No Harm Ventilate Gently Guide to Understand Mechanical Ventilation Waveforms Middle East Critical Care Assembly 1/30/2015 Mazen Kherallah, MD, FCCP http://www.mecriticalcare.net Email: info@mecriticalcare.net

More information

Accumulation of EEV Barotrauma Affect hemodynamic Hypoxemia Hypercapnia Increase WOB Unable to trigger MV

Accumulation of EEV Barotrauma Affect hemodynamic Hypoxemia Hypercapnia Increase WOB Unable to trigger MV Complicated cases during mechanical ventilation Pongdhep Theerawit M.D. Pulmonary and Critical Care Division Ramathibodi Hospital Case I Presentation Male COPD 50 YO, respiratory failure, on mechanical

More information

Presentation Overview. Monitoring Strategies for the Mechanically Ventilated Patient. Early Monitoring Strategies. Early Attempts To Monitor WOB

Presentation Overview. Monitoring Strategies for the Mechanically Ventilated Patient. Early Monitoring Strategies. Early Attempts To Monitor WOB Monitoring Strategies for the Mechanically entilated Patient Presentation Overview A look back into the future What works and what may work What s all the hype about the WOB? Are ventilator graphics really

More information

Capnography in the Veterinary Technician Toolbox. Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA

Capnography in the Veterinary Technician Toolbox. Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA Capnography in the Veterinary Technician Toolbox Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA What are Respiration and Ventilation? Respiration includes all those chemical and physical

More information

Neonatal tidal volume targeted ventilation

Neonatal tidal volume targeted ventilation Neonatal tidal volume targeted ventilation Colin Morley Retired Professor of Neonatal Medicine, Royal Women s Hospital, Melbourne, Australia. Honorary Visiting Fellow, Dept Obstetrics and Gynaecology,

More information

Potential Conflicts of Interest Received research grants from Hamilton, Covidien, Drager, General lel Electric, Newport, and Cardinal Medical Received

Potential Conflicts of Interest Received research grants from Hamilton, Covidien, Drager, General lel Electric, Newport, and Cardinal Medical Received How Does a Mechanical Ventilator t 6-22-10 Spain Work? Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Potential Conflicts of Interest Received research

More information

Flight Medical presents the F60

Flight Medical presents the F60 Flight Medical presents the F60 Reliable Ventilation Across the Spectrum of Care Adult & Pediatric Pressure/Volume Control Basic/Advanced Modes Invasive/NIV High Pressure/Low Flow O2 Up to 12 hours batteries

More information

excellence in care Procedure Management of patients with difficult oxygenation. For Review Aug 2015

excellence in care Procedure Management of patients with difficult oxygenation. For Review Aug 2015 Difficult Oxygenation HELI.CLI.12 Purpose This procedure describes the processes and procedures for a lung protective strategy in the mechanical ventilation of patients that are difficult to oxygenate

More information

Chapter 4: Ventilation Test Bank MULTIPLE CHOICE

Chapter 4: Ventilation Test Bank MULTIPLE CHOICE Instant download and all chapters Test Bank Respiratory Care Anatomy and Physiology Foundations for Clinical Practice 3rd Edition Will Beachey https://testbanklab.com/download/test-bank-respiratory-care-anatomy-physiologyfoundations-clinical-practice-3rd-edition-will-beachey/

More information

Respiratory Failure & Mechanical Ventilation. Denver Health Medical Center Department of Surgery and the University Of Colorado Denver

Respiratory Failure & Mechanical Ventilation. Denver Health Medical Center Department of Surgery and the University Of Colorado Denver Respiratory Failure & Mechanical Ventilation Denver Health Medical Center Department of Surgery and the University Of Colorado Denver + + Failure of the Respiratory Pump 1. Lack of patent airway 2. Bronchospasm

More information

Introduction to Conventional Ventilation

Introduction to Conventional Ventilation Introduction to Conventional Ventilation Dr Julian Eason Consultant Neonatologist Derriford Hospital Mechanics Inspiration diaphragm lowers and thorax expands Negative intrathoracic/intrapleural pressure

More information

Disclosures. The Pediatric Challenge. Topics for Discussion. Traditional Anesthesia Machine. Tidal Volume = mls/kg 2/13/14

Disclosures. The Pediatric Challenge. Topics for Discussion. Traditional Anesthesia Machine. Tidal Volume = mls/kg 2/13/14 2/13/14 Disclosures Optimal Ventilation of the Pediatric Patient in the OR Consulting Draeger Medical Jeffrey M. Feldman, MD, MSE Division Chief, General Anesthesia Dept. of Anesthesiology and Critical

More information

Physiological Basis of Mechanical Ventilation

Physiological Basis of Mechanical Ventilation Physiological Basis of Mechanical Ventilation Wally Carlo, M.D. University of Alabama at Birmingham Department of Pediatrics Division of Neonatology wcarlo@peds.uab.edu Fine Tuning Mechanical Ventilation

More information

Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X

Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X HELICOPTER OPERATING PROCEDURE HOP No: C/12 Issued: May 2011 Page: 1 of 5 Revision No: Original Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X TRIM No: 09/300 Document No: D10/9973 X

More information

UNDERSTANDING NEONATAL WAVEFORM GRAPHICS. Brandon Kuehne, MBA, RRT-NPS, RPFT Director- Neonatal Respiratory Services

UNDERSTANDING NEONATAL WAVEFORM GRAPHICS. Brandon Kuehne, MBA, RRT-NPS, RPFT Director- Neonatal Respiratory Services UNDERSTANDING NEONATAL WAVEFORM GRAPHICS Brandon Kuehne, MBA, RRT-NPS, RPFT Director- Neonatal Respiratory Services Disclosures Purpose: To enhance bedside staff s knowledge of ventilation and oxygenation

More information

Automatic Transport Ventilator

Automatic Transport Ventilator Automatic Transport Ventilator David M. Landsberg, MD, FACP, FCCP, EMT-P Luke J. Gasowski, RRT, NPS, ACCS, CCP-C, FP-C Christopher J. Fullagar, MD, FACEP, EMT-P Stan Goettel, MS, EMT-P Author credits /

More information

The physiological functions of respiration and circulation. Mechanics. exercise 7. Respiratory Volumes. Objectives

The physiological functions of respiration and circulation. Mechanics. exercise 7. Respiratory Volumes. Objectives exercise 7 Respiratory System Mechanics Objectives 1. To explain how the respiratory and circulatory systems work together to enable gas exchange among the lungs, blood, and body tissues 2. To define respiration,

More information

Ventilating the Sick Lung Mike Dougherty RRT-NPS

Ventilating the Sick Lung Mike Dougherty RRT-NPS Ventilating the Sick Lung 2018 Mike Dougherty RRT-NPS Goals and Objectives Discuss some Core Principles of Ventilation relevant to mechanical ventilation moving forward. Compare and Contrast High MAP strategies

More information

Managing Patient-Ventilator Interaction in Pediatrics

Managing Patient-Ventilator Interaction in Pediatrics Managing Patient-Ventilator Interaction in Pediatrics Robert L. Chatburn, MHHS, RRT-NPS, FAARC Clinical Research Manager - Section of Respiratory Therapy Professor of Medicine Case Western Reserve University

More information

Mechanical ven3la3on. Neonatal Mechanical Ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on 8/25/11. What we need to do"

Mechanical ven3la3on. Neonatal Mechanical Ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on 8/25/11. What we need to do 8/25/11 Mechanical ven3la3on Neonatal Mechanical Ven3la3on Support oxygen delivery, CO2 elimination" Prevent added injury, decrease ongoing injury" Enhance normal development" Mark C Mammel, MD University

More information

New Frontiers in Anesthesia Ventilation. Brent Dunworth, MSN, CRNA. Anesthesia Ventilation. New Frontiers in. The amount of gas delivered can be

New Frontiers in Anesthesia Ventilation. Brent Dunworth, MSN, CRNA. Anesthesia Ventilation. New Frontiers in. The amount of gas delivered can be New Frontiers in Anesthesia Ventilation Senior Director, Nurse Anesthesia Department of Anesthesiology University of Pittsburgh Medical Center Content Outline 1 2 Anesthesia Evolution Anesthesia Evolution

More information

Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo

Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo Link full download: http://testbankair.com/download/test-bank-for-pilbeams-mechanicalventilation-physiological-and-clinical-applications-6th-edition-by-cairo/

More information

Ventilators. Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course

Ventilators. Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course Ventilators Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course Objectives Discuss Classification/ terminology Look at Modes of ventilation How some specific ventilators work

More information

Mechanical Ventilation of the Patient with ARDS

Mechanical Ventilation of the Patient with ARDS 1 Mechanical Ventilation of the Patient with ARDS Dean Hess, PhD, RRT, FAARC Assistant Professor of Anesthesia Harvard Medical School Assistant Director of Respiratory Care Massachusetts General Hospital

More information

Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation.

Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation. Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation. Paradoxical breathing Hyper-resonance on percussion:

More information

OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION

OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION L. Rudo Mathivha Intensive Care Unit Chris Hani Baragwanath Aacademic Hospital & the University of the Witwatersrand OUTLINE Introduction Goals & Indications

More information

QUICK REFERENCE GUIDE

QUICK REFERENCE GUIDE cm H O 2 cm H O 2 cm HO 2 PSI cm H O 2 ON OFF UPPER LIMIT LOWER LIMIT UPPER LIMIT LOWER LIMIT LIFE PULSE HIGH-FREQUENCY VENTILATOR QUICK REFERENCE GUIDE 01388-08.11 MONITOR PIP JET VALVE ALARMS READY SILENCE

More information

PROCEDURE (TASK): ROUTINE VENTILATOR CHECK. 5. Verifies current ventilator Insures correspondence between physician's

PROCEDURE (TASK): ROUTINE VENTILATOR CHECK. 5. Verifies current ventilator Insures correspondence between physician's PROCEDURE (TASK): ROUTINE VENTILATOR CHECK I. KEY PERFORMANCE ELEMENTS Procedural Element (Step): Description of Performance: 5. Verifies current ventilator Insures correspondence between physician's settings

More information

Bunnell LifePulse HFV Quick Reference Guide # Bunnell Incorporated

Bunnell LifePulse HFV Quick Reference Guide # Bunnell Incorporated Bunnell Incorporated n www.bunl.com n 800-800-4358 (HFJV) n info@bunl.com 436 Lawndale Drive n Salt Lake City, Utah 84115 n intl 801-467-0800 n f 801-467-0867 Bunnell LifePulse HFV Quick Reference Guide

More information

Simulation 10: 27 Year-Old Male Trauma Patient

Simulation 10: 27 Year-Old Male Trauma Patient Simulation 10: 27 Year-Old Male Trauma Patient Flow Chart Opening Scenario Section 1 Type: IG Handed off 27 YO male with blunt chest trauma/pulmonary contusions on PC A/C ventilation; PIP = 30 cm H2O,

More information

Introduction. Respiration. Chapter 10. Objectives. Objectives. The Respiratory System

Introduction. Respiration. Chapter 10. Objectives. Objectives. The Respiratory System Introduction Respiration Chapter 10 The Respiratory System Provides a means of gas exchange between the environment and the body Plays a role in the regulation of acidbase balance during exercise Objectives

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation

More information

Panther 5 Acute Care Ventilator

Panther 5 Acute Care Ventilator 1 HIGHLIGHTS High performance and advanced features target the ICU environment Utilizes an internal blower with a specially designed flow control valve removing the need for using compressed air without

More information

OXYGEN THERAPY. (Non-invasive O2 therapy in patient >8yrs)

OXYGEN THERAPY. (Non-invasive O2 therapy in patient >8yrs) OXYGEN THERAPY (Non-invasive O2 therapy in patient >8yrs) Learning aims Indications and precautions for O2 therapy Targets of therapy Standard notation O2 delivery devices Taps, tanks and tubing Notation

More information

6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge

6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge 6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists Course Test Results for the accreditation of the acquired knowledge Q. Concerning the mechanics of the newborn s respiratory

More information

RESPIRATORY PHYSIOLOGY. Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie

RESPIRATORY PHYSIOLOGY. Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie RESPIRATORY PHYSIOLOGY Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie Outline Ventilation Diffusion Perfusion Ventilation-Perfusion relationship Work of breathing Control of Ventilation 2 This image

More information

AUTOVENT 4000 VENTILATOR

AUTOVENT 4000 VENTILATOR OVERVIEW AUTOVENT 4000 Only properly trained and approved Escambia County Bureau of Public Safety Paramedics are to use the AutoVent 4000 ventilator manufactured by LSP to transport patients already on

More information

Collin County Community College. Lung Physiology

Collin County Community College. Lung Physiology Collin County Community College BIOL. 2402 Anatomy & Physiology WEEK 9 Respiratory System 1 Lung Physiology Factors affecting Ventillation 1. Airway resistance Flow = Δ P / R Most resistance is encountered

More information

Understanding and comparing modes of ventilation

Understanding and comparing modes of ventilation Understanding and comparing modes of ventilation Löwenstein Medical GmbH & Co. KG Content Volume-Controlled Ventilation Modes VCV PLV VC-SIMV Optional VCV Flexible VCV Pressure-Controlled Ventilation Modes

More information

SLE5000 Infant Ventilator with HFO

SLE5000 Infant Ventilator with HFO SLE5000 Infant Ventilator with HFO When the smallest thing matters SLE5000 - The Total Solution for Infant Ventilation Shown on optional roll stand. Ventilator may be mounted either way round on stand.

More information

NSQIP showed that the University of Utah was a high outlier in for patients receiving >48 cumulative hours of mechanical ventilation.

NSQIP showed that the University of Utah was a high outlier in for patients receiving >48 cumulative hours of mechanical ventilation. A multidisciplinary quality improvement approach to ventilator management results in decreased ventilator times and a reduction in ventilator associated pneumonia Gillian eton MD, teven Johnson MBA, Gabriele

More information

Virginia Beach EMS. Oxylator EMX. Debra H. Brennaman, RN, MPA, NREMT-P

Virginia Beach EMS. Oxylator EMX. Debra H. Brennaman, RN, MPA, NREMT-P Virginia Beach EMS Oxylator EMX Debra H. Brennaman, RN, MPA, NREMT-P Oxylator EMX Overview Patient responsive oxygen powered resuscitation / ventilation device intended to provide emergency ventilatory

More information

Peter Kremeier, Christian Woll. 2nd. Understanding and comparing modes of ventilation. The Kronberg List of Ventilation Modes

Peter Kremeier, Christian Woll. 2nd. Understanding and comparing modes of ventilation. The Kronberg List of Ventilation Modes Extended Edition Revised and 2nd Peter Kremeier, Christian Woll Understanding and comparing modes of ventilation The Kronberg List of Ventilation Modes Contents Preface... 3 Comparison Table - Parameters...6

More information

LAB 7 HUMAN RESPIRATORY LAB. Complete the charts on pgs. 67 and 68 and read directions for using BIOPAC

LAB 7 HUMAN RESPIRATORY LAB. Complete the charts on pgs. 67 and 68 and read directions for using BIOPAC 66 LAB 7 HUMAN RESPIRATORY LAB Assignments: Due before lab: Quiz: Three Respiratory Interactive Physiology Animations pages 69 73. Complete the charts on pgs. 67 and 68 and read directions for using BIOPAC

More information

Lab 3. The Respiratory System (designed by Heather E. M. Liwanag with T.M. Williams)

Lab 3. The Respiratory System (designed by Heather E. M. Liwanag with T.M. Williams) Name Lab Partners Lab 3. The Respiratory System (designed by Heather E. M. Liwanag with T.M. Williams) Part 1. Lung Volumes and Capacities Objectives 1. Obtain graphical representation of lung capacities

More information

VENTIlogic LS VENTIlogic plus. 100 % Mobility and Reliability in IV and NIV

VENTIlogic LS VENTIlogic plus. 100 % Mobility and Reliability in IV and NIV VENTIlogic LS VENTIlogic plus 100 % Mobility and Reliability in IV and NIV VENTIlogic VENTIlog LS Your Requirements for Reliability and Mobility are Our Benchmark. VENTIlogic LS and VENTIlogic plus are

More information

mechanical ventilation Arjun Srinivasan

mechanical ventilation Arjun Srinivasan Respiratory mechanics in mechanical ventilation Arjun Srinivasan Introduction Mechanics during ventilation PV curves Application in health & disease Difficulties & pitfalls The future. Monitoring Mechanics

More information

Module Two. Objectives: Objectives cont. Objectives cont. Objectives cont.

Module Two. Objectives: Objectives cont. Objectives cont. Objectives cont. Transition to the New National EMS Education Standards: EMT-B B to EMT Module Two Objectives: Upon completion, each participant will do the following to a degree of accuracy that meets the Ntl EMS Education

More information

PHTY 300 Wk 1 Lectures

PHTY 300 Wk 1 Lectures PHTY 300 Wk 1 Lectures Arterial Blood Gas Components The test provides information on - Acid base balance - Oxygenation - Hemoglobin levels - Electrolyte blood glucose, lactate, renal function When initially

More information

Technical Data and Specifications

Technical Data and Specifications Technical Data and Specifications INTENDED USE Ventilator designed to provide Invasive and Non-invasive ventilation for the critical care management of adult, pediatric and neonate-infant (including premature)

More information

Test your PICU/ NICU/ CHSU Knowledge

Test your PICU/ NICU/ CHSU Knowledge Test your PICU/ NICU/ CHSU Knowledge 1. On the LTV 1150 you have a 12-year-old trach patient. You are adding in 2 liters of 100% Oxygen through the flow inlet. The patient s spontaneous respiratory rate

More information

Neonatal Assisted Ventilation. Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI.

Neonatal Assisted Ventilation. Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI. Neonatal Assisted Ventilation Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI. History of Assisted Ventilation Negative pressure : Spirophore developed in 1876 with manual device to create negative

More information

VENTIlogic LS VENTIlogic plus. 100 % Mobility and Reliability in IV and NIV

VENTIlogic LS VENTIlogic plus. 100 % Mobility and Reliability in IV and NIV VENTIlogic LS VENTIlogic plus 100 % Mobility and Reliability in IV and NIV VENTIlogic LS VENTIlogic plus Your requirements for reliability and mobility are our benchmark. VENTIlogic LS and VENTIlogic plus

More information

http://www.priory.com/cmol/hfov.htm INTRODUCTION The vast majority of patients who are admitted to an Intensive Care Unit (ICU) will need artificial ventilation (Jones et al 1998). The usual means through

More information

For more information about how to cite these materials visit

For more information about how to cite these materials visit Author(s): Louis D Alecy, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/

More information

Trust Guideline for Neonatal Volume Guarantee Ventilation (VGV)

Trust Guideline for Neonatal Volume Guarantee Ventilation (VGV) A Clinical Guideline For Use in: By: For: Division responsible for document: Key words: Name of document author: Job title of document author: Name of document author s Line Manager: Job title of author

More information

Driving Pressure. What is it, and why should you care?

Driving Pressure. What is it, and why should you care? Driving Pressure What is it, and why should you care? Jonathan Pak MD March 2, 2017 Lancet 1967; 290: 319-323 Traditional Ventilation in ARDS Tidal Volume (V T ) = 10-15 ml/kg PBW PEEP = 5-12 cm H 2 O

More information

BREATHING AND EXCHANGE OF GASES

BREATHING AND EXCHANGE OF GASES 96 BIOLOGY, EXEMPLAR PROBLEMS CHAPTER 17 BREATHING AND EXCHANGE OF GASES MULTIPLE CHOICE QUESTIONS 1. Respiration in insects is called direct because a. The cell exchange O 2 directly with the air in the

More information

Manual: Biphasic Positive Airway Pressure (BiPAP) Ventilation

Manual: Biphasic Positive Airway Pressure (BiPAP) Ventilation RCH@Home Manual: Biphasic Positive Airway Pressure (BiPAP) Ventilation 1. Commonly used terms... 2 1.1 Inspiration... 2 1.2 Expiration... 2 1.3 Breath rate (bpm)... 2 1.4 Ventilation... 2 1.5 Biphasic

More information

Physiology Unit 4 RESPIRATORY PHYSIOLOGY

Physiology Unit 4 RESPIRATORY PHYSIOLOGY Physiology Unit 4 RESPIRATORY PHYSIOLOGY In Physiology Today Respiration External respiration ventilation gas exchange Internal respiration cellular respiration gas exchange Respiratory Cycle Inspiration

More information

TESTCHEST RESPIRATORY FLIGHT SIMULATOR SIMULATION CENTER MAINZ

TESTCHEST RESPIRATORY FLIGHT SIMULATOR SIMULATION CENTER MAINZ TESTCHEST RESPIRATORY FLIGHT SIMULATOR SIMULATION CENTER MAINZ RESPIRATORY FLIGHT SIMULATOR TestChest the innovation of lung simulation provides a breakthrough in respiratory training. 2 Organis is the

More information

Respiratory System Lab

Respiratory System Lab Respiratory System Lab Note: Review the safety materials and wear goggles when working with chemicals. Read the entire exercise before you begin. Take time to organize the materials you will need and set

More information

Charles W Sheppard MD Medical Director Mercy Life Line Mercy Kids Transport Springfield MO net

Charles W Sheppard MD Medical Director Mercy Life Line Mercy Kids Transport Springfield MO net Charles W Sheppard MD Medical Director Mercy Life Line Mercy Kids Transport Springfield MO Charles.Sheppard@mercy. net No Conflicts I have no interest in Anything discussed As far as I know there are no

More information

CCAT Mechanical Ventilation Clinical Practice Guideline

CCAT Mechanical Ventilation Clinical Practice Guideline CCAT Mechanical Ventilation Clinical Practice Guideline Initial publication date: Mar 2012 Last update: 22 Oct 2013 I. Background and Introductory Information A. Mechanical ventilation can injure the lung.

More information

O-Two Self-Study Guide. e600 Transport Ventilator Ventilation Modes

O-Two Self-Study Guide. e600 Transport Ventilator Ventilation Modes O-Two Self-Study Guide e600 Transport Ventilator Ventilation Modes e600 VENTILATION MODES The e600 ventilator has 13 ventilation modes: Manual Ventilation, Controlled Mandatory Ventilation (CMV), Assist

More information

Mechanical Ventilation

Mechanical Ventilation PROCEDURE - Page 1 of 5 Purpose Scope Physician's Order Indications Procedure Mechanical Artificial Ventilation refers to any methods to deliver volumes of gas into a patient's lungs over an extended period

More information

Automatic Transport Ventilators. ICU Quality Ventilation on the Street.

Automatic Transport Ventilators. ICU Quality Ventilation on the Street. Automatic Transport Ventilators ICU Quality Ventilation on the Street. Kevin Bowden, March 20 th 2014 Ventilator Definition A ventilator is an automatic mechanical device designed to provide all or part

More information

birth: a transition better guidelines better outcomes the birth experience a challenging transition the fountains of life: 2/8/2018

birth: a transition better guidelines better outcomes the birth experience a challenging transition the fountains of life: 2/8/2018 better guidelines better outcomes neonatal resuscitation Anne G. Wlodaver, MD neonatology OU medical center the birth experience a challenging transition birth requires major and sudden transitions some

More information

Invasive Ventilation: State of the Art

Invasive Ventilation: State of the Art ARDSnet NEJM 2000;342:1301 9-30-17 Cox Invasive Ventilation: State of the Art Bob Kacmarek PhD, RRT Harvard Medical School Massachusetts General Hospital Boston, Massachusetts A V T of 6 ml/kg PBW results

More information

Chapter 9 Airway Respirations Metabolism Oxygen Requirements Respiratory Anatomy Respiratory Anatomy Respiratory Anatomy Diaphragm

Chapter 9 Airway Respirations Metabolism Oxygen Requirements Respiratory Anatomy Respiratory Anatomy Respiratory Anatomy Diaphragm 1 Chapter 9 Airway 2 Respirations Every cell of the body requires to survive Oxygen must come in and carbon must go out 3 Metabolism Metabolism--Process where the body s cells convert food to Adequate

More information