Respiratory failure mechanical ventilation: Difference between revisions
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==Overview== | |||
==Mechanical ventilation== | |||
Mechanical ventilation aims to correct abnormalities in oxygenation of the blood and tissues, reduce the respiratory effort and prevent dynamic hyperinflation. | |||
===Indications=== | |||
*Life threatening respiratory failure:<ref name="pmid26976648">{{cite journal |vauthors=Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, Church AC, Creagh-Brown B, Dodd JW, Felton T, Foëx B, Mansfield L, McDonnell L, Parker R, Patterson CM, Sovani M, Thomas L |title=BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults |journal=Thorax |volume=71 Suppl 2 |issue= |pages=ii1–35 |date=April 2016 |pmid=26976648 |doi=10.1136/thoraxjnl-2015-208209 |url=}}</ref><ref name="pmid15684302">{{cite journal |vauthors=Confalonieri M, Garuti G, Cattaruzza MS, Osborn JF, Antonelli M, Conti G, Kodric M, Resta O, Marchese S, Gregoretti C, Rossi A |title=A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation |journal=Eur. Respir. J. |volume=25 |issue=2 |pages=348–55 |date=February 2005 |pmid=15684302 |doi=10.1183/09031936.05.00085304 |url=}}</ref><ref name="pmid15742175">{{cite journal |vauthors=Phua J, Kong K, Lee KH, Shen L, Lim TK |title=Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure |journal=Intensive Care Med |volume=31 |issue=4 |pages=533–9 |date=April 2005 |pmid=15742175 |doi=10.1007/s00134-005-2582-8 |url=}}</ref> | |||
**Severe respiratory failure with failure of non-invasive ventilation (NIV) in addition to rapid, shallow breathing, cardiopulmonary arrest, and severe hemodynamic compromise. | |||
*Failure of noninvasive ventilation: | |||
**Indications of failed NIV include: | |||
***A lack of improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours | |||
***Encephalopathy | |||
***Agitation | |||
***Unclearable secretions | |||
***Intolerable mask interface | |||
***Decreased oxygen saturation | |||
***Hemodynamic instability | |||
*Arterial blood gas abnormalities | |||
**Incorrectable hypoxemia despite oxygen supplementation | |||
**Severe respiratory acidosis unresponsive to therapy and/or NIV | |||
===Endotracheal intubation=== | |||
===Principles of Mechanical Ventilation=== | |||
===Types of Mechanical Ventilation=== | |||
===Ventilator Modes=== | |||
===Positive-End Expiratory Pressure=== | |||
===Inspiratory Flow=== | |||
===Ventilator Induced Lung Injury=== | |||
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Overview
Mechanical ventilation
Mechanical ventilation aims to correct abnormalities in oxygenation of the blood and tissues, reduce the respiratory effort and prevent dynamic hyperinflation.
Indications
- Life threatening respiratory failure:[1][2][3]
- Severe respiratory failure with failure of non-invasive ventilation (NIV) in addition to rapid, shallow breathing, cardiopulmonary arrest, and severe hemodynamic compromise.
- Failure of noninvasive ventilation:
- Indications of failed NIV include:
- A lack of improvement in arterial carbon dioxide tension (PaCO2) and pH within 1.5 - 2 hours
- Encephalopathy
- Agitation
- Unclearable secretions
- Intolerable mask interface
- Decreased oxygen saturation
- Hemodynamic instability
- Indications of failed NIV include:
- Arterial blood gas abnormalities
- Incorrectable hypoxemia despite oxygen supplementation
- Severe respiratory acidosis unresponsive to therapy and/or NIV
Endotracheal intubation
Principles of Mechanical Ventilation
Types of Mechanical Ventilation
Ventilator Modes
Positive-End Expiratory Pressure
Inspiratory Flow
Ventilator Induced Lung Injury
References
- ↑ Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, Church AC, Creagh-Brown B, Dodd JW, Felton T, Foëx B, Mansfield L, McDonnell L, Parker R, Patterson CM, Sovani M, Thomas L (April 2016). "BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults". Thorax. 71 Suppl 2: ii1–35. doi:10.1136/thoraxjnl-2015-208209. PMID 26976648.
- ↑ Confalonieri M, Garuti G, Cattaruzza MS, Osborn JF, Antonelli M, Conti G, Kodric M, Resta O, Marchese S, Gregoretti C, Rossi A (February 2005). "A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation". Eur. Respir. J. 25 (2): 348–55. doi:10.1183/09031936.05.00085304. PMID 15684302.
- ↑ Phua J, Kong K, Lee KH, Shen L, Lim TK (April 2005). "Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure". Intensive Care Med. 31 (4): 533–9. doi:10.1007/s00134-005-2582-8. PMID 15742175.