Mechanical ventilation resident survival guide

Mechanical ventilation Resident Survival Guide Microchapters
Overview
Classification
Indications
FIRE
Mode and variable selection
Do's
Donts

Indications

The following are the indications of mechanical ventilation:

• Cardiac or respiratory arrest
• Tachypnea or bradypnea with respiratory fatigue or impending arrest
• Acute respiratory acidosis
• Refractory hypoxemia
• Refractory hypoxemia (when the P a O 2 could not be maintained above 60 mm Hg with inspired O 2 fraction (F I O 2 )>1.0)
• Inability to protect the airway associated with depressed levels of consciousness
• Shock associated with excessive respiratory work
• Inability to clear secretions with impaired gas exchange or excessive respiratory work
• Newly diagnosed neuromuscular disease with a vital capacity <10 - 15 mL/kg
• Short term adjunct in management of acutely increased intracranial pressure (ICP) intracranial pressure (ICP) 

Non-Invasive mechanical ventilation

Consider non-invasive mechanical ventilation especially in the following conditions:

• COPD exacerbation
• Cardiogenic pulmonary edema
• Obesity hypoventilation syndrome
• Patients with asthma or patients with non-cardiogenic hypoxemic respiratory failure

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients of severe acute respiratory failure and in need of immediate intervention.

Boxes in red signify that an urgent management is needed.

Abbreviations

Boxes in red signify that an urgent management is needed.

References

				Assess the patient for respiratory distress ❑Color (Nail bed or lip cyanosis, pale or diaphoretic) ❑Respiratory rate ❑Breathing pattern ❑Use of accessory muscles ❑Paradoxical chest movement ❑Easily audible breath sounds ❑Work of breathing ❑Past medical history of COPD/COPD exacerbation, asthma ❑Pulmonary crepitations/rales/crackles ❑Third heart sound (S3) ❑Look for critical values on ABGs (pH <7.25, PaCO2 >55 mm Hg and rising, PaO2 < 70 mm Hg, alveolar-arterial O2 difference > 450, PaO2/PAO2 <0.15)
				Does the patient have any of the following findings that require invasive ventilation? ❑Respiratory arrest ❑Respiratory rate >35 breaths/min ❑Severe dyspnea with use of accessory muscle of respiration ❑Life-threatening hypoxemia (PaO2 <40 mm HG or PaO2/FiO2 <200) ❑Severe acidosis (pH <7.25) and hypercapnia (PaCO2 >60 mm Hg) ❑Cardiovascular complication (Hypotenion, shock, heart failure) ❑Failure of non-invasive mechanical ventilation