Summary
MR, 62, Lady, Housewife,
Transferred by Ambulance from Letterkenny 1/52 ago for further
continuous Critical Care Management
On the background of
6/ 52 refractory CAP complicated by
Inotrophic support
Asthma COPD
COPD Low total ventilation
PE Brainstem stroke
pneumonia Myasthenia gravis
Shunting GBS
Alveolar collapse
Tired!
RL cardiac shunt
Low O2 content
anaemia
FiO2 and PaO2
Or
Assisted Ventilation
Invasive Ventilate
Mechanical
Ventilator
Cardiac/Respiratory arrest
Nonrespiratory organ failure
GCS <10
Severe upper GI bleed
Facial surgery/trauma
Upper Airway Obstruction
High risk of aspiration
Inability to cooperate/Protect Airway
What is PEEP (Positive End-
Expiratory Pressure) ?
Apply pressure at end of expiration so
that alveoli will not collapse
General
Problems with weaning
Sedation withdrawal
Cardiovascular=Hypotension
Increase intrathoracic pressure
Decrease venous return
Decrease cardiac output
Ventilator Complications
Pulmonary
Barotrauma
pulmonary interstitial emphysema
Pneumomediastinum
Pneumoperitoneum
Pneumothorax/ tension pneumothorax
High O2free radical cellular damage
VAP >72hrs high risk
tracheal stenosis
laryngeal dysfunction
Ventilator Complications
Alkalosis
pH>7.45
Metabolic Acidosis
Increase base
Blood transfusion
Milk alkali syndrome
Loss Cl
Vomitting
Loss K
Diuretics (thiazide)
Burns
Respiratory
Alkalosis Acidosis
Head injury/Stroke CNS trauma
High altitude hypoventilation
hyperventilation COPD
Asthma
ARDS
References
http://emedicine.medscape.com/article/81012
6-overview
Toronto notes
http://www.ccmtutorials.com/index.htm
http://www.scribd.com/doc/7106291/Non-Inva
sive-Positive-Pressure-Ventilation-NIPPV?se
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