Respiratory failure mechanical ventilation
|
Respiratory failure Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Respiratory failure mechanical ventilation On the Web |
|
American Roentgen Ray Society Images of Respiratory failure mechanical ventilation |
|
Risk calculators and risk factors for Respiratory failure mechanical ventilation |
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
- Endotracheal intubation acts as the connection between the ventilator and the patient.
- Intubation can be performed endotracheally or through a tracheostomy.
- The tube must be placed correctly, and this is confirmed through:
- Chest x-ray
- Chest auscultation
- Carbon dioxide detector
- Proper cuff pressure must be maintained and not exceed 25mmHg
- The airways should be suctioned to ensure patency of the airway:
- Suctioning may occur through an open or closed circuit suction catheter.
- Routine suctioning is not recommended as this may lead to complications such as:
- Desaturation
- Arrhythmias
- Bronchospasm
- Cough
- Entry of secretions into the lower respiratory tract
- The endotracheal tube insertion depth varies by gender and is measured from the lower incisors:
- In males: 23cm
- In females: 21cm
- The tube is affixed in place using tape to prevent accidental extubation or further downward movement toward the main bronchus.
Principles of Mechanical Ventilation
- Mechanical ventilation is basically used to:
- Increase PaO2
- Lower PaCO2
- Relieve respiratory effort
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.