1) Mechanical ventilation of a normal lung is only indicated when there is dysfunction of the brainstem, spinal cord, nerves, neuromuscular junction, or respiratory muscles that prevent adequate breathing.
2) When ventilating a normal lung, the goals are to provide adequate ventilation and oxygenation while decreasing the work of breathing and avoiding complications like ventilator-induced lung injury.
3) Key settings when ventilating a normal lung include tidal volume, respiratory rate, I:E ratio, PEEP, and triggers to ensure patient comfort and synchrony with the ventilator while allowing for early weaning. Monitoring includes pulse oximetry, blood gases, and ventilator graphics to
3. When do I ventilate a normal lung?
Brainstem
Spinal cord
Nerve rootAirway
Nerve
Neuromuscular
junction
Respiratory
muscle
Lung
Pleura
Chest
wall
EXTRAPULMONARY
Components
6. Volume /
Compliance
Flow x
Resistance
Pressure=flow x resistance
Alveolar pressure=volume/compliance + PEEP
Airway pressure=Flow x Resistance + volume/compliance + PEEP
Flow=volume/time
B (P A LV)A (P AW)
Physics of Positive pressure ventilation
7. 3 key ventilator phase variables
When the breath is delivered
What limits gas delivery
what end the gas delivery
Trigger
Limit
cycle
14. Case scenario!!
• 25 yr old female admitted with history of BZD
and antidepressant,no past medical history in.
Registrar calls you in evening 7p.m patient is
unwell gurgling sounds, mild airway
obstruction drowsy .Respiration appears
shallow ?
• U advise -ABG ?
• NIV ? Invasive ventilation.?
15. Goals during Positive pressure
ventilation
• Adequacy of ventilation
• Oxygenation
• Decreased work of breathing
• Patient comfort
• Synchrony with ventilator
• Avoiding complication-VILI,VAP
• Early wean ability
What mode ??
Which setting ??
19. What next?
• Wake up call for consultant?
• Registrar reports increase in pressure alarm
repeatedly ? U Advice
• A)Suction
• B)Nebulization
• C) Chest X ray
22. Complications
• Related to intubation and extubation.
Ventilator related
• Extra pulmonary – gut ischemia, Water ADH +
23. • F
• A
• S
• T
• H
• U
• G
anand tiwari
Ancillary care
Give your patient a fast hug (at least) once a day*
Jean-Louis Vincent, MD, PhD, FCCM
24. Day 3 patient start to wake up trigger ventilator
frequently some breath stacking,vitals stable
• Restless ,bites the tube intermittently restless
• As reported by the nurse and physiotherapist.
• You suggest—
• A)weaning
• B) Sedate and ventilate
ABCDE bundle
27. Summary of recommendations of
weaning
• Protocol-directed - favorable outcome
• SBT or PS trials than-- SIMV
• 30min and 120min trials are equally successful
• Twice daily SBT no advantage over once daily
• Sedation vacation better outcome.
• Early compared to late tracheostomy leads to
better outcomes
Intensive care medicine was born along with art and science of positive pressure ventilation. Started with polio epidemic in 1952,denmark,3000 patient required critical care and 1/3 had paralysis had 10 % had respiratory insufficency,ventilation done with –negative pressure bulk flow mobilization in patient lung by cyclically creating sub atmospheric pressure around the chest or cuirass ventilator rigid shell around the chest,logistic problems of nursing care, mortality was 87% dr Lassen and dr Bjorn Ibsen invented tracheotomy and positive pressure ventilation and mortality dropped to 40%
CNS- depressant drug,structural brain damage, spinal cord disease above c5,GBS,MG,Critical illness poly neuropathy,organophosphates,amytropic lateral sclerosis, anterior horn cell disease,ms dytrophy,periodic paralysis,myopathy dyselectrolemia,ks.120,cardiac support in shock,as part of general anesthesia,marked airway or facial odema
The first positive-pressure ventilators were designed to inflate the lungs until a preset pressure was reached. This type of pressure-cycled ventilation fell out of favor because the inflation volume varied with changes in the mechanical properties of the lungs. In contrast, volume-cycled ventilation, which inflates the lungs to a predetermined volume, delivers a constant alveolar volume despite changes in the mechanical properties of the lungs. For this reason, volume-cycled ventilation has become the standard method of positive-pressure mechanical ventilation