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Respiratory Failure and Indications of Mechanical Ventilation

Respiratory Failure and Indications of Mechanical Ventilation. Lung Mechanics. transairway pressure. transrespiratory pressure. transthoracic pressure. volume. elastance = D pressure / D volume. resistance = D pressure / D flow. flow. Sustaining Oxygenation and Alveolar Ventilation.

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Respiratory Failure and Indications of Mechanical Ventilation

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  1. Respiratory Failure and Indications of Mechanical Ventilation

  2. Lung Mechanics transairway pressure transrespiratory pressure transthoracic pressure volume elastance = Dpressure / Dvolume resistance = Dpressure / Dflow flow

  3. Sustaining Oxygenation and Alveolar Ventilation Load Neuromuscular Competence The balance between load (resistive, elastic, and minute ventilation) and neuromuscular competence (drive, transmission, and muscle strength)

  4. Sustaining Oxygenation and Alveolar Ventilation Resistive Load AW Elastance Load L,CW ∆ V/Q Transmission Drive (RR) Work of Breath Muscle Strength (NIF) Minute Ventilation (VE) Load PaO2 PaCO2

  5. Case Presentation • 6 year old male with asthma who was brought to ER after riding on the school bus with severe respiratory distress • RR: 32/min, tachycardic 130/min, diaphoretic, wheezes, using accessory muscles • ABG’s: 7.47, PCO2: 30, PO2 88 O2 Sat: 95%

  6. Balanced Load and Competence ↑ ↑ Resistive Load Neuromuscular Competence ABG’s: 7.47, PCO2: 30, PO2 88 O2 , HCO3: 22, Sat: 95%

  7. Imbalanced Load and Competence ↑ Resistive Load Neuromuscular Competence ↑ ABG’s: 7.39, PCO2: 44, PO2 72 O2 , HCO3: 22, Sat: 91%

  8. Case Presentation • A 23-year-old man is being evaluated in the emergency room for severe pneumonia • His respiratory rate is 38/min and he is using accessory breathing muscles, SBP 70 and HR 135/min • FiO2: 0.9, pH 7.29, PaCO2 55 mm Hg PaO2 57 mm Hg, SaO2 86% HCO3- 23 mEq/L • Na+ 149 mEq/L, K+ 4.1 mEq/L, Cl- 100 mEq/L, CO2 24 mEq/L, %COHb 2.1% Hb13 gm%.

  9. Imbalanced Load and Competence ↑ Elastance Load Neuromuscular Competence ↑ pH 7.29, PaCO2 55 mm Hg PaO2 77 mm Hg, SaO2 87% HCO3- 23 mEq/L

  10. Case Presentation A 27-year-old man is being evaluated in the emergency department for acute dyspnea. FIO2 .21, pH, 7.19, PaCO2, 65 mm Hg, PaO2 65 mm Hg, HCO3-24 mEq/L, SaO2 90%

  11. Imbalanced Load and Competence ↓ Load Neuromuscular Competence pH, 7.19, PaCO2, 65, PaO2 65, HCO3- 24, SaO2 90%

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