1 / 20

RESPIRATORY SUPPORT

Oxygen therapy Mechanical stimulator Nasal CPAP / SIMV-CPAP BI-PAP Mechanical ventilation. RESPIRATORY SUPPORT. Respiratory Assessment. Is the patient Ventilating well? >>> Normal PCO 2 Normal ventilatory effort Increase work of breathing Able to compensate

grant
Download Presentation

RESPIRATORY SUPPORT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Oxygen therapy Mechanical stimulator Nasal CPAP / SIMV-CPAP BI-PAP Mechanical ventilation RESPIRATORY SUPPORT

  2. Respiratory Assessment • Is the patient Ventilating well? >>> Normal PCO2 • Normal ventilatory effort • Increase work of breathing • Able to compensate • Is patient getting exhausted >> Impending respiratory failure • Is the patient oxygenating well? >> Normal Pa O2 • Assess oxygen requirement • A-a gradient Vs PaO2/FiO2 >> Hypoxic respiratory failure?

  3. Respiratory Assessment • Mental Status (Is patient being sedated)‏ • RR (according to age)‏ • Work of breathing (retraction, nasal flaring, paradoxic breathing)‏ • Chest movement-Air-entry • Adventitious sounds (Stridor-wheezes, crackles)‏ • Oxygen requirements • Cardiovascular status, (Compensatory mechanisms: HR, BP, perfusion)‏ • Peak Flow • ABG

  4. Respiratory Mechanics • Flow • Compliance (degree of stiffness)‏ Compliance = Volume Pressure • Resistance = = Pressure Flow • Time Constance

  5. ARF In the absence of intracardiac shunt. • Pa02 < 50 mm Hg • PC02 > 50 mmHg • Increase PaO2/Fio2 < 200 (Normal >400)‏ • Increase A-a gradient (>300)‏ (PaO2 60 on FiO2 of 0.6 = 100)‏

  6. Indication for Intubation • For Airway protection • Facial Trauma • Alter mental status • Recurrent Apnea • Respiratory Failure • Hypoventilatory • Hypoxic • Mix • Cardiovascular instability- Shock

  7. INDICATION FOR INTUBATION AND MECHANICAL VENTILATION IN STATUS ASTHMATICUS • Alter sensorium / Coma • Inability to speak • Increasing pulsus paradosus • Signs of exhautioon (decreasing pulsus paradosus • Respiratory or cardiac arrest • Diaphoresis in the recumbent position • Acute Barotrauma • Severe Lactic Acidosis (specially in infants)‏ • Silent chest despite respiratory effort • Refractory hypoxemia (PaO2 < 60 mmHg on maximal O2)‏ • Increasing PaCO2 (50 mmHg and rising > 5 mmHg/hr)‏

  8. General Principles Approaches to Lung Protection • Small tidal volumes/pressure limitation • Prevent Barotrauma • Prevent Volutrauma • Recruitment maneuvers, with • Higher PEEP levels • Ventilation in the prone position

  9. OXYGEN THERAPY“Low Flow Oxygen < 35 %” • Nasal Cannula: • No more than 3L/min • Each L/min delivers ~ 4 % Oxygen > RA • At low flows, no need to humidify • Simple Mask • Use for an emergency/ transport • Deliver ~ 30% at 6-8 L/min

  10. OXYGEN THERAPY“Moderate Amount= >35% < 50%)‏ VENTURY MAST: 28% TO 50 % AEROSOLIZED MASK 25% TO 100%

  11. Oxygen Delivery High Flow • Non re-breathing mask • high flow delivered system • with reservoir, • It deliver between 80 to 100% • FiO2. • This deliveringSystem is use • mainly for transport and for • initially emergency care and • patient stabilization.

  12. OXYHOOD25 % TO 100%

  13. NASAL cpap

  14. NON INVASIVE VENTILATION BI-PAP

  15. HOW TO ORDER MECHANICAL STIMULATOR(Pt with recurrent apnea, in between O2 Sat 100% in RA)1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

  16. HOW TO ORDER NCPAP (Nasal Continuous Positive airway pressure)(Pt with frequent apnea, intermittent desaturations)1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

  17. HOW TO ORDER NCPAP /SIMV (Pt with frequent apnea, irregular respirations with intermittentdesaturations, in between active)1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

  18. HOW TO ORDER SIMV in the Bear cub ventilator. (Pt with frequent apnea, irregular respirations with intermittentdesaturations, Patient is intubated1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

More Related