1 / 11

Vent 101 Everything You Need to Know About Ventilators on One Whiteboard

Vent 101 Everything You Need to Know About Ventilators on One Whiteboard. (Really) Doug Powell, M.D. 4BN 3SFG (A) Surgeon Prolonged Field Care Working Group Staff Intensivist , Womack Army Med Center. Pathology of Respiratory Failure. Hypoxic: “stuff in alveoli” Water: pulmonary edema

timothyg
Download Presentation

Vent 101 Everything You Need to Know About Ventilators on One Whiteboard

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. Vent 101Everything You Need to Know About Ventilators on One Whiteboard (Really) Doug Powell, M.D. 4BN 3SFG (A) Surgeon Prolonged Field Care Working Group Staff Intensivist, Womack Army Med Center

  2. Pathology of Respiratory Failure • Hypoxic: • “stuff in alveoli” • Water: pulmonary edema • Pus: pneumonia • Blood: alveolar hemorrhage (rare) • Protein: ARDS • Collapsed alveoli: atelectasis

  3. Pathology of Respiratory Failure • Hypercapic • Won’t breathe • CNS: drugs! > injury, stroke, OSA, OHS, hypothermia • Can’t breathe • Peripheral nervous system (GuillianBarre…) • Respiratory muscles (myesthenia gravis…) • Chest wall, pleura (burn eschar, flail chest) • Upper airway (trauma, mass, edema compressing) • Can’t breathe enough • (PE, exacerbation of asthma, COPD)

  4. Physiology - Compliance • Causes problems with OXYGENATION • Intrinsic: Stuff in alveoli Air > Water> Blood> Pus> Protein >> decreasing compliance/ harder to oxygenate >> • Extrinsic: Stuff outside of lungs • Body mass (obesity) • Rigid chest (eschar, paralysis – acutely)

  5. Ventilators on 1 Page

  6. The Only Vent Settings You Need to Know • Low tidal volume, volume assist control (AC-V) • Tidal Volume (Vt): 6 – 8 cc/ kg (ideal body weight) • Rate: 14 (physiologic) • FiO2: 100% (turn down based on pulseOx) • PEEP: 5

  7. Monitoring • Clinical parameters • Respiratory rate (spontaneous) • Comfort • Chest, abdomen rise/ fall together • Cough, gagging • SpO2 (saturation of peripheral oxygenation/ Pulse Ox): • Goal: > 90% • ETCO2 (end – tidal CO2) • Goal: 40mmHg

  8. Problems w/Oxygenation • Increase PEEP • Benefits: comfortable, works without supplemental O2! • Risks: pressure overload, barotrauma • Increase FiO2 (i.e., crank the oxygen up) • Benefits: fast • Risks: burns through supplies, free radical toxicity (~ > 60%/ > 24 hours)

  9. Problems with CO2 • Increase Vt: never > 10cc/kg w/o consult • Benefits: it works • Risks: volu-trauma, increased mortality • Increase rate • Benefits: no risks • Risks: none

  10. Troubleshooting Vent • Pressure alarm – causes: treatments • Tube blocked: secretions, mucus plug – suction patient • Tube kinked: bite block (tape roll) • Bronchospasm: give albuterol • Abdominal pressure: place NG/ OG tube • Auto-peep: disconnect circuit • Uncertain: disconnect circuit • Patient uncomfortable: • Increase sedation (if ketamine, give Versed IV) • Telemedicine: if possible, send video clip

  11. Vent Care • Mouth care: • Vaseline lips • Move tube one side to other • Mouth/ tooth cleaning • Positioning: HOB 30 degrees (if possible) • Secretions: monitor for and suction • Don’t suction if you don’t need to (gurgling, pressure alarm, decreasing oxygenation)

More Related