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Mechanical Ventilation - Coggle Diagram
Mechanical Ventilation
Blue hat - Overview
Provides Breathing support
Ultimately to increase survivability
Used when there's severe incapacity to breathe
White hat - Facts
Indicators
Metabolic abnormalities
Respiratory Failure
Sepsis
Somnoles
Post- major surgery
When the haemodynamic is unstable
Poor ABG trend
PaCO2>60
pH <7.25
PaO2 <60
Not tolerating non-invasive therapy
Poor obs
Decreased VT
Excessive increased WOB
Increased RR of >=35/min
Severe Dyspnoea
Respiratory failure
Despite Maximal therapy
Ways of deliverance
ETT
Tracheostomy
When in urgent
Mods of Ventilation
Continuous Mandatory Ventilation (CMV)
known as
IPPV
Continuous Mandatory Ventilation
Presets number of breaths/minute
Not triggered by patient's breath
Performs all WOB
Indications
no respiratory effort
because of dysfunction to CNS
e.g
Gillian-Barre
High level Spinal Cord lesions
Advantages
mode to be used before AC ventilation
Disadvantage
Inefficient if patient attempts to breathe
May result in respiratory muscle weakness/atrophy
SIMV
Spontaneous breaths initiation from patient
if no breath is initiated
mandatory breaths will be given
at a certain timeframe
Indication
Allow patient setting their own RR
Weaning from mechanical ventilation
Normal Respiratory drive but resp. muscles unable to perform all WOB
Advantage
Less atrophy of resp. muscles
Better distribution of gas within lung
Allowing patient to initiate the breaths
Disadvantage
Associates with longest weaning rate
Lowest success rates of weaning compare to other weaning modes
Pressure Support
activated when
patient's spontaneous respiratory activity is augmented
by a present inspiratory positiv epressure
Promoting the flow of gas into the lungs
no set VT as it's variable
Can be used in conjunction with SIMV
Indication
Reducing SOB
To augment spontaneous inspiratory volumes
Weaning from mechanical ventilation
Advantage
used to overcome resistance - WOB
Allow augmentation of inadequate spontaneous VT
Disavantage
Alveolar ventilation is not guaranteed
if either
Compliance decreased
Resistance increased
VC
deliverance of a presets breaths number
When patient delivers spontaneous breaths
it delivers an assisted breath
Sensitive and responds to patients 'spontaneous respiratory efforts
Indications
Normal respiratory drive but weak respiratory muscles to perform WOB
Advantage
Constant volume guaranteed
Disadvantage
Deliverance my result in high PIP and maldistribution of gases
may lead to pulmonary barotrauma
under when
lungs are non-compliants
disease process is diffuse
Pressure Control
a preset RR
a preset amount of inspiratory pressure delivered in every breath
Indications
providing full ventilatory support
for noncompliant lungs
to get airway pressure under control
Advantage
More proficient in maintaining open airwas and improving gas distribution
reduce pulmonary barotrauma
Disadvantage
may result in cardiac output reduction
PRVC
patient receives a
preset number of breaths
a preset VT
in the form of pressure breath
a sequence of 4 test breaths initially given
The ventilator goes to the lowest pressure possible
Indications
for those who are suitable for Pressure Control
but has no reliable respiratory drive
noncompliant lungs
Advantage
Combines the advantages of pressure and volume controlled ventilation
Disadvantage
in the event of large air leak
increase of pressure control level
leads to possible aggravating air loss
Usual Settings
PEEP: 5-15cmH2O
PS: 5-20cmH2O
RR: 12
I:E: 1:3
Vt: 6-8ml/kg
Insp. flow rate: 50-100l/min
PIP<40cmH2O, Plateau pressure<35cmH2O
Yellow hat - benefit
refresher to mechanical ventilation
Green hat - Creativity
Understanding the respiratory implication when patient is from ICU
Not too relevant to my current practice
can be an important knowledge due to recent pandemic
Red hat - Feeling
Intimidated
Feeling inadequate
Black hat - caution/danger
Lack of experience
Limited understanding to ICU environment