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ventilator - Coggle Diagram

- - - - or changing the ventilatory mode to CPAPsb to help patient overcome the resistance of the ETT and ventilatory circuit
      - Desaturation, tachyapnoea (RR > 35/min-'),
      - While a significant number of patients may fail SBT at the first attempt, patients with multiple co-morbidities, elderly patients and prolonged ventilation are at a higher risk of failing SBT and weaning attempts. Patients who fail SBT and/or extubation need a programmed weaning plan with gradual increments in time on CPAP and T-piece
      - A weaning protocol can be used in ICUs to facilitate nurse-led weaning.
  - - - Haemodynamic stability as evidenced by stable heart rate <120/m
      - Absent to minimal vasopressor require-ment (e.g. Noradrenaline <0.3 ug.kg1.min1)
      - Rate and/or rhythm control of anyarrhythmias
    - - Adequate muscle power i.e. at least 3/5 of the MRC scale
      - Intact laryngo-pharyngeal reflexes Resolution
      - No evidence of central apnea
      - or control of delirium Appropriate level of sedation
    - - Intact cough and swallow reflex
      - PaO2:Fi0z >200 mm Hg
      - ventilatory support e.g. CPAP..b 5/5 cm
    - - Corrected acid - base balance
      - Electrolytes in an acceptable range, especially K, POi, Mg2+, Ca2+
      - Optimized fluid balance i.e. no evidence of overload
      - Pain under control
      - No residual effects of muscle paralysing drug
      - Normothermia
- - - - ventilator-associated pneumonia
        
        ICU
        
        5 It usually develops more than 48 hours after intubation.
      - V/Q mismatch and asynchrony
      - atelectasis
      - ventilator-associated lung injury
      - volume and pressure-induced trauma
    - - supine position
      - presence of NG or NJ tube
      - enteral nutrition
      - use of antibiotics
      - excessive sedation
      - chronic respiratory disease
      - multi-organ failure
      - reintubation
      - cardiac arrest
      - eldrly age group
    - - VAP can also be caused by occasionally by Staphylococcus aureus, Sternotrophomonas maltophilia or opportunistic organisms and fungi.
    - - During mechanical ventilation, air tends to take the path of low resistance.
        
        Hence, with high tidal volumes and high pressure ventilation, the compliant, aerated areas are vulnerable to over-distension with subsequent reduction in surfactant and damage to the alveolo-capillary membrane with alveolar oedema.
        
        The added shear stress due to the opening and closing of airways and alveoli lead to the initiation of a biological inflammatory cascade and recruitment of inflammatory mediators and cells.
        
        The effect is a decrease in oxygenation and compliance of the lung.
        
        High tidal volume and over-distension (volutrauma) play a bigger role in VALI than high inspiratory or airway pressures (barotrauma).
        
        pneumomediastinum
        
        Over-distension can also lead to alveolar rupture and a tension pneumothorax.
        
        pneumothorax
        
        subcutaneous emphysema
- - - - Intermittent pneumatic boots, elastic stockings (TEDS) and low molecular weight heparin are commonly employed options for VTE prophylaxis
  - - - suppression prophylaxis is routinely commenced with proton-
        pump inhibitors (e.g. pantoprazole) or Hz-receptor antagonists(e.g. ranitidine). Its use is reviewed daily and may need continuation in patients at high risk of upper gastro-intestinal haemorrhage
  - - - PPI, e.g. pantoprazole 40 mg/day