Cardiopulmonary Resuscitatio CPR
Mechanical Ventilation (Acute Respiratory Failure)
0 Acute respiratory failure is the inability to keep arterial PaO2, PaCO2 and pH within acceptable limits.
0 In a patient with suspected acute respiratory failure, some physiological measurements are used to indicate mechanical ventilation.
0 These are the parameters of respiratory mechanics, ventilation and oxygenation.
Acute Respiratory Failure
- Respiratory Mechanics
- Maximum inspiratory pressure (MIP: cmH2O)
- Peak expiratory pressure (PEP: cmH2O)
- and (mL/kg)
- VT (mL/kg)
- Respiratory frequency (Respiratory rate/minute)
- FEV1 (mL/kg)
ventilation
- PH
- PaCO2 (mmHg)
- VD/VT
Oxygenation
- PaO2 (mmHg) (while FiO2:0.21)
- P(A-a)O2 (mmHg)
- (Arterial/ Alveolar) PO2
Mechanical ventilation indications
• Acute ventilation failure (PaCO2 > 50 mmHg and pH < 7.30)
• Severe refractory hypoxemia (FiO2) 60% while PaO2) 60mmHg, SaO2<90%)
• Presence of clinical signs of severe respiratory failure and increased respiratory rate predisposing to respiratory failure (respiratory rate >35/minute, intercostal and supraclavicular retractions, nasal wing breathing, paradoxical abdominal breathing, unconsciousness)
• respiratory arrest
Noninvasive mechanical ventilation (NIMV)
• Noninvasive mechanical ventilation patient selection
- Acute respiratory acidosis
- Respiratory distress
- Use of accessory respiratory muscles or abdominal paradox
- The patient is cooperative
- Hemodynamically stable
- Absence of active cardiac ischemia and arrhythmia
- Absence of excessive secretion
- Normal upper airway functions
- Absence of acute facial trauma
Noninvasive mechanical ventilation contraindications
- cardiac and/or respiratory arrest
- Medically unstable patient (septic, cardiogenic shock, uncontrolled infarction, uncontrolled arrhythmia)
- Inability to protect the respiratory tract
- Inability to expel secretions
- Uncooperative and agitated patient
- The patient who cannot put a mask on his face
- Upper gastrointestinal bleeding after upper respiratory tract and gastrointestinal system surgery, acute myocardial infarction.
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Differences
between NIMV and IMV |
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NIMV |
IMV |
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1. Delivery of mechanical ventilation support to
the patient |
with mask |
with intubation tube |
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2. Application site |
emergency department, ICU intermediate intensive
care, home |
ICU |
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3. The need for sedation |
rare |
there is often |
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4. Secretions |
the patient removes himself |
should be aspirated |
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5. Nutrition |
feeds itself |
need to be fed |
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6. Communication with the environment |
can speak |
bad |
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7. Pneumonia complication |
less (<5%) |
high |
NIMV in acute respiratory failure due to COPD
1. Identification of the patient who needs a mechanical ventilator
A. Symptoms and signs of acute respiratory distress
a. Increasing moderate/severe dyspnea
b. Respiratory rate>24, use of accessory respiratory muscles, paradoxical breathing
B. Gas exchange disorder
a. PaC02>45 mm Hg and pH<?.35
b. b- PaO/FiO2<200
2. Being a suitable patient for NIMV
Complications of Mechanical Ventilation
The respiratory system
- Airway complications
traumatic complications
Prolonged intubation attempt
Endobronchial intubation, esophageal intubation
Tube migration, occlusion by secretion
Tracheal stenosis, tracheomalacia
Tracheostoma complications
- Volutrauma / barotrauma
Pulmonary interstitial emphysema
Pneumothorax, pneumomediastinum
pneumopericardium
Ventilator-associated lung injury
venous air embolism
Dynamic hyperinflation (autoPEEP)
Oxygen toxicity and hypoxemia
ventilator-associated pneumonia
pulmonary embolism
Patient ventilator incompatibility
cardiovascular system
- The negative effects of mechanical ventilation on cardiac functions are more pronounced in patients who have undergone PEEP.
- Decreased right ventricular preload due to increased intrathoracic pressure (direct effect of positive pressure ventilation)
- Increase in right ventricular end load due to increase in lung volumes.
- With continuous positive intrathoracic pressure, venous return decreases, alveolar vessels are exposed to pressure due to alveolar stretching, pulmonary vascular resistance increases.
- As a result, right ventricular preload increases and cardiac output decreases as a result of decreased left ventricular compliance.
- Arterial air embolism
Nosocomial pneumonia or hospital-acquired pneumonia (HAP)
GIS, renal and CNS complications
