Ventilator Management in the Cardiac Intensive Care Unit

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Presentation transcript:

Ventilator Management in the Cardiac Intensive Care Unit Carlos Corredor, MRCP, FRCA, Sian I. Jaggar, CertMedEd, MD, FRCA Cardiology Clinics Volume 31, Issue 4, Pages 619-636 (November 2013) DOI: 10.1016/j.ccl.2013.07.002 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 Lung and chest wall pressure-volume curve. Continuous-line curves are pressure-volume diagrams for lung and chest wall. Dotted-line curve represents pressure-volume curve of the total respiratory system. At FRC, combined pressure of the total system is 0. RV, right ventricular. Cardiology Clinics 2013 31, 619-636DOI: (10.1016/j.ccl.2013.07.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 The hemodynamic effects of positive pressure ventilation. Left side of the heart (LH), airway pressure (Paw), pleural pressure (Ppl), right side of the heart (RH). Cardiology Clinics 2013 31, 619-636DOI: (10.1016/j.ccl.2013.07.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 Airway pressure is maintained at end expiration (shaded area). PEEP (mechanical ventilation) and CPAP (spontaneous breathing)> Paw Airway pressure. Cardiology Clinics 2013 31, 619-636DOI: (10.1016/j.ccl.2013.07.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 Starling forces imbalance leading to pulmonary edema of cardiac origin. If left atrial pressure exceeds 20 cm H2O, pulmonary capillary hydrostatic pressure increases markedly causing net accumulation of fluid in the interstitium and alveolar space. Starling equation: πpc, pulmonary capillary colloid osmotic pressure; πpi, pulmonary interstitium colloid osmotic pressure; K, filtration coefficient endothelium; Ppc, pulmonary capillary hydrostatic pressure; Ppi, pulmonary interstitium hydrostatic pressure; Q, net flow of fluid across pulmonary capillary membrane. Cardiology Clinics 2013 31, 619-636DOI: (10.1016/j.ccl.2013.07.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 Sample algorithm for institution of SBT in the CICU. Cardiology Clinics 2013 31, 619-636DOI: (10.1016/j.ccl.2013.07.002) Copyright © 2013 Elsevier Inc. Terms and Conditions