RESPIRATORY SUPPORT 1.Oxygen therapy 2.Mechanical stimulator 3.Nasal CPAP / SIMV-CPAP 4.BI-PAP 5.Mechanical ventilation

Respiratory Assessment Is the patient Ventilating well? >>> Normal PCO 2 –Normal ventilatory effort –Increase work of breathing Able to compensate Is patient getting exhausted >> Impending respiratory failure Is the patient oxygenating well? >> Normal Pa O 2 –Assess oxygen requirement –A-a gradient Vs PaO2/FiO2 >> Hypoxic respiratory failure?

Respiratory Assessment 1.Mental Status (Is patient being sedated)‏ 2.RR (according to age)‏ 3.Work of breathing (retraction, nasal flaring, paradoxic breathing)‏ 4.Chest movement-Air-entry 5.Adventitious sounds (Stridor-wheezes, crackles)‏ 6.Oxygen requirements 7.Cardiovascular status, (Compensatory mechanisms: HR, BP, perfusion)‏ 8.Peak Flow 9. ABG

Respiratory Mechanics Flow Compliance (degree of stiffness)‏ Compliance = Volume Pressure Resistance = = Pressure Flow Time Constance

ARF In the absence of intracardiac shunt. Pa02 < 50 mm Hg PC02 > 50 mmHg Increase PaO2/Fio2 400)‏ Increase A-a gradient (>300)‏ (PaO2 60 on FiO2 of 0.6 = 100)‏

Indication for Intubation For Airway protection –Facial Trauma –Alter mental status –Recurrent Apnea Respiratory Failure –Hypoventilatory –Hypoxic –Mix Cardiovascular instability- Shock

1.Alter sensorium / Coma 2.Inability to speak 3.Increasing pulsus paradosus 4.Signs of exhautioon (decreasing pulsus paradosus 5.Respiratory or cardiac arrest 6.Diaphoresis in the recumbent position 7.Acute Barotrauma 8.Severe Lactic Acidosis (specially in infants)‏ 9.Silent chest despite respiratory effort 10.Refractory hypoxemia (PaO2 < 60 mmHg on maximal O2)‏ 11.Increasing PaCO2 (50 mmHg and rising > 5 mmHg/hr)‏ INDICATION FOR INTUBATION AND MECHANICAL VENTILATION IN STATUS ASTHMATICUS

General Principles Approaches to Lung Protection Small tidal volumes/pressure limitation –Prevent Barotrauma –Prevent Volutrauma Recruitment maneuvers, with –Higher PEEP levels –Ventilation in the prone position

OXYGEN THERAPY “Low Flow Oxygen < 35 %” Nasal Cannula: No more than 3L/min Each L/min delivers ~ 4 % Oxygen > RA At low flows, no need to humidify Simple Mask Use for an emergency/ transport Deliver ~ 30% at 6-8 L/min

OXYGEN THERAPY “Moderate Amount= >35% < 50%)‏ VENTURY MAST: 28% TO 50 % AEROSOLIZED MASK 25% TO 100%

Oxygen Delivery High Flow Non re-breathing mask high flow delivered system with reservoir, It deliver between 80 to 100% FiO2. This delivering System is use mainly for transport and for initially emergency care and patient stabilization.

OXYHOOD 25 % TO 100%

NASAL cpap

NON INVASIVE VENTILATION BI-PAP

HOW TO ORDER MECHANICAL STIMULATOR (Pt with recurrent apnea, in between O2 Sat 100% in RA) 1) Under order entry, SELECT Mechan- 2) Select Peds/Neo 3) Fill up the blanks as showed below

HOW TO ORDER NCPAP (Nasal Continuous Positive airway pressure) (Pt with frequent apnea, intermittent desaturations) 1) Under order entry, SELECT Mechan- 2) Select Peds/Neo 3) Fill up the blanks as showed below

HOW TO ORDER NCPAP /SIMV (Pt with frequent apnea, irregular respirations with intermittent desaturations, in between active) 1) Under order entry, SELECT Mechan- 2) Select Peds/Neo 3) Fill up the blanks as showed below

HOW TO ORDER SIMV in the Bear cub ventilator. (Pt with frequent apnea, irregular respirations with intermittent desaturations, Patient is intubated 1) Under order entry, SELECT Mechan- 2) Select Peds/Neo 3) Fill up the blanks as showed below