1. BY: TRAVIS LENTINI Establishing the Need for Mechanical Ventilation

2. Indications for Mechanical Ventilation Surgery (sedation) Respiratory Failure (I & II) Coma Neuromuscular Disease Trauma (C-spine damage) Sepsis (increased C02 production) Cardiac Failure Compromised Airway Overdose Inability to Oxygenate (shunt, physical deformity)

3. Indications for Non Invasive Ventilation Cardiogenic Pulmonary Edema Weaning after Intubation Hyperinflation Therapy Post-Op OSA Alveolar Recruitment Delivering Medication

4. IMPENDING RESPIRATORY ARREST/APNEA RESPIRATORY FAILURE (I & II) ARDS SEVERE HYPOXEMIA SEVERE ASTHMA NEUROMUSCULAR DISEASE ACUTE BRAIN INJURY HEART FAILURE AND CARDIOGENIC SHOCK Pathological Conditions That Require Mechanical Ventilation

5. Physical Conditions That Require Mechanical Ventilation Traumatic brain injury Ischemic Encephalopathy Spinal Muscular Atrophy Bronchopulmonary dysplasia (in infants) Tracheobronchomalacia Scoliosis Kyphoscoliosis

6. Initial Settings on Ventilator Once need for mechanical ventilation has been established, we need to determine the mode, breath type and settings (for this presentation we are going to cover AC mode) In AC mode there are two breath types: Volume Control, and Pressure Control

7. Initial Settings for Volume Control In a patient with no pulmonary history: We can set a Vt (we want a Vt between 8-12 mL/kg) Flow (normal is 40-60 LPM) PEEP (normal beginning range is 0-5) Fi02 Rate (normal is 8-12) In this mode pressure and I-time are variable

8. Volume Control Settings When a Patient Has a Pulmonary History When a patient has a restrictive pulmonary history (such as ARDS), we use protective methods To prevent overdistention and injury to the lung we use small volumes and high rates In this scenario we would use a Vt of 5-7mL/kg instead of the normal 8-12 Due to the small volumes the rate needs to be increased from the normal 8-12

9. Initial Settings for Pressure Contorol When a patient has no pulmonary history: We set a pressure limit (normal is 15-25 cmH20) Inspiratory time (normal range 0.8-1.2) We can set a rise time PEEP (normal beginning range is 0-5) Fi02 Rate (normal is 8-12) In this mode Vt and flow are variable

10. Pressure Control Settings When a Patient has a Pulmonary History Again, when a patient has a restrictive pulmonary history we are going to use protective methods Since we are in Pressure Control we cannot lower the Vt; so instead we are going to decrease the Pressure limit (which in turn, will decrease the Vt) Since the patient will be receiving lower volumes, we again will have to increase the rate

11. Initial Setting Changes When ABG’s are Drawn

12. Changes Made When A Patient is in Resp Acidosis If an ABG is drawn and the patient is in Respiratory Acidosis then we are going to increase their Vt or Pressure limit first (as long as the Vt is within range) If the Vt is at the high end of our normal range, then we will increase the rate If patient is breathing above BUR, we need to set rate above total rate These are the changes we also make when the patient is in metabolic acidosis as well

13. Changes Made When A Patient is in Metabolic Alkalosis In contrast to when a patient is in respiratory/metabolic acidosis, we are going to decrease the rate first If the patient is in SIMV or breathing above the BUR, then we are going to decrease the Vt or Pressure limit