. L. min. 4 min. min. L. min. I. A 64 year old female with pulmonary edema NORMAL

Size: px
Start display at page:

Download ". L. min. 4 min. min. L. min. I. A 64 year old female with pulmonary edema NORMAL"

Transcription

1 NSWR KY TO NOTS on RSPT Module G - PaCO and lveolar Ventilation 1 Problems Given a fixed alveolar ventilation of L/, calculate the PaCO when the CO production is 300 ml/ VCO 300mL PaCO 589 = = = = 6 75 mm Hg = 65 mm Hg L B Given a fixed alveolar ventilation of L/, calculate the PaCO when the CO production is 00 ml/ VCO 00mL PaCO 35 = = = = 86 3 mm Hg = 86 mm Hg L For each of the following conditions, state if the PaCO PTCO difference should be normal/near normal or widened I 6 year old female with pulmonary edema NORML II III IV 35 year old women with normal lungs who is hyperventilating NORML year old man with right lower lobe pneumonia NORML year old woman with pulmonary embolism INCRSD V 78 year old man with hypovolemic shock INCRSD VI 30 year old man with normal lungs, exercising on a treadmill at 5 mph for 10 NORML C Given a V t of 00 ml, physiologic V d of 00 ml and a f of 16/, calculate the alveolar ute ventilation ( V ) = V V f = 0 L 0 L 16 = 16 = 3 L ( t d ) ( ) D Given a V of 10 L/, and a V D of L/, calculate thev L L L = D = 10 = 6 Given a V of 1 L/, f of 0/, and a physiologic V d of 10 ml, calculate the alveolar ute ventilation ( V ) 1L 10 ml 1 1L L 9 6L = D = ( Vd f ) = = = ( ) Case Study n intern is called to the hospital bedside of an elderly woman late at night The patient was admitted to the hospital 3 days earlier for a problem unrelated to her heart or lungs She is anxious and complains of shortness of breath Her lung fields are clear to auscultation and

2 xample 1 xample vital signs are normal except for slight tachycardia and a respiratory rate of 30/ nurse comments that the patient gets like this every night The physician orders an anti-anxiety drug for what he describes as hyperventilation and anxiety bout 30 utes later, the patient s breathing slows considerably and she becomes cyanotic whereby she is intubated and transferred to the intensive care unit What would you guess this patient s blood gas values were before she received the anti-anxiety drug? PaCO = 3 mm Hg, PaO 70 mm Hg PaCO = 3 mm Hg, PaO 80 mm Hg F PaCO = 58 mm Hg, PaO 6 mm Hg Discussion: The intern mistakenly suspected that the patient was hyperventilating without reference to an BG He assumed she was hyperventilating because she was breathing fast In reality, the patient was hypoventilating and hypoxemic She had undiagnosed COPD and chronic hypercapnia By giving an anti-anxiety agent, she decreased her alveolar ventilation, which resulted in a rise in PaCO and a decrease in PaO Narcotics, sedatives/anti-anxiety agents should be given with caution to any spontaneously breathing patient with airway disease (COPD) or neuromuscular disease COPD since these drugs can depress respiration patient with respiratory acidosis on mechanical ventilatory support is 6 and weighs 190 lbs The xhaled V t is 00 ml, and the f is 10/ The patient is on controlled volume ventilation The PaCO is 60 mm Hg, ph 733 The patient s desired PaCO is 0 mm Hg What ventilator change must be made to decrease the PaCO? The doctor asks you to increase the V t to correct the PaCO to 0 mm Hg ctual PaCO x ctual V t = Desired PaCO x Desired Vt 60 mm Hg x 00 ml = 0 mm Hg x (?) 00ml*mm Hg=0 mm Hg x (?) 00 ml = 600 ml = Desired V t 0 woman who is 5 is on controlled ventilation She has a PaCO of 58 mm Hg; ph is 78, V t 65 ml, and a f of 7/ Plateau pressure is measured as 30 cm H O How can a desired PaCO of 0 mm Hg be achieved? (IBW is 5 kg) ctual PaCO x ctual f = Desired PaCO x Desired f 58 mm Hg x 7/ = 0 mm Hg x (?) 06 mmhg * breaths/ = 0 mm Hg x (?) 06 = 10 breaths/ 0

3 xample 3 xample xample 5 xample 6 patient has a ph of 766, PaCO 0 mm Hg, HCO 3 - mq/l, PaO 89 mm Hg on FIO of 0% is being ventilated in the control mode with no spontaneous breaths and a V t of 700 ml, f of 18/ The doctor asks you to correct the ph and PaCO ctual PaCO x ctual f = Desired PaCO x Desired f 0 mm Hg x 18/ = 0 mm Hg x (?) 360 mmhg * breaths/ = 0 mm Hg x (?) 360 = 9 breaths/ 0 You are ventilating a patient on the Servo ventilator The V is set at 7 L/ and f at 1/ on /C volume ventilation The ph 79, PaCO 60 mm Hg, HCO - 3 is 8 mq/l, the PaO 89 mmhg and the FIO 0 Which ventilator change would you make to restore the PaCO to normal? ctual PaCO x ctual V = Desired PaCO x Desired V 60 mm Hg x 7 L/ = 0 mm Hg x (?) 0 mm Hg* L/ = 0 mm Hg x (?) 0 = 10 5 L/ is Desired V 0 You are ventilating a patient in /C mode with a V t of 600 ml, f 1/, FIO 50%, Peak flowrate 60 L/ The PaCO is 60 mm Hg, HCO 3-35, ph 739, PaO 88 mm Hg What ventilator change would you recommend? Increase the V t to 800 ml Increase the f to 16/ Decrease the f to 8/ Increase the FIO to 60% Maintain current settings You are ventilating an 18-year old male patient with a closed head injury from an automobile accident The ph is 753, PaCO 5 mm Hg, HCO 3-0 mq/l, PaO 100 mm Hg You notice that the patient is receiving IV mannitol The V t is 700 ml, f 16/, FIO 0% on /C volume ventilation The nurse asks your recommendation for ventilator changes What changes would you recommend? Increase the V t to 800 ml Decrease the V t to 500 ml Decrease the f to 1/ maintain current settings DCPTIV QUSTION ND ICP MSURMNT Decrease the FIO to 30%

4 xample 7 You are ventilating a burn patient in ICU on /C Volume Ventilation The V t is 10 Liters, f 10/, PaCO is 0 mm Hg, ph 70, PaO 89 mm Hg, HCO - 3 mq/l The patient s spontaneous V t is 800 ml and f is 15/ The patients total V is L/ How would you interpret the patient s condition? List clinical situations in which CO production may be increased? INCRSD CO PRODUCTION SCONDRY TO BURN IT IS LSO INCRSD WITH SPSIS, FVR, OVRFDING (SPCILLY WITH CRBOHYDRTS), XRCIS, ND XCSSIV BICRBONT DMINISTRTION (HCO 3 - CONVRTS BCK TO CO ) xample 8 You are ventilating a patient on the Servo ventilator with a ute ventilation of 8 L/ The ph is 73, PaCO 66 mm Hg, HCO 3-3 mq/l, PaO 68 mm Hg The doctor asks you to correct the ph What is the desired level of PaCO? To get to a ph level in the normal range you need an HCO 3 - : PaCO (in mq/l) ratio of 0:1 The current ratio is 3:(66*03) or 3:198 or 16:1 ratio To return to a normal ph (using only the PaCO, ie no change in HCO 3- ) we need to solve the following ratio: 3 :( Desired PaCO * 03) = 0:1 3/(Desired PaCO * 03) = 0/1 0 * (Desired PaCO * 03) = 3 * 1 (Desired PaCO * 03) = 3/0 (Desired PaCO * 03) = 16 Desired PaCO = 16/03 = 533 mm Hg How would you change the ventilator settings to correct to the new PaCO level? ctual PaCO x ctual V = Desired PaCO x Desired V 66 mm Hg x 8 L/ = 53 mm Hg x Desired V 58 mm Hg * L/ = 53 mm Hg x Desired V 58 = 10 L/ is Desired V 53

5 xample 9 You are ventilating a patient on the servo with a ute ventilation of 1 L/, PaCO, HCO 3-18, ph 750 How would you change the ventilator (change only the PaCO ) to restore a normal ph? The first step is to detere the level of PaCO desired? Current ratio is 18/(*03) or 18/7 or 5:1 ratio 18:(Desired PaCO * 03) = 0:1 18/(Desired PaCO * 03) = 0/1 0 * (Desired PaCO * 03) = 18 * 1 (Desired PaCO * 03) = 18/0 (Desired PaCO * 03) = 09 Desired PaCO = 09/03 = 30 mm Hg How would you change the ventilator settings to correct to the new PaCO level? ctual PaCO x ctual V = Desired PaCO x Desired V mm Hg x 1 L/ = 30 mm Hg x Desired V 88 mm Hg * L/ = 30 mm Hg x Desired V 88 = 9 6 L/ is Desired V 30

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL)

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL) Self-Assessment RSPT 2350: Module F - ABG Analysis 1. You are called to the ER to do an ABG on a 40 year old female who is C/O dyspnea but seems confused and disoriented. The ABG on an FiO 2 of.21 show:

More information

Diagnosis and Management of Acute Respiratory Failure

Diagnosis and Management of Acute Respiratory Failure Diagnosis and Management of Acute Respiratory Failure Steven B. Leven, M.D., F.C.C.P. Clinical Professor, Pulmonary/Critical Care Medicine UCI Director MICU and Respiratory Therapy, UCI Medical Center

More information

Outline. ABG Interpretation: A Respirologist s approach. Acid-Base Disturbances. What use is an ABG? Acid-Base Disturbances. Alveolar Ventilation

Outline. ABG Interpretation: A Respirologist s approach. Acid-Base Disturbances. What use is an ABG? Acid-Base Disturbances. Alveolar Ventilation Outline ABG Interpretation: A Respirologist s approach Dr. Shane Shapera Division of Respirology University Health Network October 2014 A quick review of acidbase physiology The 8 steps to ABG interpretation

More information

What is the next best step?

What is the next best step? Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female

More information

Images have been removed from the PowerPoint slides in this handout due to copyright restrictions.

Images have been removed from the PowerPoint slides in this handout due to copyright restrictions. Arterial Blood Gas Interpretation Routine Assessment Inspection Palpation Auscultation Labs Na 135-145 K 3.5-5.3 Chloride 95-105 CO2 22-31 BUN 10-26 Creat.5-1.2 Glu 80-120 Arterial Blood Gases WBC 5-10K

More information

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.

More information

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE

More information

Concerns and Controversial Issues in NPPV. Concerns and Controversial Issues in Noninvasive Positive Pressure Ventilation

Concerns and Controversial Issues in NPPV. Concerns and Controversial Issues in Noninvasive Positive Pressure Ventilation : Common Therapy in Daily Practice Concerns and Controversial Issues in Noninvasive Positive Pressure Ventilation Rongchang Chen Guangzhou Institute of Respiratory Disease as the first choice of mechanical

More information

Physiological Causes of Abnormal ABG s

Physiological Causes of Abnormal ABG s Physiological Causes of Abnormal ABG s Major Student Performance Objective 1 1. The student will be able to discuss causes for various types of blood gas results. 2. They will also be required to discuss

More information

OXYGENATION AND ACID- BASE EVALUATION. Chapter 1

OXYGENATION AND ACID- BASE EVALUATION. Chapter 1 OXYGENATION AND ACID- BASE EVALUATION Chapter 1 MECHANICAL VENTILATION Used when patients are unable to sustain the level of ventilation necessary to maintain the gas exchange functions Artificial support

More information

Weaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim

Weaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim Weaning from Mechanical Ventilation Dr Azmin Huda Abdul Rahim Content Definition Classification Weaning criteria Weaning methods Criteria for extubation Introduction Weaning comprises 40% of the duration

More information

Identification and Treatment of the Patient with Sleep Related Hypoventilation

Identification and Treatment of the Patient with Sleep Related Hypoventilation Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures

More information

Capnography: The Most Vital Sign

Capnography: The Most Vital Sign Capnography: The Most Vital Sign Mike McEvoy, PhD, NRP, RN, CCRN Cardiac Surgical ICU RN & Chair Resuscitation Committee Albany Medical Center EMS Coordinator Saratoga County, NY www.mikemcevoy.com CO

More information

Arterial Blood Gases. Dr Mark Young Mater Health Services

Arterial Blood Gases. Dr Mark Young Mater Health Services Arterial Blood Gases Dr Mark Young Mater Health Services Why do them? Quick results Bedside test Range of important information Oxygenation Effectiveness of gas exchange Control of ventilation Acid base

More information

Lecture Notes. Chapter 2: Introduction to Respiratory Failure

Lecture Notes. Chapter 2: Introduction to Respiratory Failure Lecture Notes Chapter 2: Introduction to Respiratory Failure Objectives Define respiratory failure, ventilatory failure, and oxygenation failure List the causes of respiratory failure Describe the effects

More information

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley SIMPLY Arterial Blood Gases Interpretation Week 4 Dr William Dooley Plan Structure for interpretation 5-step approach Works for majority of cases Case scenarios Some common concerns A-a gradient BE Anion

More information

Acid Base Balance by: Susan Mberenga RN, BSN, MSN

Acid Base Balance by: Susan Mberenga RN, BSN, MSN Acid Base Balance by: Susan Mberenga RN, BSN, MSN Acid Base Balance Refers to hydrogen ions as measured by ph Normal range: 7.35-7.45 Acidosis/acidemia: ph is less than 7.35 Alkalosis/alkalemia: ph is

More information

Acid Base Imbalance. 1. Prior to obtaining the ABG s an Allen s test should be performed. Explain the rationale for this.

Acid Base Imbalance. 1. Prior to obtaining the ABG s an Allen s test should be performed. Explain the rationale for this. Acid Base Imbalance Case 1. An 18-year-old male arrives via EMS to the emergency department. He is experiencing Tachypnea, dizziness, numbness and paraesthesia. He is anxious, respirations are 28 per minute

More information

Arterial Blood Gas Analysis

Arterial Blood Gas Analysis Arterial Blood Gas Analysis L Lester www.3bv.org Bones, Brains & Blood Vessels Drawn from radial or femoral arteries. Invasive procedure Caution must be taken with patient on anticoagulants ph: 7.35-7.45

More information

UNIT VI: ACID BASE IMBALANCE

UNIT VI: ACID BASE IMBALANCE UNIT VI: ACID BASE IMBALANCE 1 Objectives: Review the physiological mechanism responsible to regulate acid base balance in the body i.e.: Buffers (phosphate, hemoglobin, carbonate) Renal mechanism Respiratory

More information

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D.

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D. Pilbeam: Mechanical Ventilation, 4 th Edition Test Bank Chapter 1: Oxygenation and Acid-Base Evaluation MULTIPLE CHOICE 1. The diffusion of carbon dioxide across the alveolar capillary membrane is. A.

More information

Respiratory Failure. Causes of Acute Respiratory Failure (ARF): a- Intrapulmonary:

Respiratory Failure. Causes of Acute Respiratory Failure (ARF): a- Intrapulmonary: Respiratory failure exists whenever the exchange of O 2 for CO 2 in the lungs cannot keep up with the rate of O 2 consumption & CO 2 production in the cells of the body. This results in a fall in arterial

More information

Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on

Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with

More information

OSCAR & OSCILLATE. & the Future of High Frequency Oscillatory Ventilation (HFOV)

OSCAR & OSCILLATE. & the Future of High Frequency Oscillatory Ventilation (HFOV) & & the Future of High Frequency Oscillatory Ventilation (HFOV) www.philippelefevre.com What do we know already? Sud S et al. BMJ 2010 & Multi-centre randomised controlled trials of HFOV verses current

More information

NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity

NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Use of NIV 1998-2010 50 45 40 35 30 25 20 15 10 5 0 1998

More information

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease 136 PHYSIOLOGY CASES AND PROBLEMS Case 24 Chronic Obstructive Pulmonary Disease Bernice Betweiler is a 73-year-old retired seamstress who has never been married. She worked in the alterations department

More information

Chapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Flail Chest 1 Figure 21-1. Flail chest. Double fractures of three or more adjacent ribs produce instability of the chest wall and paradoxical motion of the thorax. Inset, Atelectasis, a common

More information

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water Module H: Carbon Dioxide Transport Beachey Ch 9 & 10 Egan pp. 244-246, 281-284 Carbon Dioxide Transport At the end of today s session you will be able to : Describe the relationship free hydrogen ions

More information

Capnography 101. James A Temple BA, NRP, CCP

Capnography 101. James A Temple BA, NRP, CCP Capnography 101 James A Temple BA, NRP, CCP Expected Outcomes 1. Gain a working knowledge of the physiology and science behind End-Tidal CO2. 2.Relate End-Tidal CO2 to ventilation, perfusion, and metabolism.

More information

ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018

ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018 ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018 Thomas F. Morley, DO, FACOI, FCCP, FAASM Professor of Medicine Chairman Department of Internal Medicine Director of the Division of Pulmonary,

More information

Keeping Patients Off the Vent: Bilevel, HFNC, Neither?

Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Robert Kempainen, MD Pulmonary and Critical Care Medicine Hennepin County Medical Center University of Minnesota School of Medicine Objectives Summarize

More information

Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo

Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/

More information

Indications for Respiratory Assistance. Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer

Indications for Respiratory Assistance. Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer Indications for Respiratory Assistance Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer Respiratory Assistance Non-invasive - Nasal specs - Facemask/ Resevoir

More information

Non-Invasive Assessment of Respiratory Function. Chapter 11

Non-Invasive Assessment of Respiratory Function. Chapter 11 Non-Invasive Assessment of Respiratory Function Chapter 11 Pulse Oximetry Laboratory measurements of ABG s are the gold standard for measuring levels of hypoxemia, however since these are performed intermittently

More information

Case Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity

Case Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity Case Scenarios Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Case 1 A 36 year male with cirrhosis and active GI bleeding is intubated to protect his airway,

More information

Causes and Consequences of Respiratory Centre Depression and Hypoventilation

Causes and Consequences of Respiratory Centre Depression and Hypoventilation Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During

More information

Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University

Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Assess adequacy of ventilation and oxygenation Aids in establishing a diagnosis and severity of respiratory failure

More information

Case discussion Acute severe asthma during pregnancy. J.G. van der Hoeven

Case discussion Acute severe asthma during pregnancy. J.G. van der Hoeven Case discussion Acute severe asthma during pregnancy J.G. van der Hoeven Case (1) 32-year-old female - gravida 3 - para 2 Previous medical history - asthma Pregnant (33 w) Acute onset fever with wheezing

More information

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3

More information

Respiratory insufficiency in bariatric patients

Respiratory insufficiency in bariatric patients Respiratory insufficiency in bariatric patients Special considerations or just more of the same? Weaning and rehabilation conference 6th November 2015 Definition of obesity Underweight BMI< 18 Normal weight

More information

Mechanical Ventilation Principles and Practices

Mechanical Ventilation Principles and Practices Mechanical Ventilation Principles and Practices Dr LAU Chun Wing Arthur Department of Intensive Care Pamela Youde Nethersole Eastern Hospital 6 October 2009 In this lecture, you will learn Major concepts

More information

Objectives. Health care significance of ARF 9/10/15 TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION

Objectives. Health care significance of ARF 9/10/15 TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION Louisa Chika Ikpeama, DNP, CCRN, ACNP-BC Objectives Identify health care significance of acute respiratory

More information

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 RESPIRATORY FAILURE Acute respiratory failure is defined by hypoxemia with or without hypercapnia. It is one

More information

Exam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies

Exam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies Exam 1 Review Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies WBC Count Differential A patient had been admitted to the hospital for acute shortness of breath. A CXR examination

More information

By Mark Bachand, RRT-NPS, RPFT. I have no actual or potential conflict of interest in relation to this presentation.

By Mark Bachand, RRT-NPS, RPFT. I have no actual or potential conflict of interest in relation to this presentation. By Mark Bachand, RRT-NPS, RPFT I have no actual or potential conflict of interest in relation to this presentation. Objectives Review state protocols regarding CPAP use. Touch on the different modes that

More information

Arterial Blood Gases Interpretation Definition Values respiratory metabolic

Arterial Blood Gases Interpretation Definition Values respiratory metabolic Arterial Blood Gases Interpretation Definition A blood gas test measures the amount of oxygen and carbon dioxide in the blood. It is also useful in determining the ph level of the blood. The test is commonly

More information

Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017

Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Capnography: The Most Vital of Vital Signs Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Assessing Ventilation and Blood Flow with Capnography Capnography

More information

RESPIRATORY SYSTEM and ACID BASE

RESPIRATORY SYSTEM and ACID BASE RESPIRATORY SYSTEM and ACID BASE Arif HM Marsaban Rudyanto Sedono Department of Anesthesiology and Intensive Therapy Faculty of medicine University of Indonesia Dr Cipto Mangunkusumo General Hospital Jakarta

More information

RESPIRATORY FAILURE. Dr Graeme McCauley KGH

RESPIRATORY FAILURE. Dr Graeme McCauley KGH RESPIRATORY FAILURE Dr Graeme McCauley KGH Definitions Failure to oxygenate-pao2 < 60 Failure to clear CO2-PaCO2 > 50 Acute vs Chronic Hypoxemic failure- type l Hypercapneic failure- type ll Causes of

More information

ARDS Management Protocol

ARDS Management Protocol ARDS Management Protocol February 2018 ARDS Criteria Onset Within 1 week of a known clinical insult or new or worsening respiratory symptoms Bilateral opacities not fully explained by effusions, lobar/lung

More information

Mechanical Ventilation 1. Shari McKeown, RRT Respiratory Services - VGH

Mechanical Ventilation 1. Shari McKeown, RRT Respiratory Services - VGH Mechanical Ventilation 1 Shari McKeown, RRT Respiratory Services - VGH Objectives Describe indications for mcvent Describe types of breaths and modes of ventilation Describe compliance and resistance and

More information

Recent Advances in Respiratory Medicine

Recent Advances in Respiratory Medicine Recent Advances in Respiratory Medicine Dr. R KUMAR Pulmonologist Non Invasive Ventilation (NIV) NIV Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive

More information

CSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018

CSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 CSIM annual meeting - 2018 Acute respiratory failure Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 NRGH affiliated with UBC medicine Disclosures None relevant to this presentation. Also no

More information

QuickLung Breather Patient Settings

QuickLung Breather Patient Settings The QuickLung Breather is capable of simulating a spontaneously breathing patient in a variety of modes and patterns. In response to customer requests, we have compiled five common respiratory cases below.

More information

1. What is the acid-base disturbance in this patient?

1. What is the acid-base disturbance in this patient? /ABG QUIZ QUIZ 1. What is the acid-base disturbance in this patient? Presenting complaint: pneumonia 1 point Uncompensated metabolic alkalosis Partially compensated respiratory alkalosis Mixed alkalosis

More information

Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE

Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE Indications for Vapotherm High Velocity Nasal Insufflation (Hi-VNI ) administration, the patient should be: Spontaneously

More information

Capnography. Capnography. Oxygenation. Pulmonary Physiology 4/15/2018. non invasive monitor for ventilation. Edward C. Adlesic, DMD.

Capnography. Capnography. Oxygenation. Pulmonary Physiology 4/15/2018. non invasive monitor for ventilation. Edward C. Adlesic, DMD. Capnography Edward C. Adlesic, DMD University of Pittsburgh School of Dental Medicine 2018 North Carolina Program Capnography non invasive monitor for ventilation measures end tidal CO2 early detection

More information

Control of Ventilation [2]

Control of Ventilation [2] Control of Ventilation [2] สรช ย ศร ส มะ พบ., Ph.D. ภาคว ชาสร รว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล มหาว ทยาล ยมห ดล Describe the effects of alterations in chemical stimuli, their mechanisms and response to

More information

Acute respiratory failure. Arterial blood gas assessment. finn rasmussen 2011

Acute respiratory failure. Arterial blood gas assessment. finn rasmussen 2011 Acute respiratory failure Arterial blood gas assessment finn rasmussen 2011 Normal P a CO 2 = 40mmHg Normal P a O 2 = 90-95 mmhg ALVEOLAR VENTILATION Normal HCO 3- = 22-27 mmol/l H + 2 0 CO + 2 H HCO -

More information

I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device

I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device II. Policy: Continuous Positive Airway Pressure CPAP by the Down's system will be instituted by Respiratory Therapy personnel

More information

BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT

BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides

More information

Respiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross

Respiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross Respiratory Physiology Part II Bio 219 Napa Valley College Dr. Adam Ross Gas exchange Gas exchange in the lungs (to capillaries) occurs by diffusion across respiratory membrane due to differences in partial

More information

Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients

Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific

More information

Nursing of long-term ventilated SCI-patients - needs, goals and limitations

Nursing of long-term ventilated SCI-patients - needs, goals and limitations Nursing of long-term ventilated SCI-patients - needs, goals and limitations 2016 International SCI Nurse Conference Rome, Italy S. Tiedemann BG Klinikum Hamburg Chief physician: PD Dr. R. Thietje Blohm+Voss

More information

1. What is delayed sequence intubation? Can it be used for severe Asthma exacerbation? 2. What about pregnancy and Asthma is so important?

1. What is delayed sequence intubation? Can it be used for severe Asthma exacerbation? 2. What about pregnancy and Asthma is so important? Chapter 073 Asthma Episode Overview 1. 10 different causes of a wheeze. 2. List 8 risk factors for death from asthma 3. List 6 objective findings of severe asthma 4. 10 therapies for an acute severe asthma

More information

Are you ready to have fun?

Are you ready to have fun? Arterial Blood Gas INTERPRETATION By Nena Bonuel, MSN, RN, CCRN, CNS, ACNS-BC Nurse Specialist, Center for Professional Excellence Are you ready to have fun? 1. Yes! 2. I rather go shopping 3. I still

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The use of proning in the management of Acute Respiratory Distress Syndrome Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning

More information

EISA I. AFIFY, M.D.; AHMED T. SHAARAWY, M.D.; AHMED E. KABIL, M.D. and MAGDY S. TAHA, M.Sc.

EISA I. AFIFY, M.D.; AHMED T. SHAARAWY, M.D.; AHMED E. KABIL, M.D. and MAGDY S. TAHA, M.Sc. Med. J. Cairo Univ., Vol. 84, o. 2, December: 377-383, 2016 www.medicaljournalofcairouniversity.net Comparison between Pressure Regulated Volume Control Ventilation and Synchronized Intermittent Mandatory

More information

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation.

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. Chapter 1: Principles of Mechanical Ventilation TRUE/FALSE 1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. F

More information

to optimize By Jin Xiong Lian, BSN, RN, CNS

to optimize By Jin Xiong Lian, BSN, RN, CNS Using ABGs to optimize By Jin Xiong Lian BSN RN CNS AN ARTERIAL BLOOD GAS (ABG) analysis can tell you about the patient s oxygenation (via PaO 2 and SaO 2 ) acid-base balance pulmonary function (through

More information

(To be filled by the treating physician)

(To be filled by the treating physician) CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type

More information

NIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH

NIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940

More information

Bronchoalveolar lavage (BAL) with surfactant in pediatric ARDS

Bronchoalveolar lavage (BAL) with surfactant in pediatric ARDS Bronchoalveolar lavage (BAL) with surfactant in pediatric ARDS M. Luchetti, E. M. Galassini, A. Galbiati, C. Pagani,, F. Silla and G. A. Marraro gmarraro@picu.it www.picu.it Anesthesia and Intensive Care

More information

ETCO2 MONITORING NON-INTUBATED PATIENTS

ETCO2 MONITORING NON-INTUBATED PATIENTS Although the standard of care in ETC02 is well established for intubated patients, there has been little emphasis on the use of capnography in nonintubated patients till now. In addition to confirming

More information

June 2011 Bill Streett-Training Section Chief

June 2011 Bill Streett-Training Section Chief Capnography 102 June 2011 Bill Streett-Training Section Chief Terminology Capnography: the measurement and numerical display of end-tidal CO2 concentration, at the patient s airway, during a respiratory

More information

Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin

Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin Respiratory Medicine Some pet peeves and other random topics Kyle Perrin Overview 1. Acute asthma Severity assessment and management 2. Acute COPD NIV and other management 3. Respiratory problems in the

More information

NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)

NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive

More information

Weaning and extubation in PICU An evidence-based approach

Weaning and extubation in PICU An evidence-based approach Weaning and extubation in PICU An evidence-based approach Suchada Sritippayawan, MD. Div. Pulmonology & Crit Care Dept. Pediatrics Faculty of Medicine Chulalongkorn University Kanokporn Udomittipong, MD.

More information

Effects of PPV on the Pulmonary System. Chapter 17

Effects of PPV on the Pulmonary System. Chapter 17 Effects of PPV on the Pulmonary System Chapter 17 Pulmonary Complications Lung Injury Gas distribution Pulmonary blood flow VAP Hypoventilation Hyperventilation Air trapping Oxygen toxicity WOB Patient-Ventilator

More information

Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล

Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล Goal of Mechanical Ventilation Mechanical ventilation is any means in which physical device or machines are

More information

Don t let your patients turn blue! Isn t it about time you used etco 2?

Don t let your patients turn blue! Isn t it about time you used etco 2? Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P

More information

Interesting Capnography Cases

Interesting Capnography Cases Interesting Capnography Cases Mike McEvoy, PhD, NRP, RN, CCRN Cardiac Surgical ICU RN & Chair Resuscitation Committee Albany Medical Center EMS Coordinator Saratoga County, NY www.mikemcevoy.com Outline

More information

You are caring for a patient who is intubated and. pressure control ventilation. The ventilator. up to see these scalars

You are caring for a patient who is intubated and. pressure control ventilation. The ventilator. up to see these scalars Test yourself Test yourself #1 You are caring for a patient who is intubated and ventilated on pressure control ventilation. The ventilator alarms and you look up to see these scalars What is the most

More information

APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017

APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017 APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017 Disclosures No conflicts of interest Objectives Attendees will be able to: Define the mechanism of APRV Describe

More information

RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS

RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS QUIZ REVIEW The correct answer is in bold font. 1. Hypoxic respiratory failure involves: a. Low oxygen b. High oxygen

More information

Foundation in Critical Care Nursing. Airway / Respiratory / Workbook

Foundation in Critical Care Nursing. Airway / Respiratory / Workbook Foundation in Critical Care Nursing Airway / Respiratory / Workbook Airway Anatomy: Please label the following: Tongue Larynx Epiglottis Pharynx Trachea Vertebrae Oesophagus Where is the ET (endotracheal)

More information

County of Santa Clara Emergency Medical Services System

County of Santa Clara Emergency Medical Services System County of Santa Clara Emergency Medical Services System Policy #700-M12: Continuous Positive Airway Pressure CONTINUOUS POSITIVE AIRWAY PRESSURE Effective: February 8, 2013TBD Replaces: NewFebruary 8,

More information

Shock. Zeng xuan Hu OCT17

Shock. Zeng xuan Hu OCT17 Shock Zeng xuan Hu OCT17 1 Objective Concept Categories Principles of management 2 Definition Inadequate tissue perfusion to maintain normal cellular function Not all hypotensive patients are in shock

More information

11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options

11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options Beyond CPAP Kristie R Ross, M.D. November 12, 2015 No relevant financial conflicts of interest Sponsored by The Warren Alpert Medical School of Brown University Describe advanced ventilation options Compare

More information

Acute respiratory failure

Acute respiratory failure Rita Williams, NP-C, PA PeaceHealth Medical Group Pulmonary & Critical Care Acute respiratory failure Ventilation/perfusion mismatching Most common cause of hypoxemia Normal is 1:1 ratio or 1 Ventilation

More information

Acute Respiratory Distress Syndrome (ARDS) An Update

Acute Respiratory Distress Syndrome (ARDS) An Update Acute Respiratory Distress Syndrome (ARDS) An Update Prof. A.S.M. Areef Ahsan FCPS(Medicine) MD(Critical Care Medicine) MD ( Chest) Head, Dept. of Critical Care Medicine BIRDEM General Hospital INTRODUCTION

More information

C h a p t e r 1 4 Ventilator Support

C h a p t e r 1 4 Ventilator Support C h a p t e r 1 4 Ventilator Support Shirish Prayag Ex. Hon. Asst. Prof of Medicine, BJ Medical College and Sassoon Hospital, Pune; Chief Consultant in Internal Medicine and Critical Care, Shree Medical

More information

Slide 1. Slide 2. Slide 3 VENTILATOR MADNESS.. MAKING SENSE OF IT ALL!! Objectives: I have nothing to disclose.

Slide 1. Slide 2. Slide 3 VENTILATOR MADNESS.. MAKING SENSE OF IT ALL!! Objectives: I have nothing to disclose. Slide 1 VENTILATOR MADNESS.. MAKING SENSE OF IT ALL!! Maryann M Brogden ND, MSN, RN, APN-C, CCNS, SCRN Slide 2 I have nothing to disclose. Slide 3 Objectives: Identify Criteria for Intubation Differentiate

More information

MECHANICAL VENTILATION PROTOCOLS

MECHANICAL VENTILATION PROTOCOLS GENERAL or SURGICAL Initial Ventilator Parameters Ventilator Management (see appendix I) Assess Patient Data (see appendix II) Data Collection Mode: Tidal Volume: FIO2: PEEP: Rate: I:E Ratio: ACUTE PHASE

More information

EMS System for Metropolitan Oklahoma City and Tulsa 2017 Medical Control Board Treatment Protocols

EMS System for Metropolitan Oklahoma City and Tulsa 2017 Medical Control Board Treatment Protocols S O EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC 3H WAVEFORM CAPNOGRAPHY ADULT & PEDIATRIC Indications: 1. Medical General Assessment/General Supportive Care. 2. Trauma General Assessment/Trauma & Hypovolemic

More information

Oxygen and ABG. Dr Will Dooley

Oxygen and ABG. Dr Will Dooley Oxygen and ABG G Dr Will Dooley Oxygen and ABGs Simply in 10 cases Recap of: ABG interpretation Oxygen management Some common concerns A-a gradient Base Excess Anion Gap COPD patients CPAP/BiPAP First

More information

High Flow Oxygen Therapy in Acute Respiratory Failure. Laurent Brochard Toronto

High Flow Oxygen Therapy in Acute Respiratory Failure. Laurent Brochard Toronto High Flow Oxygen Therapy in Acute Respiratory Failure Laurent Brochard Toronto Conflicts of interest Our clinical research laboratory has received research grants for clinical research projects from the

More information

Regulation of Respiration. Regulation of Respiration. Regulation of Respiration. Regulation of Respiration 4/10/2016. Nervous system regulation

Regulation of Respiration. Regulation of Respiration. Regulation of Respiration. Regulation of Respiration 4/10/2016. Nervous system regulation Respiratory Regulation and Respiratory Disease Nervous system regulation Various levels of activity produce different demands Medulla Regulation of respiratory rate PaCO 2 normal range 35-45 mmhg Nervous

More information

Dr. Sinan Butrus F.I.C.M.S. Clinical Standards & Guidelines. Kurdistan Board For Medical Specialties

Dr. Sinan Butrus F.I.C.M.S. Clinical Standards & Guidelines. Kurdistan Board For Medical Specialties Guidelines For the Management of Respiratory Acidosis By Dr. Sinan Butrus F.I.C.M.S Clinical Standards & Guidelines Kurdistan Board For Medical Specialties Respiratory acidosis is an acid-base balance

More information

Volume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study

Volume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study D-32084-2011 Volume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study Robert DiBlasi RRT-NPS, FAARC Respiratory Care Manager of Research & Quality

More information