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

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

2 Goal of Mechanical Ventilation Mechanical ventilation is any means in which physical device or machines are used to assist or replace mechanical ventilation Maintaining alveolar ventilation necessary to meet metabolic needs for oxygen uptake and carbon dioxide removal

3 Indication for mechanical ventilation Need for high level of inspired oxygen (hypoxic respiratory failure) Need for assist or control ventilation (hypercapnic respiratory failure, surgery) Organ protection Intracranial hypertension Pulmonary hypertensive crisis, severe abdominal hypertension Decrease work of breathing : heart failure, severe metabolic acidosis

4 Ventilator Support Strategies Total support Full support Partial support Weaning

5 Type of Mechanical Ventilation Negative pressure ventilation Positive pressure ventilation

6 Negative Pressure Ventilation Decrease effect of positive pressure ventilation Eg. Pulmonary hypertension? Adequacy of ventilation Pressure effect

7 Iron Lung Chest Cuirass

8 Positive Pressure Ventilation Non invasive positive Invasive positive pressure ventilation

9 Non invasive Positive Pressure Ventilation

10

11

12 Initiation or Trigger Mechanism Time trigger Pressure trigger Flow trigger

13

14

15 Limiting Mechanism Volume limited Pressure limited Flow limited

16 Cycling Mechanism Volume cycled Pressure cycled Time cycled Flow cycled

17 Mechanical Function in Positive Pressure Ventilation Mode Initiation Limit Cycle Volume Preset CMV Time Volume Volume/Time Assist/control Pressure Volume Volume/Time IMV Time Volume Volume/Time SIMV Time/pressure Volume Volume/Time Pressure Preset PSV Pressure Pressure Flow PCV Time Pressure Time

18 Mode of Mechanical Ventilation Controlled Ventilation Assist -Control Ventilation Synchronized intermittent mandatory ventilation Pressure support ventilation

19 Control Ventilation Assist/Control Ventilation Intermittent Mandatory Ventilation Pressure Support Ventilation Continueous Positive Airway Pressure Ventilation

20 Flow Trigger

21 Volume Control Ventilation

22 Pressure Control Ventilation

23 Pressure Regulated Volume Control Adaptive Pressure Ventialtion ( APV) Inverse Ratio Ventialtion

24 BIPAP Biphasic Positive Airway Pressure

25 High Frequency..High Oscillator Ventialtion

26 Continuous Care During Mechanical Ventilation Ventilator parameter Humidification and temperature Sedation and analgesia Weaning

27 Ventilator Parameter Inspiratory pressure I:E ratio FiO2 Minute ventilation

28 Recommendation for monitoring during mechanical ventilatory support CXR after intubation or deterioration ABG after initial setting Vital sign Measure inspiratory plateau Pulse oxymeter Ventilator alarm

29 Obstructive airway disease Asthma, COPD Support oxygenation and ventilation until primary pathology has resolved May produced hyperinflation, auto-peep, secondary hypotension

30 Obstructive airway disease More attention to the balance of the cycle of inspire and expire time (I:E) Adequate expire time Adequate peak inspiratory pressure

31 Restrictive airway disease Scoliosis morbid obesity Low tital volume, high rate Maintain minute ventilation

32 Ventilator Management in heart disease Decrease the work of breathing Ensure adequate oxygen delivery to the heart Heart lung interaction

33 Ventilator Management in heart disease Cardiogenic pulmonary edema may benefit from mechanical ventilation induced increase in intrathoracic pressure which will decrease LV filling Lower pulmonary capillary pressure) and decrease LV after load (increase stroke volume)

34 Problems & Complications Associated with Mechanical Ventilation Complications associated with mechanic Volume trauma Barotruma Asynchony Oxygen toxicity Nonsynchrony Complication associated in the process of treatment - Ventilator associated pneumonia - Heart lung interaction

35 Hypotension associated with mechanical ventilation Tension pneumothorax Converse from negative to positive intrathoracic pressure Auto -PEEP Acute MI

36 Weaning FiO2 Rate, IMV Pressure support T piece

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