Optimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care
|
|
- Amber Bell
- 6 years ago
- Views:
Transcription
1
2 Optimize vent weaning and SBT outcomes Identify underlying causes for SBT failures Role SBT and weaning protocol have in respiratory care
3 Lower risk of developing complications Lower risk of VAP, other hospital acquired infections Shorter length of stay Cost savings to patient and hospital
4 Ventilator Spontaneous mode Pressure support 8cmH20 Peep 5 100% tube compliance, Peep 5 Pressure support 0, Peep 0 to get RSBI reading T-Piece With oxygen
5 Large randomized trial compared routine SBTs to two other weaning strategies that did not include SBT s. Compelling evidence that protocol driven ventilator discontinuation strategies more successful Clear evidence RN/RT can reduces costs for patients utilizing protocols
6 Ely published results of 2-step protocol driven by RN/RT using daily screening procedure followed by SBT in those who met screening criteria and extubation was recommended.
7 151 patients managed with the protocol had a higher severity of illness than the 149 control subjects, they were removed from the ventilator 1.5 days earlier (with 2 days less weaning), had 50% fewer complications related to the ventilator and had mean ICU costs of care that were lower by >$5,000 per patient.
8 Another study showed the mean duration of mechanical ventilation could be reduced by 30 hours. Marelich showed duration of ventilatory support could be reduced almost 50% using nurse-driven and therapist-driven protocols
9 Patient assessment Can patient protect their airway Patient hemodynamically stable How long patient on ventilator Underlying cause for intubation resolved
10 Order for SBT Complete patient assessment for potential weaning PaO2/Fi02 ratio > than 150 or Sp02 > 90% on fi02 <.50 Peep < 8cmh20 Intact airway reflexes
11 Not on continuous infusion of vasopressors (Dopamine < 5mcg/kg/min allowed) Respiratory rate < 35 Any contraindication of this guideline requires call to physician prior to proceeding RT to consult with RN about patient sedation status. Perform RSBI if above criteria met
12 Spontaneous Mode PEEP 5cmH20 and Pressure Support 5cmH minutes Observe RSBI RSBI <100, initiate Spontaneous Breathing Trial (SBT) Head of Bed 30 degrees or greater Suction patient if necessary Alarms set and active during trial
13 Discontinue SBT If any of the following sustained longer than 5 minutes despite minor interventions such as suctioning or reassurance Blood pressure < 90 or greater than 200mmhg Respiratory rate is > than 35 and 50% reduction in minute volume Pulse greater than 120 or sustained 20% increase Severe anxiety
14 Significant decrease in level of consciousness from baseline EtC02 increase of 20 mmhg from baseline (only if EtCo2 monitoring in place) New onset or increased frequency of arrhythmias Sp02 is less than 90% on Fi02 less than or equal 50% RSBI greater than 100
15 If patient tolerates SBT after 30 minutes, call ordering physician or mid-level provider for further orders. If RSBI determination is greater than 100, begin Augmented Pressure Support in SIMV with Pressure Support Start with Pressure Support of 15cmH20 SIMV rate minus two of initial prescribed rate
16 Titrate pressure support for Spontaneous tidal volume of 6ml/kg of Ideal body weight When SIMV rate reaches 2, change ventilator mode to spontaneous If respiratory rate is less than 30 and RSBI is less than 100, begin SBT. If not, continue pressure support settings and notify physician or mid-level provider
17 Underlying cause for intubation not corrected Sepsis, ARDS, Lung injury Heart failure - BUN Stress Anxiety Drug use
18 Sedation/narcotic use Central apnea Nutritional support Phosphate/magnesium deficiency Cause muscle weakness
19 Studies are conflicting as to placing patient on weaning type mode of ventilation/simv as opposed to assist control ventilation. Patient dependent, some need more or full support between SBT trials, suggest a gradual change to weaning modes.
20 CABG < 6 hrs. CABG and valve repair <24 hrs. Ventilator checks q1 hr.. Q30 minute checks 4-6 hr.. Charting HR, RR, BP, Chest tube output Sedation, vasopressor ABG done 30 min hour upon arrival 8ml/kg VT, titrate FIO2 aggressively as tolerated
21 Starting hour 4 Sedation off, Fi , PEEP 5cmH20 Assess patient for SBT Patient has to follow commands Hand grip for 5 seconds Move feet/toes If patient meets criteria, place on SBT RT to remain at bedside for 5-10 minutes If patient not ready, place back on vent settings and try again in minutes.
22 Criteria for extubation Pt clinical stable Pt awakening from anesthesia Normal body temperature Pain under control Chest tube drainage <50ml hour or decreasing/stable PEEP 5cmH20, Fi02 <60% Sp02 > 92%
23 If patient does well on SBT ABG drawn ph pco P/F ratio > 150 on Fi02 < 50% Or Pre-Op baseline for patients with COPD If ABG outside these parameters call physician
24 If Patient not extubated in 6 hr. window Vent check every hour Adjust vent settings Bipap orders PRN IPAP 15, EPAP 5, Rate of 12 keep Sp02 >92% Continue ETC02 monitoring 12 hr. after extubation, or continuous if sleep apnea while on IV opioids
25 Female patient, mid 50 s GI Bleed Intubated to protect airway only Bedside procedure x 2 Extubate after 2 nd procedure Goal intubation <24 hr. No Respiratory history
26 Failed first SBT in the morning Pt sedated for comfort High anxiety Family very concerned Dr. wanted patient extubated
27 Explained SBT process to Patient and Family Sedation was weaned off Pt anxiety addressed Pt on Spontaneous mode for about 5 hours Successfully extubated patient in 6 hrs.
28 Adult average ventilator days per month Goal is 4.2 days July 4.71 days mostly below TOTAL VENTILATOR PATIENTS per month CVICU goal < 6hrs 60% of time. missed goal 4 times July 2015 Society of Thoracic Surgeons (STS) 3 star rating
29 29
30 30
31 31
32 Advocate for Patients Be proactive in SBT Protocol for Vent Weaning/SBT
Spontaneous Breathing Trial and Mechanical Ventilation Weaning Process
Page 1 of 5 ASSESSMENT INTERVENTION Patient receiving mechanical ventilation Baseline ventilatory mode/ settings RT and RN to assess criteria 1 for SBT Does patient meet criteria? RT to initiate SBT Does
More informationCrit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders
Crit Vent Bundle for Mechanical Ventilation (337) [337] Physician - Also, enter Critical Care Admission Orders Initial Vent Settings (Single Response) [6360] If no previous orders and no choice made by
More informationMECHANICAL 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 informationSedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe )
PROTOCOL Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe ) Page 1 of 6 Scope: Population: Outcome: Critical care clinicians and providers. All ICU patients intubated or mechanically
More informationDefinitions. Definitions. Weaning. Weaning. Disconnection (Discontinuation) Weaning
Definitions 2 Disconnection (Discontinuation) Implies patient no longer needs that form of therapy 80% of patients requiring temporary MVS do not require weaning Definitions 3 Implies some need for MVS
More informationCase 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 informationWeaning 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 informationWeaning 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 informationAlthough the literature reports that approximately. off a ventilator
Taking your patient off a ventilator Although the literature reports that approximately 33% of patients in the ICU require mechanical ventilation (MV),! the figure is closer to 90% for the critically SONIA
More information17400 Medina Road, Suite 100 Phone: Minneapolis, MN Fax:
17400 Medina Road, Suite 100 Phone: 763-398-8300 Minneapolis, MN 55447-1341 Fax: 763-398-8400 www.pulmonetic.com Clinical Bulletin To: Cc: From: Domestic Sales Representatives and International Distributors
More informationInterfacility Protocol Protocol Title:
Interfacility Protocol Protocol Title: Mechanical Ventilator Monitoring & Management Original Adoption Date: 05/2009 Past Protocol Updates 05/2009, 12/2013 Date of Most Recent Update: March 23, 2015 Medical
More informationWhat 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 informationProvide guidelines for the management of mechanical ventilation in infants <34 weeks gestation.
Page 1 of 5 PURPOSE: Provide guidelines for the management of mechanical ventilation in infants
More informationPrepared 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 informationPOLICY. Number: Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE. Authorization
POLICY Number: 7311-60-024 Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE Authorization [ ] President and CEO [ x ] Vice President, Finance and Corporate Services Source:
More informationAPRV Ventilation Mode
APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher
More informationALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Intubation Phase Notify Therapy for STAT intubation Medications SUB Rapid Sequence Induction (SUB)* ***Reminder: Order SUB Rapid Sequence Induction (SUB) on a separate form*** lidocaine
More informationWeaning: The key questions
Weaning from mechanical ventilation Weaning / Extubation failure: Is it a real problem in the PICU? Reported extubation failure rates in PICUs range from 4.1% to 19% Baisch SD, Wheeler WB, Kurachek SC,
More informationMechanical 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 informationNIV - 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 informationCSIM 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 informationNIV 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 informationCLINICAL VIGNETTE 2016; 2:3
CLINICAL VIGNETTE 2016; 2:3 Editor-in-Chief: Olufemi E. Idowu. Neurological surgery Division, Department of Surgery, LASUCOM/LASUTH, Ikeja, Lagos, Nigeria. Copyright- Frontiers of Ikeja Surgery, 2016;
More informationLiberation from Mechanical Ventilation in Critically Ill Adults
Liberation from Mechanical Ventilation in Critically Ill Adults 2017 ACCP/ATS Clinical Practice Guidelines Timothy D. Girard, MD, MSCI Clinical Research, Investigation, and Systems Modeling of Acute Illness
More informationAn Overview of the Chronic Critical Illness Syndrome (CCIS) and Weaning the PMV Patient
An Overview of the Chronic Critical Illness Syndrome (CCIS) and Weaning the PMV Patient Fall 2011 CCIS has been known for some time HISTORICAL PRECURSORS INCLUDE: SIRS Systemic Inflammatory Response Syndrome
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available ONLY at: BMC-B BMC-D BMC-N BMC-S Intubation Phase Notify Therapy for STAT intubation SUB Rapid Sequence Induction(SUB)* ***The above subphase is available at the end of the powerplan under the
More informationEffectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists
Original Article Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists Cenk Kirakli, Ozlem Ediboglu, Ilknur Naz, Pinar Cimen,
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationMEDICAL CITY CONGENITAL HEART SURGICAL UNIT VENTILATOR AND SUPPORT WEANING PROTOCOL
MEDICAL CITY CONGENITAL HEART SURGICAL UNIT VENTILATOR AND SUPPORT WEANING PROTOCOL Purpose To provide consistent clinical practice and timely interventions in in the management of patients requiring mechanical
More informationNon-invasive Ventilation protocol For COPD
NHS LANARKSHIRE MONKLANDS HOSPITAL Non-invasive Ventilation protocol For COPD April 2017 S Baird Review Date: Oct 2019 Approved by Medical Directorate Indications for Non-Invasive Ventilation (NIV) NIV
More informationSurgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09
Surgery Grand Rounds Non-invasive Ventilation: A valuable tool James Cromie, PGY 3 8/24/09 History of mechanical ventilation 1930 s: use of iron lung 1940 s: First NIV system (Bellevue Hospital) 1950 s:
More informationI. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP
I. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP II. Policy: PSV with BiPAP device/nasal CPAP will be initiated upon a physician's order by Respiratory Therapy personnel trained
More informationPOST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT
PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS
More informationApproach to type 2 Respiratory Failure
Approach to type 2 Respiratory Failure Changing Nature of NIV Not longer just the traditional COPD patients Increasingly Obesity Neuromuscular Pneumonias 3 fold increase in patients with Ph 7.25 and below
More informationUCH WEANING FROM MECHANICAL VENTILATION PATHWAY
UCH WEANING FROM MECHANICAL VENTILATION PATHWAY WAKE WARM AND WEAN. POST OPERATIVE PATIENTS WHO HAVE BEEN VENTILATED < 24 HOURS DAILY EXTUBATION SCREEN A DAILY SCREEN TO BE CARRIED OUT ON ALL PATIENTS
More informationQuickLung 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 informationBiLevel Pressure Device
PROCEDURE - Page 1 of 7 Purpose Scope Classes/ Goals Define indications and care settings for acute and chronic initiation of Noninvasive Positive Pressure Ventilation. Identify the role of Respiratory
More informationBasics of NIV. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity
Basics of NIV Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Objectives: Definitions Advantages and Disadvantages Interfaces Indications Contraindications
More informationOxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators
Oxygenation Failure Increase FiO2 Titrate end-expiratory pressure Adjust duty cycle to increase MAP Patient Positioning Inhaled Vasodilators Extracorporeal Circulation ARDS Radiology Increasing Intensity
More informationTracking lung recruitment and regional tidal volume at the bedside. Antonio Pesenti
Tracking lung recruitment and regional tidal volume at the bedside Antonio Pesenti Conflicts of Interest Maquet: Received research support and consultation fees Drager: Received research support and consultation
More informationRecovery from ICU-acquired weakness; do not forget the respiratory muscles!
Recovery from ICU-acquired weakness; do not forget the respiratory muscles! Beatrix Clerckx Department of Rehabilitation Sciences, Department of Intensive Care Medicine, University Hospitals Leuven, Catholic
More informationThe Art and Science of Weaning from Mechanical Ventilation
The Art and Science of Weaning from Mechanical Ventilation Shekhar T. Venkataraman M.D. Professor Departments of Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Some definitions
More informationNew Modes and New Concepts In Mechanical Ventilation
New Modes and New Concepts In Mechanical Ventilation Prof Department of Anesthesia and Surgical Intensive Care Cairo University 1 2 New Ventilation Modes Dual Control Within-a-breath switches from PC to
More informationTest 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 informationSimulation 15: 51 Year-Old Woman Undergoing Resuscitation
Simulation 15: 51 Year-Old Woman Undergoing Resuscitation Flow Chart Flow Chart Opening Scenario Section 1 Type: DM Arrive after 5-6 min in-progress resuscitation 51 YO female; no pulse or BP, just received
More informationASPIRUS WAUSAU HOSPITAL, INC. Passion for excellence. Compassion for people. SUBJECT: END TIDAL CARBON DIOXIDE MONITORING (CAPNOGRAPHY)
Passion for excellence. Compassion for people. P&P REF : NEW 7-2011 ONBASE POLICY ID: 13363 REPLACES: POLICY STATUS : FINAL DOCUMENT TYPE: Policy EFFECTIVE DATE: 4/15/2014 PROPOSED BY: Respiratory Therapy
More informationWEANING READINESS & SPONTANEOUS BREATHING TRIAL MONITORING
CLINICAL EVIDENCE GUIDE WEANING READINESS & SPONTANEOUS BREATHING TRIAL MONITORING Weaning readiness and spontaneous breathing trial monitoring protocols can help you make the right weaning decisions at
More informationRespiratory Care Services
Respiratory Care Services Who we are 45 Licensed Respiratory Care Practitioners & 3 per diem Hospital assistants Out patient services Limited to Asthma Clinic Pilot In-patient services Primarily intensive
More informationRespiratory Care and Organ Donation
Respiratory Care and Organ Donation Whitni Noyes, RN, OPTC Midwest Transplant Network Midwest Transplant Network CMS requires every accredited hospital to have an agreement with an OPO. MTN is the first
More information7 Initial Ventilator Settings, ~05
Abbreviations (inside front cover and back cover) PART 1 Basic Concepts and Core Knowledge in Mechanical -- -- -- -- 1 Oxygenation and Acid-Base Evaluation, 1 Review 01Arterial Blood Gases, 2 Evaluating
More informationNON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
More informationVentilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc
Ventilatory Management of ARDS Alexei Ortiz Milan; MD, MSc 2017 Outline Ventilatory management of ARDS Protected Ventilatory Strategy Use of NMB Selection of PEEP Driving pressure Lung Recruitment Prone
More informationNAVA. In Neonates. Howard Stein, M.D. Director Neonatology. Neurally Adjusted Ventilatory Assist. Toledo Children s Hospital Toledo, Ohio
NAVA Neurally Adjusted Ventilatory Assist In Neonates Howard Stein, M.D. Director Neonatology Toledo Children s Hospital Toledo, Ohio Disclaimers Dr Stein: Is discussing products made by Maquet Has no
More informationDifficult weaning from mechanical ventilation
Difficult weaning from mechanical ventilation Paolo Biban, MD Director, Neonatal and Paediatric Intensive Care Unit Division of Paediatrics, Major City Hospital Azienda Ospedaliera Universitaria Integrata
More informationAFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL
AFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL A. Definition of Therapy: 1. Cough machine: 4 sets of 5 breaths with a goal of I:E pressures approximately the same of 30-40. Inhale time = 1 second, exhale
More informationRespiratory 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 informationARDS: 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 informationNON INVASIVE LIFE SAVERS. Non Invasive Ventilation (NIV)
Table 1. NIV: Mechanisms Of Action Decreases work of breathing Increases functional residual capacity Recruits collapsed alveoli Improves respiratory gas exchange Reverses hypoventilation Maintains upper
More informationVolume 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 informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationBiPAPS/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 informationBy 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 informationModule 4: Understanding MechanicalVentilation Jennifer Zanni, PT, DScPT Johns Hopkins Hospital
Module 4: Understanding MechanicalVentilation Jennifer Zanni, PT, DScPT Johns Hopkins Hospital Objectives Upon completion of this module, the learner will be able to: Identify types of airways and indications
More informationPotential Conflicts of Interest
Potential Conflicts of Interest Patient Ventilator Synchrony, PAV and NAVA! Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 4-27-09 WSRC Received research
More informationJulie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist
Julie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist Objectives Define capnography vs. end tidal CO2 (EtCO 2 ) Identify what normal vs. abnormal EtCO2 values mean and what to do Understand when to
More informationWhere Emergency Medicine Meets Critical Care: Next Level Resuscitation
Where Emergency Medicine Meets Critical Care: Next Level Resuscitation Rob Green, BSc, MD, DABEM, FRCPC, FRCP(Edin) Professor, Dalhousie University Departments of Emergency Medicine,Critical Care Medicine
More informationNew York Science Journal 2017;10(5)
Value of Automatic Tube Compensation during Weaning of Mechanically Ventilated Patient in Medical Intensive Care Unit Mohamed Abouzeid. 1, Ahmed E. Kabil. 2, Ahmed Al-Ashkar 1 and Hafez A. Abdel-Hafeez
More informationMechanical 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 informationCase Scenario 3: Shock and Sepsis
Name: Molly Boyle 1. Define the term shock (Lewis textbook): Shock is a syndrome characterized by decreased perfusion and impaired metabolism. Shock can have a number of causes that result in damage to
More informationBest of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine
Best of Pulmonary 2012-2013 Jennifer R. Hucks, MD University of South Carolina School of Medicine Topics ARDS- Berlin Definition Prone Positioning For ARDS Lung Protective Ventilation In Patients Without
More informationCLINICAL CONSIDERATIONS FOR THE BUNNELL LIFE PULSE HIGH-FREQUENCY JET VENTILATOR
CLINICAL CONSIDERATIONS FOR THE BUNNELL LIFE PULSE HIGH-FREQUENCY JET VENTILATOR 801-467-0800 Phone 800-800-HFJV (4358) Hotline TABLE OF CONTENTS Respiratory Care Considerations..3 Physician Considerations
More informationNIV 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 informationEuropean Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE. Data Collection Forms
European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE Data Collection Forms Study ID: Date of Data collection: FORM 0: - ORGANIZATIONAL DATA OF THE PARTICIPATING
More informationMechanical ventilation in the emergency department
Mechanical ventilation in the emergency department Intubation and mechanical ventilation are often needed in emergency treatment. A ENGELBRECHT, MB ChB, MMed (Fam Med), Dip PEC, DA Head, Emergency Medicine
More informationRon Hosp, MS-HSA, RRT Regional Respiratory Specialist. This program has been approved for 1 hour of continuing education credit.
Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist This program has been approved for 1 hour of continuing education credit. Course Objectives Identify at least four goals of home NIV Identify candidates
More informationCaring For the ICU Boarder. Kami M. Hu, MD Depts of Emergency & Internal Medicine University of Maryland SOM
Caring For the ICU Boarder Kami M. Hu, MD Depts of Emergency & Internal Medicine University of Maryland SOM I have no relevant financial relationships with the manufacturer(s) of any commercial product(s)and/or
More informationSARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1070 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE CRITERIA: CARDIOVASCULAR INTENSIVE Job Title of Reviewer: Director, CVICU EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY
More informationProportional Pressure Support (PPS) Clinicians successfully match patient s respiratory demands and facilitate weaning by using PPS
LOREM IPSUM D-76319-2013 2. ÜBERSCHRIFT 3. Überschrift Lorem ipsum Proportional Pressure Support (PPS) Clinicians successfully match patient s respiratory demands and facilitate weaning by using PPS 1
More informationLearning Objectives. 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence
Learning Objectives 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence Pre-hospital Non-invasive vventilatory support Marc Gillis, MD Imelda Bonheiden Our goal out there
More informationCapnography: 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 informationNIV in hypoxemic patients
NIV in hypoxemic patients Massimo Antonelli, MD Dept. of Intensive Care & Anesthesiology Università Cattolica del Sacro Cuore Rome - Italy Conflict of interest (research grants and consultations): Maquet
More informationFAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME
FAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME Guillaume CARTEAUX, Teresa MILLÁN-GUILARTE, Nicolas DE PROST, Keyvan RAZAZI, Shariq ABID, Arnaud
More informationNon-invasive Positive Pressure Mechanical Ventilation: NIPPV: CPAP BPAP IPAP EPAP. My Real Goals. What s new in 2018? OMG PAP?
Non-invasive Positive Pressure Mechanical Ventilation: What s new in 2018? Geoffrey R. Connors, MD, FACP Associate Professor of Medicine University of Colorado School of Medicine Division of Pulmonary
More informationInteraction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico
Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico Balance is not that easy! Weaning Weaning is the liberation of a patient from
More informationHow to optimize timing of extubation? Andrew JE Seely MD, PhD, FRCSC
How to optimize timing of extubation? Andrew JE Seely MD, PhD, FRCSC Disclosure Therapeutic Monitoring Systems (TMS) Founder and Chief Science Officer TMS Aim: improve patient care through innovative variability-derived
More informationCardiorespiratory Physiotherapy Tutoring Services 2017
VENTILATOR HYPERINFLATION ***This document is intended to be used as an information resource only it is not intended to be used as a policy document/practice guideline. Before incorporating the use of
More informationWorldwidE AssessmeNt of Separation of patients From ventilatory assistance WEAN SAFE
European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section ESICM Trial Group WorldwidE AssessmeNt of Separation of patients From ventilatory assistance WEAN SAFE Data Collection
More informationMT Custom Weaning Protocol for your Ventilator Patients SMARTCARE /PS
MT-0913-2008 Custom Weaning Protocol for your Ventilator Patients SMARTCARE /PS 02 SmartCare /PS automates weaning The problem however is that no matter how good the written protocol is, physicians and
More informationHome Mechanical Ventilation. Anthony Bateman
Home Mechanical Ventilation Anthony Bateman What is Long Term Ventilation? LTV is the provision of respiratory support to individuals with non-acute respiratory failure Progression of expected disease
More informationCharisma High-flow CPAP solution
Charisma High-flow CPAP solution Homecare PNEUMOLOGY Neonatology Anaesthesia INTENSIVE CARE VENTILATION Sleep Diagnostics Service Patient Support charisma High-flow CPAP solution Evidence CPAP therapy
More information5. 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 informationNon-Invasive Ventilation of the Restricted Thorax: Effects of Ventilator Modality on Quality of Life. The North Study
Non-Invasive Ventilation of the Restricted Thorax: Effects of Ventilator Modality on Quality of Life The North Study Lorna Cummins RRT, Pat Hanly MD, Andrea Loewen MD, Karen Rimmer MD Raymond Tye RRT,
More informationProne ventilation revisited in H1N1 patients
International Journal of Advanced Multidisciplinary Research ISSN: 2393-8870 www.ijarm.com DOI: 10.22192/ijamr Volume 5, Issue 10-2018 Case Report DOI: http://dx.doi.org/10.22192/ijamr.2018.05.10.005 Prone
More informationAnd Then There is Failure
Heart Failure And Then There is Failure Heart Failure Brenda Phipps BSN Nurse Educator Minneapolis VA Tina Wright MSN Clinical Nurse Leader Minneapolis VA Symptoms SOB, use of accessory muscles Crackles,
More informationDivision of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy
Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy Original Date: 04/2011 Purpose: To specify physiologic criteria for appropriate
More informationKICU Spontaneous Awakening Trial (SAT) Questionnaire
KICU Spontaneous Awakening Trial (SAT) Questionnaire Please select your best answer(s): 1. What is your professional role? 1 Staff Nurse 2 Nurse Manager 3 Nurse Educator 4 Physician 5 Medical Director
More informationPAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ
PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ Dr. Miquel Ferrer UVIIR, Servei de Pneumologia, Hospital Clínic, IDIBAPS, CibeRes, Barcelona. E- mail: miferrer@clinic.ub.es
More informationPostoperative Respiratory failure( PRF) Dr.Ahmad farooq
Postoperative Respiratory failure( PRF) Dr.Ahmad farooq Is it really or/only a postoperative issue Multi hit theory first hits second hits Definition Pulmonary gas exchange impairment that presents after
More informationBronchoscopy SICU Protocol
Bronchoscopy SICU Protocol Updated January 2013 Outline Clinical indications Considerations Preparation Bronchoscopy technique Bronchoalveolar Lavage (BAL) Post-procedure Purpose Bronchoscopy is a procedure
More information