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Ventilator Management

Ventilator Management is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Mechanical ventilation is machine generated flow of gas into and out of the lungs that acts as a substitute for normal respiratory function
Basic Concepts: Physiology and Pulmonary Mechanics
  • Mechanical ventilation is positive pressure ventilation indicating that forced gas delivery generates positive pressure during inspiration
  • Negative pressure ventilation:
    • Natural respiratory pattern
    • At rest (functional residual capacity) surface tension of alveoli is balanced by elastic recoil of chest wall; alveoli pressure equals atmospheric pressure at this point
    • In inspiration, lungs expand causing alveolar pressure to become negative compared with atmospheric pressure and air travels down pressure gradient into lungs
    • Exhalation is normally passive, but can be made active with the use of accessory muscles in the setting of airway obstruction/increased airway resistance
  • Minute ventilation (MV):
    • Total volume of breaths in 1 min
    • Breaths in 1 min is respiratory rate (RR)
    • Standard breath is called tidal volume (TV)
    • MV = TV × RR: Each component can be adjusted to control ventilation
  • Oxygenation is controlled with adjusting fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP)
  • Compliance:
    • Describes lung distensibility
    • Defined as change in volume with given change in pressure
    • Decreased lung compliance can be caused by problems with the lung parenchyma (i.e., pneumonia, ARDS) or problems with the chest wall/pleura (i.e., abdominal distension)
    • Lung compliance determines plateau pressure:
      • Plateau pressure is the steady state pressure; represents the attenuated pressure that is distributed to the small airways and alveoli during positive pressure ventilation
      • Goal ≤30 mm Hg
  • Resistance:
    • Defined as change in pressure with given flow
    • Main determinant is airway radius
    • Increased resistance can be caused by problems with the airways (i.e., bronchospasm), problems with the endotracheal tube (i.e., secretions), or problems with ventilator tubing
    • Resistance determines peak pressure:
      • Peak pressure is the pressure seen in the larger airways before delivered volume is distributed to smaller airways and alveoli
      • Also determined by TV delivered
      • Goal ≤40 mm Hg

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Citation

Rosen, Peter, et al., editors. "Ventilator Management." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307287/all/Ventilator_Management.
Ventilator Management. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307287/all/Ventilator_Management. Accessed April 26, 2019.
Ventilator Management. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307287/all/Ventilator_Management
Ventilator Management [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307287/all/Ventilator_Management.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ventilator Management ID - 307287 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307287/all/Ventilator_Management PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -