Ventilator Management
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Basics
Description
Description
- Mechanical ventilation is machine generated flow of gas into and out of the lungs that acts as a substitute for normal respiratory function
- 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
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TY - ELEC
T1 - Ventilator Management
ID - 307287
ED - Barkin,Adam Z,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Shayne,Philip,
ED - Wolfe,Richard E,
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 -