Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1524 Ventilator Management in the ICU Ventricular Fibrillation (VF)

■For difficult weaning, consider other strategies such as pressure

support, neuromuscular problems (e.g., myopathy, neuropathy,

diaphragm dysfunction), nutrition (e.g., malnutrition, over-feeding),

electrolyte disturbance (e.g., hypokalemia, hypophosphatemia, hy-

pocalcemia), acid-base disturbance (e.g., metabolic alkalosis),

oversedation, retained secretions

complications and prognosis

■Pneumothorax – incidence depends on etiology of respiratory

failure; about 10% of patients with ARDS; insert chest tube immedi-

ately

■Ventilator-associated pneumonia – 20–50% of patients; tracheal

aspirate for gram stain and culture; consider bronchoalveolar lavage

or protected specimen brush sampling; antibiotics based on culture

results

■Prognosis – mortality depends on underlying condition and not

mode of mechanical ventilation. ARDS mortality about 40%.

VENTRICULAR FIBRILLATION (VF) AND

SUDDEN DEATH

EDMUND C. KEUNG, MD

history & physical

History

■VF present in 75% of patients resuscitated from out-of-hospital car-

diac arrest.

■Most commonly associated with coronary artery disease, acute

myocardial infarction or ischemia, dilated cardiomyopathy with

reduced LV function, CHF, severe metabolic derangement. Usually

preceded by VT.

■Sudden cardiac death: unexpected, nontraumatic death in stable

patients who die within 1 hour after onset of symptoms. 75% or

more have significant coronary artery disease. First symptom in 20%

of CAD patients.

Signs & Symptoms

■Immediate catastrophic cardiovascular collapse