P1: SBT
0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18
60 Acute Respiratory Failure/Monitoring■Treat airway compromise, impaired secretions, or persistent dysp-
nea with intubation and ventilation
Treatment Options
■Airway Maneuvers:
➣Relieve upper airway obstruction with chin lift and/or jaw thrust
maneuvers
➣Consider oral or nasal airway
■Noninvasive mechanical ventilation:
➣A temporary bridge when resolution is expected in <24 hours
CPAP nasal or mask
Startat5cmH
2 O
BiPAP Nasal or Mask
Startat10CMH 2 O inspiration/5 cm H 2 O expiration
■Endotracheal intubation and Ventilation:
➣Assist Control: Machine delivers preset tidal volume with each
spontaneous or ventilator-initiated breath
➣Intermittent Mandatory Ventilation: Provides preset tidal vol-
umes only on ventilator-initiated breaths
➣Pressure Support: Only spontaneous breaths are augmented
➣Initial ventilator settings:
FiO2−1.0
Tidal Volume- 6–10 ml/kg
RR 10− 12
PEEP−5cmH 2 O
Pressure Support−5cmH 2 OSide Effects and Complications
■Airway maneuvers: Inadequate relief of obstruction; clinical
deterioration; regurgitation and aspiration of gastric contents
■Noninvasive mechanical ventilation:
➣Inadequate delivery of positive pressure support
Pressure leak around mask
Gastric insufflation with aspiration
➣Pressure necrosis of nose and mouth by continuous mask pres-
sure
➣Inadequate enteral nutrition
➣Agitation requiring sedation
■Endotracheal Intubation:
➣Esophageal intubation
➣Failure to intubate trachea after paralysis
➣Mainstem bronchial intubation with intrapulmonary shunt