exam? Atelectasis, bronchospasm, pneumothorax, pneumonia? (Consider needle
thoracentesis) Circulation: shock? sepsis?
- Well, it isn’t working...
(^) Are these the right settings? Is this the right mode? Does the ventilator
need to do more work? Is the underlying process getting worse? (or new
problem?) Is there air leaks? Does the patient need to be more sedated? Is the
patient ready to be extubated?
Consider Patient - Ventilator Interaction problems
Ventilator must recognize patient’s respiratory efforts (trigger)
Ventilator must be able to meet patient’s demands (response)
Ventilator must not interfere with patient’s efforts (synchrony)
You might have to: Lower your Expectations
Permissive Hypercapnia: accept higher PaCO2s in exchange for limiting Vt /
PIP Permissive Hypoxemia: accept PaO2 of 55-65; SaO2 88-
90% in exchange for limiting FiO2 (<.60) and PEEP?
F. NON - INVASIVE VENTILATION...
- Continuous positive airway pressure ventilation.
Although CPAP can be delivered while an endotracheal tube is in place,
CPAP can be delivered using nasal prongs. Patient must initiate all breaths. It is