Really Doug Powell MD 4BN 3SFG A Surgeon Prolonged Field Care Working Group Staff Intensivist Womack Army Med Center Pathology of Respiratory Failure Hypoxic stuff in alveoli ID: 931463
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Slide1
Vent 101Everything You Need to Know About Ventilators on One Whiteboard
(Really)
Doug Powell, M.D.
4BN 3SFG (A) Surgeon
Prolonged Field Care Working Group
Staff
Intensivist
, Womack Army Med Center
Slide2Pathology of Respiratory Failure
Hypoxic:
“stuff in alveoli”
Water: pulmonary edema
Pus: pneumonia
Blood: alveolar hemorrhage (rare)
Protein: ARDS
Collapsed alveoli: atelectasis
Slide3Pathology of Respiratory Failure
Hypercapic
Won’t breathe
CNS: drugs! > injury, stroke, OSA, OHS, hypothermia
Can’t breathe
Peripheral nervous system (
Guillian
Barre
…
)
Respiratory muscles (
myesthenia
gravis
…
)
Chest wall, pleura (burn
eschar
, flail chest)
Upper airway (trauma, mass, edema compressing)
Can’t breathe enough
(PE, exacerbation of asthma, COPD)
Slide4Physiology - ComplianceCauses problems with OXYGENATION
Intrinsic: Stuff in alveoli
Air > Water
> Blood
> Pus
> Protein
>> decreasing compliance/ harder to oxygenate >>
Extrinsic: Stuff outside of lungs
Body mass (obesity)
Rigid chest (
eschar
, paralysis
–
acutely)
Slide5Ventilators on 1 Page
Slide6The Only Vent Settings You Need to Know
Low tidal volume, volume assist control
(AC-V)
Tidal Volume (
Vt
): 6
–
8 cc/ kg (ideal body weight)
Rate: 14 (physiologic)
FiO2: 100% (turn down based on
pulseOx
)
PEEP: 5
Slide7Monitoring
Clinical parameters
Respiratory rate (spontaneous)
Comfort
Chest, abdomen rise/ fall together
Cough, gagging
SpO2
(saturation of peripheral oxygenation/ Pulse Ox):
Goal: > 90%
ETCO2 (end
–
tidal CO2)
Goal: 40mmHg
Slide8Problems w/OxygenationIncrease PEEP
Benefits: comfortable,
works without supplemental O2!
Risks: pressure overload, barotrauma
Increase FiO2 (i.e., crank the oxygen up)
Benefits: fast
Risks: burns through supplies, free radical toxicity (~ > 60%/ > 24 hours)
Slide9Problems with CO2Increase
Vt
: never > 10cc/kg w/o consult
Benefits: it works
Risks:
volu
-trauma, increased mortality
Increase rate
Benefits: no risks
Risks: none
Slide10Troubleshooting Vent
Pressure alarm
–
causes: treatments
Tube blocked: secretions, mucus plug
–
suction patient
Tube kinked: bite block (tape roll)
Bronchospasm: give albuterol
Abdominal pressure: place NG/ OG tube
Auto-peep: disconnect circuit
Uncertain: disconnect circuit
Patient uncomfortable:
Increase sedation (if ketamine, give Versed IV)
Telemedicine: if possible, send video clip
Slide11Vent CareMouth care:
Vaseline lips
Move tube one side to other
Mouth/ tooth cleaning
Positioning: HOB 30 degrees (if possible)
Secretions: monitor for and suction
Don’t suction if you don’t need to (gurgling, pressure alarm, decreasing oxygenation)