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Online ventilator training.pptx

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Online ventilator training.pptx

  1. 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  2. 2. • Physiological PEEP. • PIP Peak Inspiratory Pressure at the end of inspiration. High when airway resistance is high. • Plateau pressure- At the end of inspiration before expiration begins. Rises with pneumonia, atelactesis • Pressure and flow are common trigerring mechanisms.
  3. 3. Indications
  4. 4. Indications • P0.1 –change in airway pressure ater beginningof inspiration. • Against an occluded air way. • 0.1 second. • Used ot asses ventrilatroy drive and demang of a person.
  5. 5. • Put the larget size endotracheal trube to have least airway resistance. • Copliance measurement are very important. • Always see peak and platue pressure. • Respiratory pause .1 to .3. • High resistance – High expiratoray pressure • Low compliane- High inspiratory pressure
  6. 6. Initiating ventilation :modes and settings
  7. 7. Initiating ventilation :modes and settings • invasive and non invasive • Full venrilator support(fvs) • Partial ventrilatory support(pvs)
  8. 8. MODES OF VENTRILATION
  9. 9. MODES OF VENTRILATION • TYPE OF BREATH DELIVERY. • TARGETED CONTROL VARIALBLE. • TRYPE OF BREATH DELIVERY.
  10. 10. • MANDITAORY BREATHING • SPONTANEOUS BREATH. • ASSISTED BREATH.
  11. 11. TARGETED CONTRLOL VARIABLE
  12. 12. TARGETED CONTRLOL VARIABLE • DETERMENENT OF GAS FLOW • VOLUEM /PRESSURE DEPENDENT VARIABLE • SELECTION BASED OF WHETHER CONSTANT VOLUEM IS IMPORTANT OR A LIMITED PRESSURE
  13. 13. VOLUME CONTROL.
  14. 14. VOLUME CONTROL. • DELIVER A CONSTANT VOLUME • MAINTABUT-I A PARTICULAR PACO2 • NOT ALTERED BYVARIATIONS IN LLUNG COMPLIANCE OR AIRWAY PRESSURE. • WORSENING LLUNG CONDITION LEADS TO HIGH AIRWAY AND PLAEU PRESSURE-OVERDISTENTIONN. • MIGHT NORT MEENT HIGH FLOW REQUIREMENT OF PTS AS FLOW IS
  15. 15. VOLUME CONTROL • Use largest size ETT • Watch for bronchospasm, oedema, mucus plug, secretions. • Inspiration Expiration ratio – keep expiration 1:4 for high resistance. – Keep 1;2 or 1;1 for low compliance
  16. 16. Which Control to Use
  17. 17. Which Control to Use 1. Volume control. Volume is fixed Flow and pressure are varying. It’s safe 2. Pressure control best but needs expert care. 3. Dual mode. 1. PrVC- Pressure controlled Volume control 4. IRVC – Inverse Ratio VC
  18. 18. Scalars
  19. 19. Scalars • Three graphs 1. Volume Vs time 2. Flow Vs time 3. Pressure Vs time
  20. 20. Pressures •
  21. 21. Pressures • PP -Peak pressure – in airway • Plateau Pressure- In alveoli at the end of inspiration. • PEEP- • PIP- Peak Inspiratorry Pressure
  22. 22. Suctioning
  23. 23. Suctioning • Only SOS on collection of secretions - Seasaw pattern in FLOW- VOLUME Loop.
  24. 24. Mechanical Ventilation in ARDS
  25. 25. Mechanical Ventilation in ARDS • In 1994 renamed Acute Respiratory Distress Syndrome.
  26. 26. ARDS • Severe Hypoxemia + BL Patchy shadows • Berlin definition 1. Timing- Within 1week 2. Imaging 3. Origin of oedema 4. Oxygenation PF ratio.
  27. 27. ARDS
  28. 28. ARDS • Pathophysiology damaged oedematous alveolar membrane leads to BABY LUNG. • Causses 1. Sepsis 2. Trauma 3. Aspiration 4. Pneumonia 5. TRALI-Transfusion Related Lung Injury
  29. 29. Management of ARDS
  30. 30. Management of ARDS 1. ARDS is Compliance problem not resistance problem. 2. Treat the cause- don’t wait for ARDS to resolve. 3. Supportive care- 1. Prone position 2. Early invasive ventilatory support. 3. Low tidal volume 4 -6 ml./Kg. 4. High rate. 5. Pharmacological support. sedatives and neuromuscular blockade,
  31. 31. Problems in Mechanical Ventilation
  32. 32. Problems in Mechanical Ventilation VILI- Ventilator Induced Lung Injury • Volutrauma • Barotrauma • Biotrauma
  33. 33. Recuitment Maneuver
  34. 34. Recuitment Maneuver Recuitable lung CT 1. Should be Sedated , paralysed. 2. Should be Hemodynamically stable. 3. Can repeat in 15 minutes 4. High Tidal volume for 2minutes. 5. High PIP volume for 2minutes. 6. High PEEP upto 30 for 2minutes. 7. Proning. 8. ECMO
  35. 35. Strategies
  36. 36. Strategies • Ideal is Pressure Controlled Ventilation. • Non intensivist - Use Volume Controlled Ventilation. • Titrated PPEP upto 15 • CT/ USG-for recruitable alveoli > Rerecruit. • Keep Driving pressure 12-14. DP= Plateau Pressure – PEEP. • Permisible Hypercapnia • Max. Plateau pressure 30 • Max. Rate 30
  37. 37. Alarm Ringing
  38. 38. Alarm Ringing • Never silence an alarm. • Secretions. • Leak • Kinks • Bronchospasm • High PEEP Alarm ringing –Reset at higher level.
  39. 39. On improvement
  40. 40. On improvement • Reduce FiO2 • Reduce Rate • Reduce PEEP
  41. 41. Covid
  42. 42. Covid • Goundglssing. Peripheral demarcated. • Pneumonia. • No Pleural effusion fibrosis. •
  43. 43. Covid Symptoms
  44. 44. Covid Symptoms Asymptomatic, Mild, severe, critical • Fever • Cough • Dyspnoea. • Loss of smell. • MODS
  45. 45. Covid Basic investigation
  46. 46. Covid Basic investigation • CBC- Lymphonea. • CRP biomarker for secondary infection. • PCT • LFT • KFT • Xray Chest • CT if Covid -Ve
  47. 47. Severe Covid
  48. 48. Severe Covid • Azithromycin 500mg od 5days. • +- Chloroquine • QT interval • Antivirals • Convalescent plasma. • Rarely Methylprednisolone low dose. • No nebulization. • No broncholators. • No Noninvasive ventilation.
  49. 49. Covid
  50. 50. Covid • Don’t combine chloroquine and antiviral.
  51. 51. Covid: Non invasive ventilation
  52. 52. Covid: Non invasive ventilation • NIPPV • Non invasive ventilation is not indicated in Covid. • IPAP- Inspiratory Airway Pressure • EPAP (PEEP) : In pulmonary oedema.
  53. 53. Covid
  54. 54. Covid • CPAP • BiPAP
  55. 55. Covid • I Time – Inspiratory time. • E Time- Expiratory time.
  56. 56. Weaning Mode
  57. 57. Weaning Mode • When disease has improved. • Hemodynamically, neurologically - Stable • Pressure support. Don’t go above 30. • Assist control
  58. 58. Triggers
  59. 59. Triggers 1. Biased Flow 2. Pressure 3. Time Sensitivity we have to set.
  60. 60. • Pressure support Vs. Pressure control in former exhalation will start automatically (as per Cycling off % setting)
  61. 61. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  62. 62. Get this ppt in mobile
  63. 63. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

Notas do Editor

  • drpradeeppande@gmail.com
    7697305442

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