RESPIRATORY SUPPORT
1.
2.
3.
4.
5.
Oxygen therapy
Mechanical stimulator
Nasal CPAP / SIMV-CPAP
BI-PAP
Mechanical ventilation
Respiratory Assessment
• Is the patient Ventilating well? >>> Normal PCO2
– Normal ventilatory effort
– Increase work of breathing
• Able to compensate
• Is patient getting exhausted >> Impending respiratory
failure
• Is the patient oxygenating well? >> Normal Pa O2
– Assess oxygen requirement
– A-a gradient Vs PaO2/FiO2 >> Hypoxic respiratory
failure?
Respiratory Assessment
1. Mental Status (Is patient being sedated)
2. RR (according to age)
3. Work of breathing (retraction, nasal flaring,
paradoxic breathing)
4. Chest movement-Air-entry
5. Adventitious sounds (Stridor-wheezes,
crackles)
6. Oxygen requirements
7. Cardiovascular status, (Compensatory
mechanisms: HR, BP, perfusion)
8. Peak Flow
9. ABG
Respiratory Mechanics
• Flow
• Compliance (degree of stiffness)
Compliance = Volume
Pressure
• Resistance = = Pressure
Flow
• Time Constance
ARF
In the absence of intracardiac shunt.
• Pa02 < 50 mm Hg
• PC02 > 50 mmHg
• Increase PaO2/Fio2 < 200 (Normal >400)
• Increase A-a gradient (>300)
(PaO2 60 on FiO2 of 0.6 = 100)
Indication for Intubation
• For Airway protection
– Facial Trauma
– Alter mental status
– Recurrent Apnea
• Respiratory Failure
– Hypoventilatory
– Hypoxic
– Mix
• Cardiovascular instability- Shock
INDICATION FOR INTUBATION AND MECHANICAL
VENTILATION IN STATUS ASTHMATICUS
1. Alter sensorium / Coma
2. Inability to speak
3. Increasing pulsus paradosus
4. Signs of exhautioon (decreasing pulsus paradosus
5. Respiratory or cardiac arrest
6. Diaphoresis in the recumbent position
7. Acute Barotrauma
8. Severe Lactic Acidosis (specially in infants)
9. Silent chest despite respiratory effort
10. Refractory hypoxemia (PaO2 < 60 mmHg on maximal
O2)
11. Increasing PaCO2 (50 mmHg and rising > 5 mmHg/hr)
General Principles
Approaches to Lung Protection
• Small tidal volumes/pressure limitation
– Prevent Barotrauma
– Prevent Volutrauma
• Recruitment maneuvers, with
– Higher PEEP levels
– Ventilation in the prone position
OXYGEN THERAPY
“Low Flow Oxygen < 35 %”
Nasal Cannula:
No more than 3L/min
Each L/min delivers ~ 4 % Oxygen
> RA
At low flows, no need to humidify
Simple Mask
Use for an emergency/
transport
Deliver ~ 30% at 6-8 L/min
OXYGEN THERAPY
“Moderate Amount= >35% < 50%)
VENTURY MAST: 28% TO 50 %
AEROSOLIZED MASK
25% TO 100%
Oxygen Delivery
High Flow
Non re-breathing mask
•high flow delivered system
with reservoir,
• It deliver between 80 to 100%
FiO2.
• This delivering System is use
mainly for transport and for
initially emergency care and
patient stabilization.
OXYHOOD
25 % TO 100%
NASAL cpap
NON INVASIVE VENTILATION
BI-PAP
HOW TO ORDER MECHANICAL STIMULATOR
(Pt with recurrent apnea, in between O2 Sat 100% in RA)
1) Under order entry, SELECT Mechan2) Select Peds/Neo
3) Fill up the blanks as showed below
HOW TO ORDER NCPAP (Nasal Continuous Positive airway pressure)
(Pt with frequent apnea, intermittent desaturations)
1) Under order entry, SELECT Mechan2) Select Peds/Neo
3) Fill up the blanks as showed below
HOW TO ORDER NCPAP /SIMV
(Pt with frequent apnea, irregular respirations with intermittent desaturations, in between
active)
1) Under order entry, SELECT Mechan2) Select Peds/Neo
3) Fill up the blanks as showed below
HOW TO ORDER SIMV in the Bear cub ventilator. (Pt with frequent apnea, irregular respirations
with intermittent desaturations, Patient is intubated
1) Under order entry, SELECT Mechan2) Select Peds/Neo
3) Fill up the blanks as showed below