Alveolar hypoventilation with hypercapnea and hypoxemia Respiratory and neuromuscular disease, including coma and OD • Inadequate pulmonary gas exchange Acute respiratory distress Clinical deterioration, especially shock RR 35 breaths /min Increased…
PaO2 50 mmHg or SaO2 88% Chronic hypoxemia with PaO2 55mmHg Monitoring Goals SaO2 88% (measured with pulse oximetry)
Peak pressure with normal plateau pressure Monitor will show a peak pressure >40 cm H2O and a plateau pressure <30 cm H2O Possible causes: secretions, bronchospasm, kinked tube Solution:…
Albuterol Ipratropium Levalbuterol (Xopenex) Budesonide (only Pulmicort Respule) MDI • Only aerosol system MDI can be used; drugs in powder form such as Advair diskus cannot be used. The therapist must…
40%, PEEP 5 Primary indication for mechanical ventilation improving Adequate Hb ( 10 g/dL), adequate K 3.5 mEq/L Discontinue sedation Plan sedation management during the prior hospital day Start…
Vancomycin or linezolid plus extended-spectrum penicillinbeta lactam inhibitor combination plus an aminoglycoside or a fluoroquinolone. Vancomycin or linezolid plus carbapenem plus an aminoglycoside or a fluoroquinolone. Vancomycin or linezolid plus…
6. Answer: B Rationale: Patient discomfort and agitation causes “Patient Ventilator Dys-synchrony,” reducing the effective ventilation. Appropriate sedation improves ventilation in these patients. Paralysis may be required briefly early on…
Chapter 30 Short case reviews 1. Indications for mechanical ventilation A 32 year otherwise healthy female is admitted for dysuria and fever. She is admitted to the floor for…
This pivotal study reported the outcome in 861 patients in a randomized controlled trial which compared a low tidal volume strategy (6ml/kg IBW) with a plateau pressure < 30 cm…
Chapter 27 Tracheostomy Indications Emergency tracheostomy It is performed due to an anatomic obstacle preventing the establishment of a secure airway. Planned tracheostomy Prolonged endotracheal intubation can result in tracheal…
