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Mechanical ventilation
Dr.Wail Bajhmoom
15.3.2005 A.D 5.2.1425A.H
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Background.
1929 was one of the first
negative-pressure ventilators widely used for mechanical ventilation. This metal cylinder completely covered the patient up to the neck.
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device used negative pressure to cause a drop in the intrapulmonary pressure and to allow ambient airflow into the patient's lungs.
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use of mechanical ventilation started during the polio epidemic in Scandinavia and the United States. In Copenhagen, Denmark.
polio and respiratory paralysis by manually forcing 50% oxygen through a tracheostomy reduced the mortality rate from 80% to 25%.
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Definition
Ventilators are: specially designed pumps that can support the ventilator function of the respiratory system.
They improve oxygenation through application of high oxygen content gas and positive pressure.
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Classifications.
Modern ventilators are
classified by the method of cycling from the inspiratory phase to the expiratory phase.
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Classifications.
The signal to terminate the
volume-cycled ventilator
a preset volume is the most common form of
ventilator cycling used in adult medicine because it provides a consistent breath-to-breath tidal volume.
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Indications:
Mechanical ventilation should
not be initiated without thoughtful consideration because intubation and positive-pressure ventilation could have potentially harmful effects.
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Indications:
Many factors are considered
in the decision to institute mechanical ventilation. Respiratory failure is the primary indication
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Indications:
Apnea with respiratory arrest Acute lung injury
-R.R more than 30 BPM
-Minute
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Neuromuscular disease
Clinical judgment should be used ; An increasing severity of the illness is a sign that should alert the clinician to consider instituting mechanical ventilation.
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Physiologic aspects.
Most modern mechanical ventilators
function by providing warmed and humidified gas to the airway opening in conformance with various specific volume, pressure, and time patterns. The ventilator serves as the energy source for inspiration,
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diaphragm and chest wall. Expiration is passive, driven by the recoil of the lungs and chest wall
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Ventilator mode:
This setting specifies the
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(ACMV) An inspiratory cycle is initiated either by the patient's inspiratory effort or, if no patient effort is detected within a specified time window,
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initiation of mechanical ventilation because it ensures a backup minute ventilation in the absence of an intact respiratory drive.
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weaning patients from mechanical ventilation because it provides full ventilator assistance on each patientinitiated breath.
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Synchronized Intermittent
The major difference between SIMV and ACMV is that in the former the patient is allowed to breathe spontaneously, i.e., without ventilator assist
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a breath, the ventilator delivers a fixed-tidal-volume breath and resets the internal timer for the next inspiratory cycle.
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SIMV is a useful mode of ventilation for both supporting and weaning intubated patients SIMV may be difficult to use in
patients with tachypnea because they may attempt to exhale during the ventilator-programmed inspiratory cycle.
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(CPAP) .This is not a true support-mode of ventilation, since all ventilation occurs through the patient's spontaneous efforts.
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potential in patients who have been effectively weaned and are requiring little ventilator support
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Pressure-Control Ventilation
This form of ventilation is time triggered, time cycled, and pressure limited. During the inspiratory phase, a given pressure is imposed at the airway opening, and the pressure remains at this user-specified level throughout inspiration
(PCV)
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ventilation for patients with documented barotrauma, since airway pressures can be limited,
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Pressure-Support Ventilation
(PSV)
This form of ventilation is patient triggered, flow cycled, and pressure limited; it is specifically designed for use in the weaning process.
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PSV is well tolerated by most patients who are being weaned: PSV parameters can be set in such a way as to provide full or nearly full ventilatory support and can be withdrawn slowly over a period of days in a systematic fashion to gradually load the respiratory muscles.
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COMPLICATIONS:
Endotracheal intubation and positive-
pressure mechanical ventilation have direct and indirect effects on several organ systems Including: -the lung and upper airways, the
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oxygen toxicity, tracheal stenosis, and deconditioning of respiratory muscles. emphysema, pneumomediastinum, subcutaneous emphysema, or pneumothorax.
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are at high risk for nosocomial pneumonia as a result of aspiration from the upper airways via small leaks around the endotracheal tube cuff enteric gram-negative rods, Staphylococcus aureus, and anaerobic bacteria.
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Hypotension resulting from elevated intrathoracic pressures with decreased venous return
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Gastrointestinal effects of positive-pressure ventilation include stress ulceration and mild to moderate cholestasis. It is common practice to provide prophylaxis with H2-receptor antagonists or sucralfate for stress-related ulcers.
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Weaning.
Many approaches to weaning patients
tolerated by patients who have undergone mechanical ventilation for brief periods
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Weaning.
SIMV and PSV are best for
patients who have been intubated for extended periods and require gradual respiratory-muscle reconditioning.
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ThANK YOU
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