Ventilator pada keadaan khusus

Diah pravita sari

 ASTHMA/COPD
Goals of Mechanical Ventilation in Asthma

Once the patient is intubated, the primary focus

of mechanical ventilation should be achieving
adequate oxygenation (oxygen saturation 88–
92%) and ventilation, while minimizing
hyperinflation

RESPIRATORY CARE • JUNE 2008 VOL 53 NO 6

 NIV-ASTHMA
MASK CPAP
• Reduce transdiaphragmatic pressure
• Improve comfort
• Reduce hemodynamic effects (pulsus
paradoxus)
• May decrease airflow obstruction
• Improve gas exchange, prevent exhaustion

Chest, 2003
 INTUBATION -ASTHMA
• < 1% of asthmatics require intubation for mechanical ventilation

Absolute indication
 respiratory arrest
 Coma

With maximun medical therapy

 Worsening pulmonary function test
 Decreasing PaO2
 Increasing PaCO2
 Progressive respiratory acidosis
 Declining mental status
 Increasing agitation
RESPIRATORY CARE • JUNE 2008 VOL 53 NO 6
 AUTOPEEP
• Attention should be paid to setect autoPEEP  the
difference between the ventilator set PEEP and the
totsl PEEP measured when all airflow has stopped)

• 3 ways autoPEEP occurs

1. High minute ventilation- high respiratory rates or high
tidal volume
2. Expiratory flow limitation-airway collapse due to
bronchospasm, infaamation, or remodeling
3. Expiratory resistance-kinked or obstruction
 AUTOPEEP
• If expiratory flow does not return to zero
before the next inspiration  autoPEEP is
present

• Since autoPEEP increase the presure gradien

required to inhale, the patient effort may not
be able to trigger the ventilator  missed
breath or cycle
 ARDS
• Mechanical ventilation is a cornerstone in the
management of patients with acute
respiratory distress syndrome (ARDS)
• The lung protective ventilation strategy using
low tidal volume and limiting plateau pressure
(Pplat) has been proven to improve survival in
patients with ARDS
•  low tidal volume of 6 mL/kg and limiting
the inspiratory Pplat to <28–30 cmH2O.
Lung Protective Ventilation Strategy
- Implemented immediately on intubation
- Limit tidal volume 6-8 ml/kg
- PEEP above inflection point
- FiO2< 0.6 and saturation (88-90%)
- Permissive hypercapnia

NEJM, 2000
nm
 ARDS
development of patient–ventilator
dyssynchrony  such as double triggering
Neuromuscular blocking agents (NMBAs) have
been used for decades to correct this problem
and can facilitate low tidal volume ventilation
NMBAs should be considered for early and
short-term use in patients with severe ARDS.
THANK YOU