General indications for intubation and connecting to mechanical
ventilation include the following:
-
Apnea or respiratory arrest (or
profound bradypnea)
-
Decreased level of
consciousness
-
Refractory respiratory failure leading
to significantly rising PCO2 with fatigue, decreased air movement, and altered
level of consciousness
-
Sever hypoxemia that is poorly
responsive or unresponsive to supplemental oxygen therapy alone
Asthmatic patient on mechanical ventilator
When dealing with asthmatic patient on mechanical ventilator use longer
inspiration/expiration (I/E) ratio, often 1:3-4 or even more, because this will
help to allow time for optimal exhalation, facilitating ventilation and
avoiding an excessive amount of further air trapping (auto positive end expiratory
pressure [auto PEEP]).
Mechanical ventilation is the most important risk factor for
stress ulcer in intensive care unit patients
Weaning failure
Weaning failure is defined as the failure to pass a
spontaneous-breathing trial or the need for reintubation within 48 hours
following extubation
20%
to 30% of patients are difficult to wean from invasive mechanical ventilation
Risks
of delayed weaning from ventilator:
-
Mechanical ventilator related infections e.g. (Ventilator associated pneumonia VAP)
-Ventilator
associated lung injury (VALI)
-
Complications of long time use of sedations
-
Airway trauma from prolonged intubation
-Deconditioning:
Inspiratory muscle weakness and deconditioning are common in patients on
mechanical ventilation for long time
-
High costs
-Psychological
effects
When
intubate and ventilate a patient because of asthma exacerbation focus on
maintaining O2 sat of 90% this is the most important goal, CO2 level of 60-70
and sometimes 80 with serum pH of 7.2 – 7.25 is acceptable
Larson
Maneuver
Is
attempt to break the laryngospasm by applying painful inward and anterior
pressure at soft tissue just behind the earlobes of the patient’s ears
‘Larson’s point
‘bilaterally while performing a jaw thrust.
Contraindications to PEEP:
Tension Pneumothorax
Hypovolemic shock
Bronchopleural fistula
High intracranial pressure
Right ventricular failure
Hypotension
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