take the ventilator out of the equation-bag the patient to...
TRANSCRIPT
Otherpatients(i.e.modificationsfromLUNGPROTECTIVESTRATEGY)
§ HEADINJURY:toomuchPEEPcanêBPandthusêcerebralperfusionpressure.PEEP=5(default)isOK. 30oheadup.AimforCO235-40mmHg
§ METABOLICACIDOSIS:RR>patientachieved,ETCO2<patientachieved.Lightensedationtoallowpatienttoaddadditionalbreathsasrequired-addpressuresupport(Δsupp=10,Trigger=2)tothesebreathsaspatienttired.
§ HYPERTENSIVEAPO:startPEEPat10cmH20andrapidlytitrateupwhilerapidlytitratingIVGTNforSBP<140.§ OBESE:startPEEPat10cmH20andtitrateasperPEEP/FiO2scale.ReverseTrendelenburg/ramped§ CARDIOGENICSHOCK:avoidhigh-levelPEEPascanêBP.§ PREGNANCY:leftlateralposition.TV:8ml/kgidealbodyweight,RR20-22bpmaimforlow/normalpCO2&normalpH.
Ifpatientiscrashing….§ Taketheventilatoroutoftheequation-bagthepatienttofeelhowtheyaretoventilate§ Checkthetube-displaced/dislodged/obstructed§ Checkthepatient-pneumothorax-bedsideUS/CXRandneedle/fingerthoracostomy§ Checktheventilator
5’0”153cm
5’2”156cm
5’4”163cm
5’6”168cm
5’8”173cm
5’10”178cm
6’183cm
6’2”188cm
6’4”193cm
VTwomen(6ml/kgIBW) 276 295 330 360 385 415 440 470 490VTmen(6ml/kgIBW) 305 320 360 385 415 440 470 490 520
GUIDEFORINITIALSETTINGSFORPRESSURECONTROLLEDVENTILATIONFORDRAEGEROXYLOG3000PLUS
Assumespatientisapnoeicfromsedation&nursedat30otominimiseaspiration.RecommendedforallUNCUFFEDtubes
LUNGPROTECTIVESTRATEGY(allotherpatients)
OBSTRUCTIVESTRATEGY(bronchiolitis/asthma)
Mode PC-SIMV+ PC-SIMV+
VT can’tbesetinPCmode-VTdeterminedbyPisnp can’tbesetinPCmode-VTdeterminedbyPisnp
RR seechart-thentitratetonormalpCO2/pH
(1/2normalRR)-seechartthenEXPIRATORYFLOWTIMECURVES.êRRifnotfullyexpiring
-permissivehypercapnoea(pH>7.1)
Pmax(alarm) highenoughtoallowdesiredVT(ifalarms,seebelow) highenoughtoallowdesiredVT(ifalarms,seebelow)
FiO2
titrateusingFiO2/PEEPscaleèSpO2of88-95% minimalFiO2forSpO288-95%
PEEP 5(default)
Pinsp startat20andtitratetoVTof6ml/kgIdealBodyWeight-seechart
startat20andtitratetoVTof6ml/kgIdealBodyWeight-seechart
Tinsp I:E=1:2(default) titrateTinspsothatI:E=>1:4
Slope (default) (i.e.fastinspiratoryflowrate)
Other
§ ifhighPEEPresultsinêBP,givefluids&inotropeskeepingSBPasperchart
§ ifPmaxalarms,checkforpatientagitation/tubeobstruction.ifnotthecause,performINSPIRATORYHOLDMANOEUVRE-
ifPplat>30êTVby1ml/kgsteps(min4ml/kg)
§ sedate++++,avoidongoingparalysis§ ifêêBP+difficulttoventilate,disconnecttube&allowto
expirestackedbreaths§ ifPmaxalarms,checkforpatientagitation/tubeobstruction.
ifnotthecause,performINSPIRATORYHOLDMANOEUVRE-ifPplat>30êTVby1ml/kgsteps(min4ml/kg)
FurthermodificationsdependsonhourlyABGsandhaemodynamics