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INTUBATION
Endotracheal Intubation:
Placement of tube into trachea through
mouth or nose
Indications:
Upper airway obstruction
Facilitate secretion removal
Esophageal intubation
Cuff problems
Respiratory failure
Mechanical Ventilation
Air/O2 moves in and out of lungs via machine
Types Ventilators
Negative Pressure
Positive Pressure*
Ventilator Settings
Rate
Tidal volume
FIO2
Pressure limit
PEEP
Alarms etc
Mechanical Ventilation
Three types Positive Pressure
Ventilators
Volume-cycled: terminates breath
when preset volume delivered
Time-cycled: terminates breath after
preset time elapsed
Pressure-cycled: terminates when
present airway pressure achieved
Volume-Cycled Ventilators:
Modes
Preset volume
Preset rate
Spontaneous breathing
Complications
Reduced CO
Barotrauma
Other Ventilation Maneuvers
CPAP
Pulmonary
Barotrauma (trauma d/t pressure)
Pneumothorax
Pneumomediastinum
Subcutaneous emphysema
Mechanical Ventilation:
Complications
Pulmonary
Alveolar hypoventilation
Cuff leak
Ventilator settings
Secretions
Atelectasis
Mechanical Ventilation:
Complications
Pulmonary
Alveolar hyperventilation
Due to hypoxemia, fear, pain, anxiety → alkalosis
RX: sedate, analgesia, communication, correct
hypoxemia
Pulmonary Infection
Upper airway defenses bypassed
Mechanical Ventilation:
Complications
Neurological complications
Positive pressure ventilation → increased
intrathoracic pressure
GI
Stess ulcers and GI bleeds; Rx with H2 receptor
blockers
Psychologic
Stress
Communication very important
Sedate, explain, family visits, pain
management
Facilitate expression of needs
Weaning
Criteria
Effective cough
Adequate respiratory muscle
strength
Weaning
Approaches to weaning
T-piece (spontaneous breathing for
short periods of time)
SIMV, PSV
Weaning
Monitor closely
resp rate
accessory muscle use
shallow respirations
paradoxical breathing
ABGs
rising PCO2 → acidosis
falling PO2
BP (↓ or ↑)
LOC (restless, tiring, somnolence, anxiety)
Pulse oximeter