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Mechanical ventilation is an important life-saving intervention often used in emergency departments. There are various modes and settings that must be carefully managed to prevent pulmonary and other complications. The two basic modes are volume control ventilation, which delivers a constant tidal volume, and pressure control ventilation, which sets a peak pressure limit. Proper use of mechanical ventilation aims to minimize risks like barotrauma while allowing for spontaneous breathing when possible.
Mechanical ventilation is an important life-saving intervention often used in emergency departments. There are various modes and settings that must be carefully managed to prevent pulmonary and other complications. The two basic modes are volume control ventilation, which delivers a constant tidal volume, and pressure control ventilation, which sets a peak pressure limit. Proper use of mechanical ventilation aims to minimize risks like barotrauma while allowing for spontaneous breathing when possible.
Mechanical ventilation is an important life-saving intervention often used in emergency departments. There are various modes and settings that must be carefully managed to prevent pulmonary and other complications. The two basic modes are volume control ventilation, which delivers a constant tidal volume, and pressure control ventilation, which sets a peak pressure limit. Proper use of mechanical ventilation aims to minimize risks like barotrauma while allowing for spontaneous breathing when possible.
PENDAHULUAN Tindakan setelah intubasi dan memerlukan ventilasi mekanik, merupakan intervensi penyelamat jiwa yang sering di departemen emergensi
Manajemen ventilator yang buruk dapat menyebabkan
kerusakan pulmoner serta ekstrapulmoner berat yang tidak selalu muncul di awal
Mode ventilasi adalah pengaturan siklus ventilasi saat
ekspirasi dan inspirasi agar pasien dapat bernafas spontan. Indication for mechanical ventilation Mechanical ventilation • Physiology: – Positive pressure ventilation versus natural negative pressure ventilation • Effects: – Heterogeneous ventilation • Preferential ventilation of the non-dependent regions – Increased physiologic dead space – Improvement of physiologic shunt causes by atelectasis and/or alveolar filling – Rapid disuse atrophy of the diaphragm – Impairment of mucociliary clearance • Cardiovascular effects: – Decreased venous return • Exacerbated by: – Auto-PEEP – Applied PEEP – Intravascular volume depletion – Cardiac tamponnade – Increased right ventricular afterload: • Compression of the pulmonary vascular bed Increased PVR – May decrease left ventricular afterload • Lung exansion decreased extramural pressure Mechanical ventilation: Complications • Barotrauma – Incidence ~3% – To Avoid: Keep plateau pressure < 35 cm • Vili – Over stretch – Atelectotrauma • Auto-PEEP • Asyncrhony Mechanical ventilation: Modes • There are two basic modus of mechanical ventilation, based on the method used to inflate the lung: – Volume control ventilation the lung inflated at a constant flow rate until the desired volume is delivered – Pressure control ventilation high flow rates are used at the onset of lung inflation to achieve the desire inflation pressure quickly Volume limited vs pressure limited • Volume limited • Pressure limited – Physician sets: – Physician sets: • Tidal volume • Peak airway pressure • Rate • Inspiratory time – Guaranteed constant tidal – Tidal volume and minute volume ventilation depends entirely – Guaranteed minute on patient factors: ventilation compliance and airway – High peak pressures resistance – Associated with lower peak airway pressure – Associated with more homogenous gas distribution
No difference in mortality, oxygenation, or work of breathing
WHICH METHOD IS PREFERRED • Advantage of VCV is the ability to maintain a constant level of alveolar ventilation, despite change in the mechanical properties of the lung. With PVC, alveolar ventilation will decrease if there is an increase in arways resistance • Another advantage of VCVis the ability to use the llung protective ventilation protocol • Major advantage of PVC is patient comfort, which promotes syncronous breathing with the ventilator and reduce wob. • Another advantage of PVC is the lower peak airway pressure Mechanical ventilation: Modes • Choices: – Mandatory vs non-mandatory • Mandatory – Volume vs pressure limited ventilation – Mandatory rate – Modes: » SIMV » Assist Control » PCV » Hybrid Modes: PRVC, SIMV/PRVC • Non-mandatory or assisted breaths – PSV Variables: some default values • Trigger sensitivity: -1 to -3 cm • Tidal volume: 6-8mg/kg/IBW • Rate: 10 to 14 • PEEP: 5 cm H2O • Flow rate: 60 L/min • I to E ratio • Peak pressure • Plateau pressure – Surrogate for peak alveolar distending pressure • Peak – Plateau – Resistive pressure • Mean airway pressure – Pressure applied acorss the lung and chest wall averaged throughout the ventilary cycle Assist-Control • Allows the patient the initiate a ventilator breath, but possible, ventilator breath are delivered at a preselected rate. • Set variables – Volume controlled or pressure controlled – Flow rate or Ti – PEEP FiO2 – Mandatory rate • Spontaneous breaths – Additional cycles can be triggered; patient triggered & time triggered SIMV • Allows patients to breath spontaneously between ventilator breaths. Ventilator breaths are delivered in synchrony with the patients spontaneous breath, this is called SIMV • Set variables – Targeted volume or pressure – Flow rate – Manatory frequency – PEEP – FiO2 – PS augmentation for spontaneous breaths • Spontaneous breaths – Increased wob, wich can be reduced by pressure-support ventilation duing spontaneous breathing period PSV • Pressure-augmented spontaneous breathing • Patient terminates the lung inflation, the breath terminated when the flow rate falls to 25% of the peak level • Allows the patient to determine the duration of lung inflation, and the resulting tidal volume LUNG PROTECTIVE