...LOW TIDAL volume (6 ml/kg) and high PEEP have advantage in ARDS (acute respiratory distress syndrome) but PEEP (positive end expiratory pressure) must be individualised according to cardiovascular response and by a new monitoring tool Poes measurements (oesophageal pressure).
...Though, initially must be paralysed and sedated to ventilate, SIMV mode must be used as soon as possible to prevent stacking of breaths, fighting the ventilator and to prevent diaphragmatic disuse atrophy.
...if the patient is not unconscious (conscious and spontaneously breathing), BiPAP is a preferred mode of ventilation (otherwise intubated and ventilated) for COPD and asthma patients. BiPAP (bi-level positive airway pressure) uses two settings unlike CPAP (continuous positive airway pressure). It uses inspiratory pressure (15-25 cmH2O) and expiratory pressure, PEEP (about one-fourth of the inspiratory pressure, 4-6 cmH2O, generally.
..."Using small (eg, 6 mL/kg) tidal volumes with plateau airway pressures less than 30 to 35 cmH2O is clearly the standard of care in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)."
..."Two novel PPV strategies that have been proposed as lung protective for patients with severe oxygenation failure are airway pressure release ventilation (APRV) and high-frequency ventilation (HFV). APRV uses a long inflation period with superimposed spontaneous breathing. It is thus an alternative to tidal volume and PEEP to raise mean airway pressure. HFV uses very small tidal volumes and rapid breathing frequencies (up to 900 breaths/minute). Gas transport is thus by nonconvective flow, and substantial mean pressures can be provided with very small tidal distentions."
..."The ventilator discontinuation process continues to occupy a significant portion of a patient's need for mechanical ventilatory support. Several evidence-based guidelines have argued convincingly that daily spontaneous breathing trials (SBTs) are the most direct way to assess the ability of the patient recovering from respiratory failure to tolerate ventilator discontinuation."
Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome: http://err.ersjournals.com/content/24/135/132
New Advances in Mechanical Ventilation:
https://www.medscape.org/viewarticle/568522
Recent advances in mechanical ventilation:
https://www.amjmed.com/article/S0002-9343(04)00755-7/fulltext
...Though, initially must be paralysed and sedated to ventilate, SIMV mode must be used as soon as possible to prevent stacking of breaths, fighting the ventilator and to prevent diaphragmatic disuse atrophy.
...if the patient is not unconscious (conscious and spontaneously breathing), BiPAP is a preferred mode of ventilation (otherwise intubated and ventilated) for COPD and asthma patients. BiPAP (bi-level positive airway pressure) uses two settings unlike CPAP (continuous positive airway pressure). It uses inspiratory pressure (15-25 cmH2O) and expiratory pressure, PEEP (about one-fourth of the inspiratory pressure, 4-6 cmH2O, generally.
..."Using small (eg, 6 mL/kg) tidal volumes with plateau airway pressures less than 30 to 35 cmH2O is clearly the standard of care in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)."
..."Two novel PPV strategies that have been proposed as lung protective for patients with severe oxygenation failure are airway pressure release ventilation (APRV) and high-frequency ventilation (HFV). APRV uses a long inflation period with superimposed spontaneous breathing. It is thus an alternative to tidal volume and PEEP to raise mean airway pressure. HFV uses very small tidal volumes and rapid breathing frequencies (up to 900 breaths/minute). Gas transport is thus by nonconvective flow, and substantial mean pressures can be provided with very small tidal distentions."
..."The ventilator discontinuation process continues to occupy a significant portion of a patient's need for mechanical ventilatory support. Several evidence-based guidelines have argued convincingly that daily spontaneous breathing trials (SBTs) are the most direct way to assess the ability of the patient recovering from respiratory failure to tolerate ventilator discontinuation."
Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome: http://err.ersjournals.com/content/24/135/132
New Advances in Mechanical Ventilation:
https://www.medscape.org/viewarticle/568522
Recent advances in mechanical ventilation:
https://www.amjmed.com/article/S0002-9343(04)00755-7/fulltext
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