RESPIRATORY SUPPORT

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RESPIRATORY SUPPORT

1. Oxygen therapy
2. Mechanical stimulator
3. Nasal CPAP / SIMV-CPAP
4. BI-PAP
5. Mechanical ventilation

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Respiratory Assessment

• Is the patient Ventilating well? gtgtgt Normal PCO2
• Normal ventilatory effort
• Increase work of breathing
• Able to compensate
• Is patient getting exhausted gtgt Impending
  respiratory failure
• Is the patient oxygenating well? gtgt Normal Pa O2
• Assess oxygen requirement
• A-a gradient Vs PaO2/FiO2 gtgt Hypoxic respiratory
  failure?

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Respiratory Assessment

1. Mental Status (Is patient being sedated)?
2. RR (according to age)?
3. Work of breathing (retraction, nasal flaring,
   paradoxic breathing)?
4. Chest movement-Air-entry
5. Adventitious sounds (Stridor-wheezes, crackles)?
6. Oxygen requirements
7. Cardiovascular status, (Compensatory mechanisms
   HR, BP, perfusion)?
8. Peak Flow
9. ABG

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Respiratory Mechanics

• Flow
• Compliance (degree of stiffness)?
• Compliance Volume
• Pressure
• Resistance Pressure
• Flow
• Time Constance

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ARF

• In the absence of intracardiac shunt.
• Pa02 lt 50 mm Hg
• PC02 gt 50 mmHg
• Increase PaO2/Fio2 lt 200 (Normal gt400)?
• Increase A-a gradient (gt300)?
• (PaO2 60 on FiO2 of 0.6 100)?

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Indication for Intubation

• For Airway protection
• Facial Trauma
• Alter mental status
• Recurrent Apnea
• Respiratory Failure
• Hypoventilatory
• Hypoxic
• Mix
• Cardiovascular instability- Shock

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INDICATION FOR INTUBATION AND MECHANICAL
VENTILATION IN STATUS ASTHMATICUS

1. Alter sensorium / Coma
2. Inability to speak
3. Increasing pulsus paradosus
4. Signs of exhautioon (decreasing pulsus paradosus
5. Respiratory or cardiac arrest
6. Diaphoresis in the recumbent position
7. Acute Barotrauma
8. Severe Lactic Acidosis (specially in infants)?
9. Silent chest despite respiratory effort
10. Refractory hypoxemia (PaO2 lt 60 mmHg on maximal
    O2)?
11. Increasing PaCO2 (50 mmHg and rising gt 5 mmHg/hr)?

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General Principles Approaches to Lung Protection

• Small tidal volumes/pressure limitation
• Prevent Barotrauma
• Prevent Volutrauma
• Recruitment maneuvers, with
• Higher PEEP levels
• Ventilation in the prone position

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OXYGEN THERAPYLow Flow Oxygen lt 35
Nasal Cannula No more than 3L/min Each L/min
delivers 4 Oxygen gt RA At low flows, no need
to humidify
Simple Mask Use for an emergency/ transport
Deliver 30 at 6-8 L/min
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OXYGEN THERAPYModerate Amount gt35 lt 50)?
VENTURY MAST 28 TO 50
AEROSOLIZED MASK 25 TO 100
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Oxygen Delivery High Flow

• Non re-breathing mask
• high flow delivered system
• with reservoir,
• It deliver between 80 to 100
• FiO2.
• This delivering System is use
• mainly for transport and for
• initially emergency care and
• patient stabilization.

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OXYHOOD25 TO 100
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NASAL cpap
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NON INVASIVE VENTILATION BI-PAP
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HOW TO ORDER MECHANICAL STIMULATOR(Pt with
recurrent apnea, in between O2 Sat 100 in RA)1)
Under order entry, SELECT Mechan-2) Select
Peds/Neo3) Fill up the blanks as showed below
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HOW TO ORDER NCPAP (Nasal Continuous Positive
airway pressure)(Pt with frequent apnea,
intermittent desaturations)1) Under order entry,
SELECT Mechan-2) Select Peds/Neo3) Fill up the
blanks as showed below
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HOW TO ORDER NCPAP /SIMV (Pt with frequent
apnea, irregular respirations with intermittent
desaturations, in between active)1) Under order
entry, SELECT Mechan-2) Select Peds/Neo3) Fill
up the blanks as showed below
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HOW TO ORDER SIMV in the Bear cub ventilator. (Pt
with frequent apnea, irregular respirations with
intermittent desaturations, Patient is
intubated1) Under order entry, SELECT Mechan-2)
Select Peds/Neo3) Fill up the blanks as showed
below