Respiratory Care in ARDS and COPD Patients

The maximum safe pressure at the end of inspiration in the alveoli, typically 30 to 32 cm H₂O.

Noninvasive positive pressure ventilation (NPPV) can help prevent the need for intubation, reduce ICU admissions, and lower mortality rates in patients with COPD and acute chest pain exacerbation (ACPE).

A recommended tidal volume of 6 to 8 mL/kg of ideal body weight (IBW) is used for patients at risk for acute respiratory distress syndrome (ARDS) to minimize lung injury.

Positive end-expiratory pressure (PEEP) is initially set at 5 cm H₂O for COPD patients. It can be increased to match intrinsic PEEP (iPEEP) if triggers are ineffective.

Management strategies for acute asthma focus on low respiratory rates, maximizing expiratory time, and using low PEEP to minimize lung strain.

For ARDS patients, a tidal volume of 4 to 6 mL/kg based on ideal body weight (IBW) is recommended to avoid lung injury.

Using low tidal volume ventilation in ARDS patients can improve mortality and decrease the risk of ventilator-induced lung injury (VILI).

Increased peak inspiratory pressure (PIP) along with increased plateau pressure (Pplat) suggests a decrease in the compliance of the respiratory system, indicating lung stiffness.

A rise in PIP without a change in Pplat implies increased airway resistance in the lungs or the ventilator circuit.

Strategies for managing intubated COPD patients involve improving gas exchange while minimizing iPEEP by using bronchodilators, corticosteroids, and ensuring adequate expiratory time.

Permissive hypercapnia involves intentionally lowering minute ventilation to minimize barotrauma while maintaining adequate oxygenation.

A recommended initial inspiratory-to-expiratory ratio (I:E) of 1:4 is often used for COPD patients to allow sufficient time for exhalation.

Minimizing driving pressure during mechanical ventilation helps reduce the risk of ventilator-induced lung injury (VILI) by decreasing the pressure difference between the airway and alveoli.

Intrinsic PEEP (iPEEP) refers to the pressure that builds up at the end of expiration due to incomplete exhalation, especially common in patients with obstructive lung diseases.

Ventilation difficulties caused by iPEEP can be improved by lowering the respiratory rate, decreasing the inspiratory time, and increasing the inspiratory flow rate.

Potential complications of mechanical ventilation include reduced preload, increased pulmonary vascular resistance, reduced cardiac output, ventilator-induced lung injury (VILI), barotrauma, biotrauma, and atelectrauma.

If a patient remains unstable after chest decompression, other causes of instability should be investigated.

Closely monitoring pressure alarms, waveforms, and checking for the development of iPEEP in susceptible patients is crucial to prevent decompensation on the ventilator.

The first step in evaluating acute distress without hemodynamic changes is to confirm the position and patency of the endotracheal tube, including assessing the tracheal balloon.

An abrupt decrease in PIP indicates a discontinuity in the ventilator circuit, such as accidental extubation or disconnection.

The respiratory system's ability to expand and contract in response to pressure changes.

The resistance to airflow in the lungs and airways.

The pressure at the end of expiration, indicating the amount of pressure remaining in the alveoli.

The amount of air moved in and out of the lungs during each breath.

The volume of air remaining in the lungs after a normal exhale.

The force required to inflate the lungs.

Pressure buildup in the lungs due to incomplete exhalation.

A potentially harmful condition where the pressure difference between the airway and alveoli causes lung injury.

Injury to the lungs caused by excessive pressure during ventilation.

Damage caused by the mechanical forces of ventilation, such as stretching or shearing of lung tissue.