Respiratory Management and iPEEP

Remove the patient from the ventilator and manually bag with 100% oxygen, then check the ETT placement.

They suggest decreased respiratory system compliance due to issues like worsening lung compliance or pneumothorax.

Causes may include worsening airway obstruction, new bronchospasm, or obstruction of the ETT or circuit.

<p>Perform needle decompression if tension pneumothorax is suspected and consider other diagnoses like PE.</p> Signup and view all the answers

<p>iPEEP stands for increased Positive End Expiratory Pressure and is assumed when the patient shows improvement post-assessment.</p> Signup and view all the answers

<p>ETT placement must be checked to rule out possible misplacement causing ventilation issues.</p> Signup and view all the answers

<p>Abdominal distention can restrict lung expansion, leading to decreased respiratory compliance.</p> Signup and view all the answers

<p>Ventilator dyssynchrony can hinder effective ventilation and is a critical factor in elevated pressures.</p> Signup and view all the answers

<p>Needle decompression should be performed if tension pneumothorax is suspected.</p> Signup and view all the answers

<p>PE can have serious implications and is a potential cause of respiratory distress that needs urgent evaluation.</p> Signup and view all the answers

<p>Propofol infusion syndrome is a potential life-threatening complication.</p> Signup and view all the answers

<p>Continuous infusion can cause tissue accumulation, especially in obese or renal/hepatic impaired patients.</p> Signup and view all the answers

<p>Dexmedetomidine has a negligible impact on respiratory drive even when used with opioids.</p> Signup and view all the answers

<p>Key components include head elevation, sedation vacations, and oral decontamination.</p> Signup and view all the answers

<p>Assess vital signs immediately and provide bag-mask ventilation with 100% oxygen if there is severe hemodynamic compromise.</p> Signup and view all the answers

<p>Presumptive treatment involves performing needle decompression or finger thoracostomy and placing a chest tube.</p> Signup and view all the answers

<p>Maintaining this pressure helps prevent leakage and reduces the risk of VAP.</p> Signup and view all the answers

<p>Breath stacking is the accumulation of air in the lungs due to inadequate exhalation, leading to dynamic hyperinflation, high peak inspiratory pressures, and potential circulatory collapse.</p> Signup and view all the answers

<p>Decreasing the respiratory rate allows for more complete exhalation, reducing dynamic hyperinflation and improving patient-triggered breaths.</p> Signup and view all the answers

<p>Matching the set PEEP to the level of iPEEP can improve lung mechanics and facilitate the patient's ability to trigger their own breaths.</p> Signup and view all the answers

<p>Increasing the inspiratory flow rate can help reduce the duration of inspiratory time, which may decrease breath stacking and its associated complications.</p> Signup and view all the answers

<p>High peak inspiratory pressures and dynamic hyperinflation contribute to the difficulty in triggering breaths, as they alter the normal mechanics of respiration.</p> Signup and view all the answers

<p>Hypotension can occur due to decreased venous return, which results from elevated intrathoracic pressures caused by breath stacking.</p> Signup and view all the answers

<p>Interventions include adjusting the respiratory rate, inspiratory time, inspiratory flow rate, and ensuring appropriate PEEP adjustments.</p> Signup and view all the answers

<p>Preventing breath stacking can involve optimizing ventilator settings such as reducing tidal volume and ensuring adequate expiratory time between breaths.</p> Signup and view all the answers

<p>Immediately discontinue mechanical ventilation and manually bag with 100% oxygen.</p> Signup and view all the answers

<p>Endotracheal tube obstruction.</p> Signup and view all the answers

<p>It refers to the amount of pressure that remains in the lungs at the end of expiration, which can affect lung function.</p> Signup and view all the answers

<p>Endotracheal tube migration into the bronchus.</p> Signup and view all the answers

<p>It creates pressure in the thoracic cavity that collapses the lung, severely impairing breathing.</p> Signup and view all the answers

<p>Abdominal distention.</p> Signup and view all the answers

<p>Pulmonary embolus.</p> Signup and view all the answers

<p>Pain or inadequate sedation.</p> Signup and view all the answers

<p>Searching for the underlying cause.</p> Signup and view all the answers

<p>Evaluating and correcting endotracheal tube positioning.</p> Signup and view all the answers

<p>Immediately discontinue mechanical ventilation and manually bag with 100% oxygen.</p> Signup and view all the answers

<p>Endotracheal tube obstruction and abdominal distention.</p> Signup and view all the answers

<p>By ensuring adequate expiratory time and reducing respiratory rate, tidal volume, and inspiratory time.</p> Signup and view all the answers

<p>1:4.</p> Signup and view all the answers

<p>Bronchodilators and corticosteroids.</p> Signup and view all the answers

<p>Pressure-controlled (PC) ventilation is commonly used, but there is no data suggesting an advantage over volume-controlled (VC) ventilation.</p> Signup and view all the answers

<p>5 cm H₂O.</p> Signup and view all the answers

<p>Other underlying causes should be pursued.</p> Signup and view all the answers

<p>Management principles for status asthmaticus are similar but may include different pharmacologic interventions.</p> Signup and view all the answers

<p>Permissive hypercapnia allows for higher carbon dioxide levels to minimize barotrauma and maintain adequate oxygenation.</p> Signup and view all the answers

<p>Electrolytes, fluid balance, and organ function</p> Signup and view all the answers

<p>Lipid-lowering agents or alternative procedures to support lipid metabolism.</p> Signup and view all the answers

<p>Medications such as insulin or bicarbonate to correct metabolic acidosis.</p> Signup and view all the answers

<p>Carefully and with appropriate protocols for the patient.</p> Signup and view all the answers

<p>Careful consideration of alternative anesthetic agents.</p> Signup and view all the answers

<p>Strict monitoring of propofol infusion rates and durations.</p> Signup and view all the answers

<p>Regular biochemical monitoring, specifically a metabolic panel.</p> Signup and view all the answers

<p>Risk stratification.</p> Signup and view all the answers

<p>Fever, muscle pain, signs of multi-organ failure.</p> Signup and view all the answers

<p>Adequate training to recognize early symptoms and manage appropriately.</p> Signup and view all the answers

<p>Mitochondrial dysfunction</p> Signup and view all the answers

<p>Rhabdomyolysis</p> Signup and view all the answers

<p>They exert toxic effects.</p> Signup and view all the answers

<p>Irregularities in fatty acid metabolism</p> Signup and view all the answers

<p>Underlying metabolic disorder</p> Signup and view all the answers

<p>Discontinuation of propofol</p> Signup and view all the answers

<p>Hyperkalemia or hypocalcemia</p> Signup and view all the answers

<p>It causes cellular damage.</p> Signup and view all the answers

<p>Additional cellular damage</p> Signup and view all the answers

<p>It substantially increases risk.</p> Signup and view all the answers

Air trapped in the lungs during mechanical ventilation, leading to lung expansion beyond normal.

High pressure needed to inflate the lungs during mechanical ventilation, often caused by breath stacking.

The pressure remaining in the lungs at the end of exhalation.

Pressure in the lungs at the end of exhalation that is generated by the patient's own breathing effort.

The difficulty a patient experiences in initiating a breath due to increased lung pressure during mechanical ventilation.

Low blood pressure, often caused by breath stacking due to reduced blood flow to the heart.

A life-threatening condition where the circulatory system fails, often caused by severe breath stacking.

Adjusting the rate of breathing during mechanical ventilation to reduce air trapping and improve breathing.

A type of mechanical ventilation distress where the patient's lungs are stiff and difficult to inflate.

Increased resistance to airflow in the airway or ventilator circuit.

A tool for measuring the pressure needed to inflate the lungs during mechanical ventilation.

A measure of the pressure in the lungs at the end of exhalation during mechanical ventilation.

A condition where air leaks out of the lungs into the space between the lung and chest wall.

A situation where the patient's body is not working well with the ventilator, causing difficulty breathing.

A condition where the pressure in the chest cavity builds up, compressing the lungs and heart.

A blockage in the airway that can prevent air from passing through.

A condition where the lungs are not able to expand and contract properly.

A condition where the lungs are stiff and difficult to inflate, leading to inadequate oxygenation and increased work of breathing.

A condition where the airways are narrowed, making it difficult to breathe in and out, leading to inadequate oxygenation.

A type of ventilator setting where the pressure delivered to the lungs is controlled ,

A type of ventilator setting where the volume of air delivered to the lungs is controlled, allowing for greater control over lung inflation.

The ratio of inspiratory time to expiratory time during mechanical ventilation.

A condition characterized by a rapid increase in airway resistance due to inflammation and bronchospasm, leading to difficulty breathing and wheezing.

The minimum amount of air that remains in the lungs at the end of a normal exhalation.

A strategy for managing acute respiratory distress by intentionally allowing higher levels of carbon dioxide in the blood while prioritizing oxygenation.

A condition characterized by a sudden blockage of a pulmonary artery, often due to a blood clot, leading to difficulty breathing and chest pain.

A condition that requires immediate action to avoid further harm, often involving a decline in blood circulation and oxygen delivery to the body.

The pressure remaining in the airways at the end of exhalation caused by the ventilator, which can reach dangerously high levels.

A blockage in the pulmonary artery caused by a blood clot that travels from elsewhere in the body.

A condition where the tube that delivers air to the lungs slips into a bronchus, leading to decreased air flow in one or both lungs.

A condition where a leak in the tube that delivers air to the lungs causes air to escape into the stomach, causing distention. It's consequences may range from a bubbling noise to a life-threatening ventilatory failure,

A condition where the tube that delivers air to the lungs is accidentally removed from the airway.

A condition where a break in the system of the ventilator, such as a loose connection or a broken hose, disrupts airflow.

Propofol is a sedative that is given through a continuous infusion (NOT as a bolus) in critically ill patients. It's preferred over benzodiazepines for reducing the length of mechanical ventilation. However, it can cause a rare but serious complication called Propofol Infusion Syndrome.

Benzodiazepines (e.g., Midazolam, Lorazepam) are also used for sedation. However, continuous infusions of these drugs are less desirable due to potential tissue accumulation. Bolus administration is usually preferred initially.

Dexmedetomidine is a sedative that is also an analgesic, meaning it can reduce both anxiety and pain. It doesn't have a big impact on breathing, even when given with opioids. Administered as a continuous infusion, it can slow heart rate and cause blood pressure fluctuations.

Ketamine is an anesthetic and pain reliever that is helpful for mechanically ventilated patients. It works on several receptors in the brain and has a moderate pain-relieving effect. It can be given as a bolus or a continuous infusion.

Antipsychotics like haloperidol can be used as an adjunct to sedation in critically ill patients. They help manage agitation but don't provide pain relief or amnesia. Important note: they are NOT effective for preventing delirium.

VAP (Ventilator-Associated Pneumonia) is a serious complication of mechanical ventilation. About half of VAP cases develop within the first four days of ventilation.

Prevention techniques for VAP include secretion management through suctioning, GI decompression with tubes, head elevation (at least 30 degrees), and VAP bundles. These bundles involve head of bed elevation, sedation vacations, extubation readiness assessment, peptic ulcer prophylaxis, oral decontamination, and GI decompression.

A severe and potentially fatal complication that can occur in individuals receiving prolonged propofol infusions, characterized by multi-organ dysfunction.

A key factor in the development of PIS, involving an imbalance between the production of reactive oxygen species and the body's antioxidant defenses.

A central mechanism in PIS, leading to a decrease in the production of energy within cells, ultimately contributing to cellular dysfunction.

An important aspect of the pathophysiology of PIS, characterized by an excessive influx of calcium into cells, leading to disruption of cellular functions.

A significant contributor to the development of PIS, involving the activation of the immune system, leading to inflammation and further cellular damage.

A risk factor for PIS, characterized by prolonged administration of propofol, increasing the likelihood of the syndrome's development.

A critical risk factor for PIS, characterized by underlying metabolic disorders affecting lipid or fatty acid metabolism, increasing an individual's susceptibility to the syndrome.

An essential first step in the treatment of PIS, involving immediate discontinuation of propofol infusion to stop further progression of the syndrome.

A hallmark finding in PIS, characterized by an increased acidity in the blood due to metabolic disturbances.

A frequent complication observed in PIS, characterized by the breakdown of muscle tissue, leading to the release of harmful substances into the bloodstream and potentially causing acute kidney failure.

A serious condition that can develop during prolonged propofol infusion, characterized by metabolic acidosis, rhabdomyolysis, and multi-organ dysfunction.

The process of carefully monitoring and managing a patient's electrolytes, fluid balance, and organ function to prevent or address complications.

A strategy that involves closely monitoring the patient's breathing and adjusting the ventilator settings to prevent air trapping and improve breathing.

Measures taken to reduce the risk of developing Propofol Infusion Syndrome, including careful selection of anesthetic agents, close monitoring of fluid balance during propofol infusions, and strict adherence to infusion rates and durations.

A life-threatening condition characterized by a sudden drop in blood pressure, usually caused by a serious medical event or injury.

The process of carefully selecting and administering medications, particularly insulin and bicarbonate, to address metabolic acidosis and electrolyte imbalances.

A key component of supportive care that involves accurately monitoring the patient's vital signs and adjusting treatment based on the observed data.

A condition where the body's fluid balance is disrupted, leading to dehydration or fluid overload, which can have serious consequences.

A procedure used to assist patients who are unable to breathe on their own, involving a machine that delivers air to the lungs.