Mechanical ventilation 1 - ICET NEPEAN€¦ · Mechanical ventilation 1. Asthma pathophysiology. 26...
Transcript of Mechanical ventilation 1 - ICET NEPEAN€¦ · Mechanical ventilation 1. Asthma pathophysiology. 26...
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Mechanical ventilation 1
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Asthma pathophysiology
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26 yo Samoan• SOB, no chest pain, subacute onset
• Known asthmatic, poorly compliant with inhalers
• Builder, works with concrete
• Family members with coryza symptoms recently
• Increasing SOB and wheeze last 48hours
• o/e sats 96% NRB, HR 120, BP 150/80, bilateral wheeze, diaphoretic, talking in words, working hard
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Initial ABG
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Initial CXR
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CXR 30 min laterwith NIV
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What do you think about the use of NIV in this situation?
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Should he be intubated?
• Severity of respiratory failure • Cardiopulmonary reserve • Adequacy of compensation • Expected speed of response to treatment • Risk of complications associated with ventilation • Availability of staff with high level of airway skills,
the time of the day, how busy the ICU is etc
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Patient is urgently transferred to ICU and intubated … Set the ventilator
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Initial mechanical ventilation profile after intubation
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Initial ABG 30min post
ETT insertion
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Gas trapping and hyperinflation
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What parameters would you check regularly and why?
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Treatment of sick asthmatic
• Standard therapy: O2, salbutamol nebs, ipratropium nebs, steroid (? aminophylline), appropriate mechanical ventilation
• Refractory therapy: ketamine, magnesium, adrenaline, inhalational agents (sevo, isoflurane), heliox
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Emergency alarm sounds Sudden desaturation & Increased pressures
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Minimal AE bilaterally
Urgent CXR requested
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72 hours down the track and bronchospasm has settled but persistent
air leak and bubbling via drain. What is the diagnosis?
What is your further management?
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Bronchopulmonary fistula management
• Adequate sized ICC
• Ventilation measures
• Low TV, low PEEP, short inspiratory time, spontaneous breathing
• Independent lung ventilation
• HFOV
• ECMO
• Endobronchial occlusion