Vent Basics + Refractory Hypoxemia

Today in report, we discussed some vent management basics and the different mechanisms of addressing refractory hypoxemia.

Take Home Points: Vent Basics and Refractory Hypoxemia
Vent Basics – it’s about oxygenation and ventilation
Oxygenation – controlled by FiO2 and PEEP
Ventilation – controlled by respiratory rate and tidal volume
 
Assist Control Ventilation Modes – what’s controlled and what’s not 
Ventilator Mode
Tidal Volume
Respiratory Rate
Peak Pressure
Volume Control
Set
Set
Variable
Pressure Control
Variable
Set
Set
Management of Refractory Hypoxemia
Principles of managing refractory hypoxemia in ARDS – see attached article for details!
1. Lung protective ventilation
2. Paralysis – ensures patient vent synchrony
3. Prone positioning
4. Recruitment maneuvers
5. Pulmonary vasodilators – inhaled NO and inhaled prostaglandins
6. ECMO
* High frequency oscillatory ventilation associated w higher mortality in ARDS – no longer recommended!
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