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
Pressure Control
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
* High frequency oscillatory ventilation associated w higher mortality in ARDS – no longer recommended!

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