1、RESPIRATORY FAILUREMANAGEMENMANAGEMENTDr.Sivasubramanian.T.A.DEPARTMENT OF ANAESTHESIOLOGYIBRI REGIONAL REFERRAL HOSPITALRESPIRATORY CARE Ambient Pressure Therapy Positive Pressure TherapyAMBIENT PRESSURE THERAPY Oxygen Therapy Humidity Therapy Bronchial Hygeine Therapy PharmacotherapyOXYGEN THERAPY
2、Oxygen Delivery = O2 Content x Cardiac OutputO2 Content = Hb x SaO2 x 1.34 + PaO2 x 0.003OXYGEN THERAPY Aims to improve PaO2 by increasing FiO2 Effective FiO2 - 0.24 - 0.50 FiO2 0.50 not indicatedOXYGEN THERAPYDelivered by Variable Performance / Low Flow System Fixed Performance / High Flow SystemLO
3、W FLOW SYSTEMLOW FLOW SYSTEMFiO2 depends on Size of O2 Reservoir O2 Flow Rate Breathing PatternLOW FLOW SYSTEM Simplicity Patient Comfort Economical Inaccurate / Not dependablePERFORMANCEO2 Flow Rate (L/M)FiO2Nasal cannula20.2840.3660.44Oxygen Mask5 - 60.406 - 70.507 - 80.60Mask with bag60.6080.8010
4、0.80HIGH FLOW SYSTEM 3 - 4 times Minute Volume Accurate over a range of Minute Volume FiO2 0.24 - 0.40 Higher FiO2 by large-volume nebulisersHIGH FLOW SYSTEMHUMIDITY THERAPYAIR50 % HUMIDIFIED20 C 20 mg/LTHEOPHYLLINELoading dose:No prior Rx6 mg / kgOn going RxTD - TP / 0.6Rate of infusion 0.82. Cardi
5、ac Output Mean Intrathoracic Pressure - Venous Return Sympathetic tone SUPPORTIVE MODES Positive End Expiratory Pressure ( PEEP ) Continuous Positive Airway Pressure ( CPAP ) Expiratory Positive Airway Pressure ( EPAP )WEANING FROM VENTILATORWhen does one wean a patient from ventilator?1. Underlying
6、 indication - improved ?2. Cardiopulmonary reserves - Adequate?3. Factors ventilatory demand - Present?CRITERIA FOR WEANING Vital Capacity - 10 - 15 ml / kg Tidal Volume - immediate spont. 2 ml / kg Respiratory Rate - preferably 70%40 - 70 %25 - 40 %70% 70 %CHRONIC OBSTRUCTIVE AIRWAY DISEASEProblems
7、:1. Airway Resistance - Work of Breathing2. Thoracic Hyperinflation - Inspiratory muscle effeciency3. Impaired gas exchangeCHRONIC OBSTRUCTIVE AIRWAY DISEASEAirway Resistance Bronchodilators - 2 agonists, Ipratropium, ? Theophylline , ? Corticosteroids Bronchial Hygeine Therapy - importantCHRONIC OB
8、STRUCTIVE AIRWAY DISEASEImprove Gas Exchange Oxygen Therapy - High Flow Systems Positive Pressure Therapy - if needed Maintain PaO2 50 -60 mmHgACUTE LUNG INJURYSpectrum of DisorderMild Moderate SevereDiagnosisNoncardiogenic OedemaARDSHypoxaemiaModerateSevereFiO2ResponsiveRefractoryComplianceWork of
9、BreathingACUTE RESPIRATORY DISTRESS SYNDROME Maintain Vascular Volume - CVP, PAC Ensure adequate Hb level Maintain PaO2 ( at least 50 - 60 mm Hg) - Ventilate FiO2 0.5 - Use PEEP Avoid alveolar over distension - low VT - PIP 35 cm H2O -Permissive Hypercapnia PERMISSIVE HYPERCAPNIA PaCO2 50 mmHg - if
10、pH 7.25, CV Function - Normal, risk of lung injury pH 7.25 - Risk from lung injury greater than tissue acidosisOTHER TREATMENT MODES Nitric Oxide Nutrition Partial Liquid Ventilation - Perflurocarbon Extra Pulmonary Respiratory techniquesNIRIC OXIDENUTRITION Oxepa - Low CHO, High calory enteral nutr
11、ition - Mixture of Eicosapentaenoic acid (EPA) + Gamma linolenic acid (GLA) + Antioxidants +Essential vitaminsEXTRA PULMONARY RESPIRATORY TECHNIQUES Extracorporeal Membrane Oxygenation Extracorporeal Carbon Dioxide Removal Intravascular OxygenatorKey to Successful Management lies in Good Nursing Care Physiotherapy Early institution of Positive Pressure Therapy when needed High degree of suspicion for complicationsThank You !
