1、RESPIRATORY FAILUREMANAGEMENT1ppt课件RESPIRATORY CAREAmbient Pressure TherapyPositive Pressure Therapy2ppt课件AMBIENT PRESSURE THERAPYOxygen TherapyHumidity TherapyBronchial Hygeine TherapyPharmacotherapy3ppt课件OXYGEN THERAPYOxygen Delivery=O2 Content x Cardiac OutputO2 Content=Hb x SaO2 x 1.34+PaO2 x 0.
2、0034ppt课件OXYGEN THERAPYAims to improve PaO2 by increasing FiO2Effective FiO2-0.24-0.50FiO2 0.50 not indicated5ppt课件OXYGEN THERAPYDelivered byVariable Performance/Low Flow SystemFixed Performance/High Flow System6ppt课件LOW FLOW SYSTEM7ppt课件LOW FLOW SYSTEMFiO2 depends onSize of O2 ReservoirO2 Flow Rate
3、Breathing Pattern8ppt课件LOW FLOW SYSTEMSimplicityPatient ComfortEconomicalInaccurate/Not dependable9ppt课件PERFORMANCEO2 Flow Rate(L/M)FiO2Nasal cannula20.2840.3660.44Oxygen Mask5-60.406-70.507-80.60Mask with bag60.6080.80100.8010ppt课件HIGH FLOW SYSTEM3-4 times Minute VolumeAccurate over a range of Minu
4、te VolumeFiO2 0.24-0.40Higher FiO2 by large-volume nebulisers11ppt课件HIGH FLOW SYSTEM12ppt课件HUMIDITY THERAPYAIR50%HUMIDIFIED20 C 20 mg/L32ppt课件THEOPHYLLINELoading dose:No prior Rx6 mg/kgOn going RxTD-TP/0.6Rate of infusion 0.82.Cardiac Output Mean Intrathoracic Pressure-Venous Return Sympathetic tone
5、 46ppt课件SUPPORTIVE MODESPositive End Expiratory Pressure (PEEP)Continuous Positive Airway Pressure (CPAP)Expiratory Positive Airway Pressure (EPAP)47ppt课件WEANING FROM VENTILATORWhen does one wean a patient from ventilator?1.Underlying indication-improved?2.Cardiopulmonary reserves-Adequate?3.Factors
6、 ventilatory demand-Present?48ppt课件CRITERIA FOR WEANINGVital Capacity-10-15 ml/kgTidal Volume-immediate spont.2 ml/kgRespiratory Rate-preferably 70%40-70%25-40%70%70%51ppt课件CHRONIC OBSTRUCTIVE AIRWAY DISEASEProblems:1.Airway Resistance-Work of Breathing2.Thoracic Hyperinflation-Inspiratory muscle ef
7、feciency3.Impaired gas exchange52ppt课件CHRONIC OBSTRUCTIVE AIRWAY DISEASEAirway ResistanceBronchodilators-2 agonists,Ipratropium,?Theophylline,?CorticosteroidsBronchial Hygeine Therapy-important53ppt课件CHRONIC OBSTRUCTIVE AIRWAY DISEASEImprove Gas ExchangeOxygen Therapy-High Flow SystemsPositive Press
8、ure Therapy-if neededMaintain PaO2 50-60 mmHg54ppt课件ACUTE LUNG INJURYSpectrum of DisorderMild Moderate SevereDiagnosisNoncardiogenic OedemaARDSHypoxaemiaModerateSevereFiO2ResponsiveRefractoryComplianceWork of Breathing55ppt课件ACUTE RESPIRATORY DISTRESS SYNDROMEMaintain Vascular Volume-CVP,PACEnsure a
9、dequate Hb levelMaintain PaO2(at least 50-60 mm Hg)-Ventilate FiO2 0.5-Use PEEPAvoid alveolar over distension-low VT-PIP 35 cm H2O-Permissive Hypercapnia 56ppt课件PERMISSIVE HYPERCAPNIAPaCO2 50 mmHg-if pH 7.25,CV Function-Normal,risk of lung injurypH 7.25-Risk from lung injury greater than tissue acid
10、osis57ppt课件OTHER TREATMENT MODESNitric OxideNutritionPartial Liquid Ventilation-PerflurocarbonExtra Pulmonary Respiratory techniques58ppt课件NIRIC OXIDE59ppt课件NUTRITIONOxepa-Low CHO,High calory enteral nutrition-Mixture of Eicosapentaenoic acid(EPA)+Gamma linolenic acid(GLA)+Antioxidants+Essential vit
11、amins60ppt课件EXTRA PULMONARY RESPIRATORY TECHNIQUESExtracorporeal Membrane OxygenationExtracorporeal Carbon Dioxide RemovalIntravascular Oxygenator61ppt课件Key to Successful Management lies inGood Nursing CarePhysiotherapyEarly institution of Positive Pressure Therapy when neededHigh degree of suspicion for complications62ppt课件Thank You!63ppt课件
