Bb Acute Respiratory Failure

Front 1

What are indications for intubation?

Back 1

1. Mechanics
-RR>35,
-VC<15mL/kg for adults and 10mL/kg for children,
-MIF<20cm H2O,
2. Oxygenation
-PaO2<70mm Hg on FiO2 40%,
-A-a gradient>350 torr with FiO2 100%,
3. Ventilation
-PaCO2>55(except if chronic hypercarbia)
-Vd/Vt>0.6(normal is 0.3)

Front 2

What are criteria for extubation?

Back 2

1. awake and alert with stable vital signs and good strength,
2. RR<30-35/min,
3. no inotropic support,
4. afebrile,
5. ABG reasonable(PaO2>70, PaCO2<55) with FiO2 40%,
6. MIF more negative than -20 cm H2O,
7. VC>15mL/kg

Front 3

Describe Tpiece technique for weaning from mechanical ventilation

Back 3

1. T piece adapter and heated nebulizer are attached to ETT,
2. Set FiO2 slightly higher than was set with mechanical ventilation,
3. check vital signs on a very frequent basis during the first hour or two
4. if weaning is well-tolerated extubate after 2-4 hrs

Front 4

What is the IMV technique for weaning from mechanical ventilation

Back 4

IMV is gradually decreased so that eventually spontaneous ventilation begins

Front 5

How does PEEP affect FRC?

Back 5

PEEP acts by increasing FRC. For every 5cm H2O PEEP, FRC increases about 400cc

Front 6

How does PEEP affect intrapulmonary shunting?

Back 6

PEEP improves the relationship between FRC and closing capacity and thereby decreases intrapulmonary shunting

Front 7

How does PEEP affect Cardiac output?

Back 7

decreases CO by increasing intrathoracic pressure and decreasing venous return

Front 8

What are signs of fat embolism syndrome?

Back 8

1. Cardio
-tachycardia and hypotension,
-EKG changes suggest MI and right heart strain,
2. Resp
-increased VD/VT leads to moderate to severe hypoxemias,
-PaO2 falls and PaCO2 rises,
3. CNS
-confusion, obtundation, and coma are often present,
4. Blood
-rise in serum lipids, free fatty acids, and triglycerides,
-decreased Hct,
- thrombocytopenia,
-prolonged PT/PTT,
- increased fibrin degradation products,
5. Skin
-petechiae present over the ant chest, axilla, and neck, and conjunctiva

Front 9

Prophylactic vs conventional PEEP

Back 9

Prophylactic PEEP = 1-5 cm H2O
Conventional PEEP = 5-20 cm H2O

Front 10

Define total physiologic dead space.

Back 10

The sum of the anatomic dead space and alveolar dead space representing the fraction of tidal volume that does not participate in gas exchange.

Front 11

Define anatomic dead space.

Back 11

The volume of gas found in the conducting airways.

Front 12

Define alveolar dead space.

Back 12

The volume of gas that does not participate in gas exchange at the alveolar level.