Acute Respiratory Failure

BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.

Another follow up ABG at 0100 shows a small improvement on the Ph to 7.18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt continued on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. The Pt at this time is pulling a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn. The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.

Hypoxemia is defined as low levels of oxygen in the body. Based on the Rush university medical center respiratory protocol, Refractory hypoxemia is defined as Sp02 < 300 mm Hg; ARDS = PaO 2 /FIO 2 ratio <200 mm Hg”2. According to Chest article, patients with ARDS who are placed on mechanical ventilation showed an improvement in oxygen and disease severity with 24 hours, plus their mortality was increased from 13% to 28% . So lung protective maneuvers should be continued. The literature review showed that the use of high levels of positive end expiratory pressure (PEEP), recruitment maneuvers,

Airway pressure release ventilation (APRV) is a fairly new mode of ventilation, just becoming available in the U.S. in the mid-1990’s. APRV is “inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing and it is based on the principle of open lung approach”. (Daoud, Farag, & Chatburn, 2012) The open lung approach is “concept of maximizing and maintaining alveolar recruitment throughout the ventilatory cycle by potentially ventilating the lung on the steep portion of the pressure-volume curve, thus avoiding over-distention on inspiration and alveolar collapse on exhalation”. (2012) APRV “was first used and described in 1987 as CPAP with an intermittent pressure release phase. Continuous airway pressure is applied to maintain adequate lung volume and improve alveolar recruitment. It is a pressure-limited, time-cycled, volume-variable mode of ventilation.” (2012)

ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

Stretch-induced lung injury may not occur if lung compliance is not greatly reduced. However, the benefit of ventilation with a lower tidal volume was independent of the static compliance of the respiratory system at base line, suggesting that the lower tidal volume was advantageous regardless of lung compliance. Variations in chest-wall compliance, which contributes to compliance of the respiratory system and is reduced in many patients with acute lung injury and the acute respiratory distress syndrome,39 may have obscured a true interaction between tidal volume and base-line lung compliance.

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

The purpose of this study was evaluate the latter effect of Crs when being mechanically ventilated. This specific study was conducted on 144 patients, in which 93 were male and 51 were female. These study subjects had various types of heart related diseases as well as patients who had no heart issues at all. After the patients were assessed, they were split into categories that varied based on the amount of lung capacity, the type of cardiac disease, and whether or not there was a negative pulmonary status.

Primary and long term treatment for CCHs is placement of a permanent tracheostomy. This most common invasive procedure involves the child being placed on positive pressure ventilation during the night. Depending on the severity of alveolar hypoventilation, some patients may require around the clock ventilation. The suggested ventilator mode for these patients iare spontaneous intermittent mandatory ventilation (SIMV). SIMV delivers a set number of fully assisted breaths whether the breaths are patient triggered, flow-limited trigger, or time-triggered. Additional spontaneous breaths by the patient are unassisted with no ventilator help. Ventilators should be used in the spontaneous intermittent mandatory ventilation (SIMV) mode. Another recommendation is the use of an uncuffed tracheostomy to minimize granuloma formation. Ventilator settings can compensate for air leaks around the tracheotomy tube by increasing volume and peak airway pressure as necessary. Mild hyperventilation in

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

TBI is the leading cause due to high incidence, complexity and the presence of challenging clinical management situations such as intracranial hypertension, thoracic trauma and intra-abdominal hypertension. The most common manifestation of a TBI is acute RDS with a high mortality rate. Respiratory failure paired with high PEEP setting and low tidal volumes make patients with increased intracranial hypertension harder to manage. It is hard to maintain these patient’s PaCO2 within a normal range causing protective ventilation strategies to be more difficult. The protective ventilations strategies recommend the mechanical ventilation include maintaining plateau pressures lower than 30cm H2O independently of ARDS severity. However, in patients with a TBI are at greater risk for pulmonary injury, which depends on the trauma severity, even in patients with a TBI and no RDS. In both patient types, TBI with and without RDS, the protective mechanical ventilation strategies are aimed at protecting the lungs and the lung function. Because of the variety of disease causes, there is speculation as to whether ARDS should be described as a single entity, or whether for each special situation it could all be described as a specific class of ARDS, with different management of the ventilation. The aim of this study

The study shows the decrease in mechanical support can be effected by increasing periods of unassisted breathing, alternating unassisted breaths with mechanical breaths, and reduction of the support delivered

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to