BUMC Basics.pdf - Anesthesia Home
BUMC Basics.pdf - Anesthesia Home
BUMC Basics.pdf - Anesthesia Home
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89<br />
- Daily sedation vacations at 0700 (“Sedation<br />
Vacation”) if the following is NOT present<br />
• FiO2 >60%<br />
• PEEP >10cm<br />
• Neurosurgical Pt<br />
• Increased ICP<br />
• Hemodynamically Unstable<br />
• Neuromuscular Blockade<br />
Consider a pulmonary critical care consult for every<br />
patient on a ventilator. After 48 hours of MV, it is hospital<br />
policy that you must get a pulmonary critical care consult.<br />
Simplistic approach to adjusting the vent<br />
• Low pO2: increase FiO2 or increase PEEP (to recruit<br />
more alveoli)<br />
• High pCO2: increase TV or increase rate (to increase<br />
minute volume)<br />
• Use ratios: pCO2 current x RR current=pCO2 desired x<br />
RR desired<br />
• For every 10 change in pCO2, the pH changes<br />
approximately 0.8 (acutely)<br />
Troubleshooting the vent<br />
Decreased Peak Inspiratory Pressure (PIP)<br />
• Disconnect problem: Consider disconnected tubing, lost<br />
airway<br />
Increased Peak Inspiratory Pressure (PIP)<br />
• First, check plateau pressure<br />
• Do this by pressing Inspiratory Pause Button<br />
• Check PPlat<br />
- Normal (Plateau Pressure10): This means there is increased airway<br />
resistance. Examples of what could be causing this<br />
include: Patient biting tube (increase sedation or add<br />
bite block), Airway Obstruction from bronchospasm<br />
(BD), secretions/aspiration (suction), plugging<br />
(mucolytics), etc. When the alarm goes off, increase<br />
parameter for peak pressure alarm while<br />
troubleshooting the vent: otherwise ventilator stops<br />
giving a breath with each breath when peak pressures<br />
are high and patient is not ventilated.
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