• maintain patent airway
• effective coughing
• suction/position
• secretions
• humidification
• hydration
• chest p/t
• aerosols
• nebulizers

non invasive ventilation

• spontaneous respiration
• copd -hypercapnic respiratory distress
• post op resp distress
• Neuromuscular resp failure
• asthma/CF
• ards
• DNI
• pulmonary edema
• sleep apnea

• coma
• cardiac arrest/MI/Ventricular arrhythmias
• respiratory arrest
• intubation
• shock
• GI bleed
• status epilepticus

• breathing problems
• fatigue
• psychological support

• Patient cooperation
• dyspnea
• tachypnea
• increased work of breathing
• hypercapnic
• hypoxemia

• increase in ph by 0.06
• decrease co2
• correction of resp acidosis

• worsening of clinical appearance /CXR
• hypoxemia
• hypercapnic

• Acute respiratory failure
• Pao2 <50 mmHg (80-100) hypoxemia
• PaCO2 >50 mmHg(35-45) hypercapnia
• Ph <7.35 (7.35-7.45)Acidosis

• Ventilation or perfusion mechanisms are impaired
• failure to ventilate
• failure to oxygenate
• results in
• hypoxemia - restless state
• hypercapnia - sleeping state

• ↓ respiratory drive
• chest wall/lung parenchymal dysfunction
• post op

• pulse ox
• ABG
• CXR
• CBC

• co = stroke volume x hr
• stroke volume is 2/3 amount of blood pumped out of left ventricle

• reduced BP
• weakness/fatigue/dizziness
• edema/↓Urine output
• altered mental status
• cold clammy
• chest pain

• relieve bronchospasms
• reduce pulmonary congestion
• mechanical ventilation

• acute respiratory distress syndrome
• lung injury
• pulmonary edema
• severe hypoxemia
• leads to respiratory failure

• aspiration
• pneumonia
• pulmonary contusion
• near drowning
• prolonged inhalation of O2, smoke, toxic substances

• sepsis
• shock
• drug overdose
• fat emboli
• prolonged hypotension
• nonthoracic trauma
• head injury
• uremia
• acute pancreatitis
• dic, blood transfusions

• exudative - acute inflammotary phase
• proliferative - ↑ capillary permeability
• fibrotic - recovery phase

• lung injury causes inflammatory response
• interstitial damages
• ↓ lung compliance and severe hypoxemia
• non ventilating non functioning lung areas
• refractory hypoxemia

• severe dyspnea
• hypoxemia
• rapid shallow breathing - respiratory alkalosis
• rhonchi, crackles, cyanosis, intercostal rectractions
• tachycardia, hypotension, ↓ urine output

• Oxygenation ventilator - low tidal volume , PEEP
• drug therapy
• nutritional / prone support
• permissive hypercapnia

• high metabolic demand
• enteral nutritional support preferred
• calories - high, protein, fatty acids
• fat calories

• protective mechanism from injury from inflammation

• frequent assessments
• coughing
• suctioning
• frequent T / P
• decreased cardiac output

• failure of ventilation
• Acute/Chronic respiratory failure
• chest injury
• Left ventricular failure/pulmonary disease
• neuromuscular/ms disease
• CNS disease/depression

• volume of air inhaled and exhaled from the lungs

• postive end expiratory pressure
• maintenance of above atmospheric pressure at the airway throughout expiration phase
• adjusts pressure at expiration
• re inflates / improves lung compliance
• decrease cardiac output

• rarely used
• for neuromuscular diseases
• iron lung
• chest cuirass

• limited access for patient care
• inability to properly monitor pulmonary mechanics
• patient discomfort

• ↑ pressure to the lungs to improve gas exchange
• lungs are physically filled/ventilated with air

• control modes
• supportive modes

• Assist / control
• ventilation / volume regulated pressure control

• set Tidal volume / respiratory rate

• set upper airway pressure / respiratory rate
• tidal volumes vary according to lung compliance

• CPAP
• for spontaneously breathing patients to improve oxygenation
• weaning mode
• nocturnal ventilation - sleep apnea

• BiPap
• nocturnal hypoventilation d/t neuromuscular disease, chest wall deformity, obstructive sleep apnea, copd
• to prevent intubation
• prevent re intubation
• contraindicated in
• thick secretions, gastric distention, aspiration, claustrophobia

• lung injury - excessive pressure "baro"
• ventilator associated pneumonia VAP
• pseudomonas
• gram neg bacilli
• staphylococci

• oxygenate
• patent airway
• lungs clear
• abg within normal limits
• regular and easy respiratory rate

• auscultate breath sounds
• hyperoxgenate/suction
• bronchodilators and mucolytics
• T and P
• advance activity
• pulse ox

• NMBA
• improvement in severe hypoxemia
• paralysis improves pt-vent synchronism
• reduces O2 consumption
• improves chest wall compliance
• anti inflammatory effects
• may increase mortality
• weaning more difficult
• increase neuromuscular weakness

• lorazepan - ativan
• midazolam - versed
• propofol - diprivan

• pancuronium - pavulon
• rocuronium - zemuron
• vecuronium - norcuron