Immediately from the ACCP severe Care medication Board evaluate 2009 direction, this article covers each subject in a concise, easy-to-use layout. Use as a self-study source to arrange for the serious care medication subspecialty board exam.
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If hypotension occurs, intravascular volume should be rapidly expanded while steps are taken to lower the pleural pressure (smaller VT, less minute ventilation). Patients With Normal Respiratory Mechanics and Gas Exchange Patients with normal lung mechanics and gas exchange can require mechanical ventilation for several reasons: (1) because of loss of central drive to breathe (eg, drug overdose or structural injury to the brainstem); (2) because of neuromuscular weakness (eg, high cervical cord injury, acute idiopathic myelitis, myasthenia gravis); (3) as an adjunctive therapy in the treatment of shock; or (4) to achieve hyperventilation (eg, in the treatment of elevated intracranial pressure following head trauma).
2008;359(20):2095–2104. Caramez MP, Kacmarek RM, Helmy M, et al. A comparison of methods to identify open-lung PEEP. Intensive Care Med. 2009;35(4):740–747. Grasso S, Stripoli T, De Michele M, et al. ARDSnet ventilatory protocol and alveolar hyperinflation: role of positive end-expiratory pressure. Am J Respir Crit Care Med. 2007;176(8):761–767. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation.
There is no significant difference in the work required to trigger between pressure-triggered and flow-triggered settings. When autoPEEP is present the patient must lower Palv by the autoPEEP amount to have any impact on Pao or divert flow. This can dramatically increase the required effort for breath initiation, a problem that cannot be solved by adjusting the sensitivity or type of triggering. 1. Compared with conventional modes of ventilation, lung oxygen exchange is often improved with IRV, owing to increased mean alveolar pressure and volume consequent to the longer time above functional residual capacity or as a result of creation of autoPEEP.