Slide 2:
Case
A 63 year old male CABG + cryomaze
Post op course:
Inotropic support
Low urine output
Extubated the morning after surgery
Renal indices deteriorated –Furosemide-CRRT.
Resp Insufficiency-CXR diffuse infiltrates.
CMV with Vt 650ml
Respiratory deterioration-iNO therapy-Sildenafil
APRV
Extubated-EZ PAP
Post-op day12 - move to the floor.
Slide 3:
ARDS
A- Acute onset
R- Pao2/Fio2 ratio </= 200
D- Bilateral diffuse infiltrates on chest radiography
S- PA wedge pressure(Swan Ganz) </=18 mm Hg
Lung Protective Ventilation Strategies( 1)
Avoid regional over distension
Avoid barotrauma
Transpulmonary pressure < 35 cm H2O
Avoid repeated opening/closing of airway PEEP
Avoid oxygen toxicity FIO2 as low as possible
Lung Recruitment Strategies:
Inhaled Nitric Oxide
Sildenafil
Inverse Ratio Ventilation
APRV:
Slide 4:
The Static Pressure Volume Curve
HIP- High Inflection Point
LIP – Low Inflection Point
Slide 5:
The Static Pressure Volume Curve
HIP- High Inflection Point
LIP – Low Inflection Point
Slide 6:
APRV : is continuous positive airway pressure (CPAP) with an intermittent release phase.
Slide 7:
Corresponding pressure and flow curves during one cycle of inflation deflation. APRV
Indications
ALI ARDS Atelectasis after major surgery.
Beneficial effects on:
Oxygenation
Hemodynamics
Regional blood flow and Organ perfusion
Sedation and Neuromuscular blockers usage
Slide 8:
References
Houston P.An approach to ventilation in acute respiratory distress syndrome. Can J Surg. 2000 Aug;43(4):263-8.
Daoud Ehab. Airway pressure release ventilation. Annals of Thoracic Medicine; Issue: 4; pp: 176-179; Vol: 2; Year: 2007
Habashi NM. Other approaches to open-lung ventilation: Airway pressure release ventilation. Crit Care Med 2005;33:S228-40.