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    Stewart 9 Artifact2

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    Stewart 9 Artifact2

    Uploaded by

    api-260357356
    33 views9 pages

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    stewart 9 artifact2

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    Download as pptx, pdf, or txt
    33 views9 pages

    Stewart 9 Artifact2

    Uploaded by

    api-260357356

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    You are on page 1of 9

    Intubation & Mechanical

    Ventilation

    Applications in the Pediatric
    Intensive Care Unit

    Claire Stewart
    Outline
    Why intubate? causes of
    respiratory failure

    How to intubate? Pharmacology
    of intubation, tools for intubation

    What do to once intubated types
    of mechanical ventilation
    Respiratory Failure
    shunt
    V/Q mismatch
    Hypoventilation
    Diffusion impairment
    Low inspired oxygen
    Hypoxemic
    respiratory
    failure
    (PaO2 <60)
    Increased airway
    resistance
    Reduced effort/drive
    Decreased lung volume
    for gas exchange
    Hypercapnic
    respiratory
    failure
    (PaCO2>50)
    Pharmacology of
    Endotracheal Intubation
    Pre-
    medication
    Lidocaine
    Atropine
    Sedation

    Ketamine
    Versed
    Etomidate
    Analgesia

    Fentanyl
    Paralysis

    Succinylcholine
    Rocuronium
    Vecuronium
    Cisatracurium
    Tools of Endotracheal Intubation


    Suctioncatheter and Yankauer

    Oxygenappropriate bag and mask

    Emergency suppliesepinephrine, fluid bag

    End tidal monitoring

    Emergency airwaysoral airway/LMA



    Tools of Endotracheal Intubation
    Endotracheal
    tubes--Size is
    (16+age)/4



    Blade-- Miller and
    Macintosh
    http://www.savelives.com/product/greenlined-stainless-steel-sterile-disposable-fiber-
    optic-laryngoscope-blades-miller-4-large-adult-3700.cfm
    http://www.howequipmentworks.com/physics/airway/ett/endotracheal_t
    ubes.html
    Conventional
    Modes of Ventilation
    Set pressure delivered with every
    breath
    Pressure
    Control
    Set volume delivered with every
    breath
    Volume
    Control
    Set volume delivered with every
    breath with breath to breath
    pressure adjustment
    Pressure
    regulated
    volume control
    Non-Conventional
    Modes of Ventilation
    A constant distending pressure with
    pressure variations alternating around the
    MAP at very high rates
    hypoxic respiratory failure
    patients usually require neuromuscular
    blockade
    HFOV
    Two levels of positive airway pressure;
    most time spent at high pressure with a
    brief expiratory release to facilitate
    ventilation
    hypoxic respiratory failure
    allows patient to be awake
    APRV
    Ventilator Adjustments
    Hypoxia
    Increase FiO2
    Increase PEEP
    Increase iTime
    (Mean Airway
    Pressure)
    Hypercarbia
    Increase rate
    Increase tidal
    volume
    (volume mode)
    Increase delta
    pressure
    (pressure
    mode)

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