Non-Invasive & Invasive Ventilator Management
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Non-Invasive & Invasive Ventilator Management
Ventilator management is a crucial aspect of respiratory critical care, involving the use of mechanical ventilation to support patients who are unable to maintain adequate oxygenation or ventilation on their own. There are two main approaches: Non-Invasive Ventilation (NIV) and invasive ventilation.
Non-Invasive Ventilation (NIV)
1- Types of NIV:
- Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP) are common forms of NIV.
- CPAP provides a continuous pressure to keep the airways open.
- BiPAP delivers two different pressure levels, higher during inspiration and lower during expiration.
2- Indications:
- NIV is often used for conditions like acute respiratory failure, exacerbation of chronic obstructive pulmonary disease (COPD), pulmonary edema, and certain types of sleep-related breathing disorders.
3- Monitoring:
- Continuous monitoring of patient comfort, respiratory rate, tidal volume, and oxygen saturation is essential.
- Regular assessment of blood gases to ensure adequate ventilation and oxygenation.
4- Interfaces:
- NIV can avoid the need for invasive intubation and is associated with a reduced risk of complications.
5- Benefits:
- Used to optimize oxygenation and ventilation status of critically ill patients.
Invasive Mechanical Ventilation
1- Endotracheal Intubation:
- Involves the insertion of a tube through the mouth or nose into the trachea to establish an airway.
2- Ventilator Settings:
- Parameters such as tidal volume, respiratory rate, Positive End-Expiratory Pressure (PEEP), and Fraction of Inspired Oxygen (FiO2) are set on the ventilator.
3- Modes of Ventilation:
- Ventilators offer various modes, including Assist-Control ventilation (AC), Pressure Support Ventilation (PSV), and Synchronized Intermittent Mandatory Ventilation (SIMV), etc.
4- Monitoring:
- Continuous monitoring of ventiletery parameters, arterial blood gases, and patient's response to ventilation.
- Regular assessment for signs of ventilator-associated lung injury or complications.
5- Weaning:
- Gradual reduction of ventiletery support as and when the patient's condition improves.
- Transition to spontaneous breathing trials and extubation when appropriate.
6- Complications:
- Potential complications include ventilator-associated pneumonia, barotrauma, and ventilator-induced lung injury.
7- Patient Sedation and Analgesia:
- Management of sedation and pain is essential to ensure patient comfort and cooperation.