![]() By contrast, if PEEP is too low, it may result in cyclic airspace opening and closing, which in turn may also cause VALI due to the resultant repetitive shear forces. However, if PEEP increases intrathoracic pressure and if too high may impede venous return, provoking hypotension in a hypovolemic patient, may reduce left ventricular afterload, and may overdistend portions of the lung, thereby causing ventilator-associated lung injury Complications of mechanical ventilation and safeguards (VALI). ![]() This effect may be important in limiting the lung injury that may result from prolonged exposure to a high FIO2 (≥ 0.6). PEEP permits use of lower levels of FIO2 while preserving adequate arterial oxygenation. read more and ARDS Acute Hypoxemic Respiratory Failure (AHRF, ARDS) Acute hypoxemic respiratory failure is defined as severe hypoxemia (PaO2 (See also Overview of Mechanical Ventilation.) Airspace filling in acute hypoxemic respiratory failure (AHRF) may result. Findings are severe dyspnea, diaphoresis, wheezing, and sometimes blood-tinged. Higher levels of PEEP improve oxygenation in disorders such as cardiogenic pulmonary edema Pulmonary Edema Pulmonary edema is acute, severe left ventricular failure with pulmonary venous hypertension and alveolar flooding. Most patients undergoing mechanical ventilation may benefit from the application of PEEP at 5 cm H2O to limit the atelectasis that frequently accompanies endotracheal intubation, sedation, paralysis, and/or supine positioning. PEEP increases end-expired lung volume and reduces airspace closure at the end of expiration. ![]() PEEP can be applied in any ventilator mode. IBW rather than actual body weight is used to determine the appropriate tidal volume for patients who have lung disease and who are receiving mechanical ventilation: Other patients (eg, those with trauma, obtundation, severe acidosis) may be started at slightly higher tidal volume (eg, 8 to 10 mL/kg). read more, 5 Ventilator settings references Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding. read more ), such as those who are on mechanical ventilation during surgery ( 4 Ventilator settings references Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding. read more, 3 Ventilator settings references Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding. ![]() read more, 2 Ventilator settings references Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding. read more (ARDS-see sidebar Initial Ventilator Management in ARDS Initial Ventilator Management in ARDS ) however, such low tidal volume is usually also appropriate in certain patients who have normal lung mechanics ( 1 Ventilator settings references Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding. A low tidal volume of 6 to 8 mL/kg ideal body weight (IBW) was initially recommended for patients with acute respiratory distress syndrome Acute Hypoxemic Respiratory Failure (AHRF, ARDS) Acute hypoxemic respiratory failure is defined as severe hypoxemia (PaO2 (See also Overview of Mechanical Ventilation.) Airspace filling in acute hypoxemic respiratory failure (AHRF) may result. read more along with inadequate expiratory time and autoPEEP too low a rate risks inadequate minute ventilation and respiratory acidosis Respiratory Acidosis Respiratory acidosis is primary increase in carbon dioxide partial pressure (Pco2) with or without compensatory increase in bicarbonate (HCO3 −) pH is usually low but may be near. Too high a rate risks hyperventilation and respiratory alkalosis Respiratory Alkalosis Respiratory alkalosis is a primary decrease in carbon dioxide partial pressure (Pco2) with or without compensatory decrease in bicarbonate (HCO3 −) pH may be high or near normal. Patients may have dyspnea or respiratory failure if atelectasis is extensive. Too high a volume risks overinflation too low a volume allows for atelectasis Atelectasis Atelectasis is collapse of lung tissue with loss of volume. Tidal volume and respiratory rate set the minute ventilation.
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