resp 120

• Parenchymal lung problems
• Airway disease
• Pleural abnormalities
• Chest wall abnormalities
• Nuromusculars disorders
• Central nervous system 

• Hypoxia with compensatory hyperventilation
• Parenchymal lung disease
• Medications (salicylate, xanthines, analeptics)
• Mechanical ventilation
• Central nervous system disorders
• Anxiety
• Metabolic problems

These patients are often struggling to lower their PaCO2 to acheive some degree of hyperventilation to compensate for the metabolic acidosis

• pH can not be higher than 7.1
• Oxygenation must be maintained
• May have to sedate patient
• Can give Bicarb to help bump pH up

-100 to -120 mm Hg

-80 to -100 mm Hg

-60 to -100 mm Hg

• Labored breathing
• Increased RR
• Bilateral breath sounds
• Seeining secretions in tube
• Feel chest
• Increased Raw PIP

• Decrease in dynamic lung compliance and functional residual capacity
• Pulmonary atelectasis: reduction of lung volume
• Hypoxia or hypoxemia
• Tracheal or bronchial mucosal trauma
• Cardiac or respiratory arrest
• Bronchoconstriction or bronchospasm
• Pulmonary hemorrhage or bleeding
• Elevated intracranial pressure
• Cardiac dsrhythmias
• Hypertension
• Hypotension

• Peep
• FiO2
• Increase Paw

• Is the average pressure above baseline during a total respiratory cycle
• As Paw increases, the PaO2 increases

• PIP
• PEEP
• I:E
• Respiratory rate
• Flow

It affects mean alveolar pressure and alveolar recruitment and therefore oxygenation

• Enhance tissue oxygenation
• Maintain a PaO2 greater than 60 mm Hg and SpO2 at least 90%
• Recruit alveoli and keep them open
• Restore FRC
• Keep FiO2 low as possible

On a ventilaror, invasive, set rate

Non invasive, spontaneously, one pressure

• Full face mask
• Nasal mask
• Nasal pillows

• Patient must be able to protect airway
• Patient must be able to support WOB
• Maintain normal PaCO2
• Have a PaO2/FiO2 ratio greater than 200 mm Hg

• Aspiration
• CO2 retention
• Increased WOB
• Skin necrosis
• Cerebral hemorrhage

• Nasal prongs
• Premies longer

Lose pressure through open mouth

• Gastric distension
• Pressure necrosis
• Swelling of nasal mucosa
• Abrasion of the posterior pharynx

• Used for vent weaning
• Cannot protect airway

• 3 to 5 cm H2O
• Help preserve a patients normal FRC ranges
• Few complications

• PEEP is 5 cm H2O or greater
• Used to treat refractory hypoxemia
• Greater than 15 cm H2O are only benifical to ARDs
• High levels have many side effects

• Vary with patients
• Most benefits with fewest side effects

• Bilateral infiltrates on chest radiograph
• Recurrent atelectasis with low FRC
• Reduced lung compliance
• PaO2 less than 60 mm Hg on FiO2 greater than .5
• PaO2/FiO2 ratio less than 200 for ARDs and less than 300 for ALI
• Refractory hypoxemia: PaO2 increases less than 10 mm Hg with FiO2 increase of .2

Big is bad

• Hypovolemia
• Large untreated pneumothorax
• Tension pneumothorax
• Incresed intercranial pressures (ICP)
• Emphysema (use low level of PEEP)
• Unliteral lung disease

• use a closed system
• PEEP valve on ambu bag

• Patient need a good PaO2 on less than 40%
• Patient needs to be hemodymanic stable
• Some improvement in lung condition

• Increased thoracic pressure
• Decreased Cardiac output due to decreased vessel filling due to increased vascular pressure

• Mean airway pressure
• Cardiac output

Too much peep can over stretch and pulmonary capillarily become smaller

• Mean airway pressure (Paw)
• Inspiratory flow
• I:E ratio
• Inspiratory pause
• PEEP
• SIMV

Decreases Paw but increases PIP and uneven distrubution of ventilation

Increased WOB and causes auto PEEP because not enough E time

Fewest PPV side effects with a short I time and a longer E time

Helps improve oxygenation and gas distrubition but increases I time and Paw

• Restore FRC
• Recruit alveoli
• Increase Paw too much sometimes

Decrease in volume decreases pressures and Paw

• Reduced risk of batotrauma
• reduced risk of cardiovascular effects

• Uneven distribution of gas
• Decreased PaO2
• Increased PaCO2

• Increased alveoli ventilation
• Recruitment of alveoli
• Better gas distrubition

• Decreased cardiac output
• Decreased O2 transport
• Increased risk of barotrauma

• Decreased BP and cerebral blood flow
• Resp alkalosis to decrease swelling
• CO2 25-35

• Decreased renal blood flow
• Decreased urine output

• PaO2 less than 40
• PaCO2 greater than 65
• Impaires renal function

• Decreased blood flow to GI
• Gastric mucosa ischemia, which can increase risk of bleeding and gastric ulcers

Causing a decrease in cardiac output and mean arterial blood pressure or by causing an increase in CVP, which can cause an increase in intracranial pressure

• Perfusion without ventilation
• Normal person has a 2 to 3% shunt
• Greater than 30% patient is at risk for death