208 Designing Ventilation Strategies

Question 1

pulmonary effects of mechanical ventilation

Answer 1

1. barotrauma- Injury to tissues, organs, or structures within the body, resulting from rapid or significant changes in environ­ mental air pressure. Exp. PTX, SC emphysema, pneumomediastinum
2. VALI- acute lung injury due to MV, clinically indistinguishable from ALI or ARDS
3. Aspiration and VAP
4. ETT complications
5. Respiratory muscle weakness
6. Reduced mucociliary motility

Question 2

cardiovascular effects of mechanical ventilation

Answer 2

1. Hypotension
2. Falsely elevated hemodynamic measurements (PAOP and CVP)
3. VTE

Question 3

GI/GU effects of mechanical ventilation

Answer 3

1. stress ulcer/GI bleed- PPV >48hrs
2. Hypomotility
3. erosive esophagitis
4. diarrhea
5. acalculous cholecysitits
6. AKI

Question 4

Neuro effects of mechanical ventilation

Answer 4

1. peripheral neuromuscular weakness (prolonged immobilization and use of anesthesia, critical illness)
2. Increased ICP- PPV increases intrathoracic pressure and obstructs cerebral venous outflow
3. disordered sleep
4. Delirium and memory or cognitive impairment

Question 5

what is volutrauma

Answer 5

alveolar overdistenstion/increased transpulmonary pressure causing lung injury. Caused by high Vt>high airway pressure

Question 6

what is atelectrauma

Answer 6

cyclic alveolar expasion and collapse creating shear forces that distend and cause injury to adjacent alveoli and airways