MECHANICAL VENTILATION:
Maximizing Benefit and Minimizing Risk!

Up Objectives Schedule Faculty


    OBJECTIVES

Discuss the roles of time, oxygen, and pressure in alveolar recruitment and V/Q matching.

 

Explain the major differences in volume control ventilation and pressure control ventilation.

 

Define and discuss the major modes of ventilation, from the bedside clinician’s perspective.

 

Identify the pressure waveforms consistent with volume control and pressure control, and explain the clinical relevance of this difference.

 

Define PCV+ assist ventilation, emphasizing the feature which allows spontaneous breathing during mandatory ventilator breaths. 

 

Explain the concept of AutoflowTM in mechanical ventilation, including the clinical benefits.

 

List the benefits of maintained spontaneous breathing during mechanical ventilation.

 

Discuss how acute lung injury and the associated hypoxemia, hypercapnia, and mechanical ventilation worsen renal hemodynamics and function.

 

Describe the interaction between the lungs and kidneys brought about by immune and inflammatory mediators during shock, trauma, and sepsis.

 

Discuss therapeutic options for pathologic lung/kidney interaction, including fluid optimization and lung protective ventilation.

 

Recognize diaphragmatic dysfunction as a primary cause of failure to wean from the ventilator.

 

Identify mechanical ventilation as a cause of muscle fiber injury and atrophy within the diaphragm.

 

Explain the importance of mechanical ventilation strategies that allow persistent diaphragmatic activation during mechanical ventilation.

 

Discuss recent research findings regarding the use of recruitment maneuvers and higher levels of PEEP in treating hypoxemia in the most severe cases of ARDS.

 

Explain why the decrease in cardiac output that typically occurs during a recruitment maneuver invalidates the PaO2 as a measure of lung recruitment.

 

Discuss the use of spontaneous awakening trials followed by spontaneous breathing trials to improve patient outcomes related to ventilator weaning.

 

List criteria to be used in identification of patients who should not undergo a spontaneous awakening trial for safety reasons.

 

Discuss recent research findings related to weaning protocols which decrease post-traumatic stress disorder and improve 1-year survival rates.

 

Discuss the impact of mechanical ventilation on hepato-splanchnic perfusion, abdominal organ function, and clinical outcome outcomes in critical illness.

 

Discuss how routine nursing procedures and certain ventilator settings can cause repeated episodes of ischemia to the abdominal organs in the patient with limited cardiovascular reserves.

 

Explain why modes which allow spontaneous breathing during mechanical ventilation can decrease the incidence of gut mucosal damage, mesenteric ischemia, and bacteremia in critically ill patients.

 

Explore the value of brain tissue oxygen monitoring and cerebral blood flow monitoring when implementing a lung protective strategy in the acutely brain-injured patient.

 

Identify the target values for PaCO2 in the patient with traumatic brain injury and developing acute lung injury.


Discuss the pathological effects of hypoxemia in the brain-injured patient, including decreased cerebral oxygen delivery, cerebral vasodilatation, increased ICP, and decreased CPP.

 

Discuss the clinical guidelines for using PEEP during ventilation of the acutely brain-injured patient.