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Mechanical ventilation 1
Asthma pathophysiology
26 yo Samoan• SOB, no chest pain, subacute onset
• Known asthmatic, poorly compliant with inhalers
• Builder, works with concrete
• Family members with coryza symptoms recently
• Increasing SOB and wheeze last 48hours
• o/e sats 96% NRB, HR 120, BP 150/80, bilateral wheeze, diaphoretic, talking in words, working hard
Initial ABG
Initial CXR
CXR 30 min laterwith NIV
What do you think about the use of NIV in this situation?
Should he be intubated?
• Severity of respiratory failure • Cardiopulmonary reserve • Adequacy of compensation • Expected speed of response to treatment • Risk of complications associated with ventilation • Availability of staff with high level of airway skills,
the time of the day, how busy the ICU is etc
Patient is urgently transferred to ICU and intubated … Set the ventilator
Initial mechanical ventilation profile after intubation
Initial ABG 30min post
ETT insertion
Gas trapping and hyperinflation
What parameters would you check regularly and why?
Treatment of sick asthmatic
• Standard therapy: O2, salbutamol nebs, ipratropium nebs, steroid (? aminophylline), appropriate mechanical ventilation
• Refractory therapy: ketamine, magnesium, adrenaline, inhalational agents (sevo, isoflurane), heliox
Emergency alarm sounds Sudden desaturation & Increased pressures
Minimal AE bilaterally
Urgent CXR requested
72 hours down the track and bronchospasm has settled but persistent
air leak and bubbling via drain. What is the diagnosis?
What is your further management?
Bronchopulmonary fistula management
• Adequate sized ICC
• Ventilation measures
• Low TV, low PEEP, short inspiratory time, spontaneous breathing
• Independent lung ventilation
• HFOV
• ECMO
• Endobronchial occlusion
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