John J. MariniJohn J. MariniAlain F. BroccardAlain F. Broccard
University of MinnesotaUniversity of MinnesotaRegions HospitalRegions HospitalMinneapolis / St. PaulMinneapolis / St. PaulUSAUSA
Advanced MechanicalAdvanced MechanicalVentilationVentilation
Advanced Mechanical Ventilation OutlineAdvanced Mechanical Ventilation Outline
Consequences of Elevated Alveolar PressureImplications of Heterogeneous Lung Unit InflationAdjuncts to Ventilation
•Prone Positioning•Recruitment Maneuvers
Difficult Management Problems
•Acute Lung Injury•Severe Airflow Obstruction•An Approach to Withdrawing Ventilator Support
Advanced Modes for Implementing VentilationCase Scenarios
Consequences of Elevated Alveolar Pressure--1Consequences of Elevated Alveolar Pressure--1
Mechanical ventilation expands the lungs and chest wall by pressurizing theairway during inflation. The stretched lungs and chest wall develop recoiltension that drives expiration.Positive pressure developed in the pleural space may have adverse effects onvenous return, cardiac output and dead space creation.Stretching the lung refreshes the alveolar gas, but excessive stretch subjectsthe tissue to tensile stresses which may exceed the structural tolerance limitsof this delicate membrane.Disrupted alveolar membranes allow gas to seep into the interstitialcompartment, where it collects, and migrates toward regions with lower tissuepressures.Interstitial, mediastinal, and subcutaneous emphysema are frequently theconsequences. Less commonly, pneumoperitoneum, pneumothorax, andtension cysts may form.Rarely, a communication between the high pressure gas pocket and thepulmonary veins generates systemic gas emboli.
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Advanced Mechanical Ventilation - FINAL
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ANOTHER Great Study Tool! YEA!