CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E002 - Mechanical Ventilation
Jan 15, 2016
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Positive Pressure Lowers Preload And Risks Hypotension
- Positive-pressure mechanical ventilation raises intrathoracic pressure and reduces venous return.
- This decrease in preload can precipitate or worsen hypotension after intubation, so expect hemodynamic changes when switching from spontaneous to PPV.
When Not To Use NIPPV
- Avoid NIPPV for patients with depressed or absent consciousness, no respiratory drive, excessive secretions, active vomiting, hemodynamic instability, facial trauma, or agitation.
- These contraindications increase aspiration risk or make mask cooperation and effectiveness impossible.
Initial Vent Settings After Intubation
- For newly intubated, paralyzed ED patients set AC (assist-control) with Vt 6–8 mL/kg IBW and RR 12–14, FiO2 100% initially, and PEEP about 5 cm H2O.
- Aim peak/plateau pressures <30 cm H2O and rapidly wean FiO2 to target SpO2 >90%.