CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E193 - Mechanical Ventilation and Noninvasive Ventilatory Support
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Sep 3, 2018 Dive into the essentials of mechanical ventilation! Explore the intricacies of ventilator settings tailored for emergencies and the significance of effective patient care. Learn about non-invasive support like BiPAP and CPAP while navigating the complexities of intubation. Uncover strategies to ensure comfort in intubated patients and the role of the Richmond Agitation Sedation Scale. Also discussed are the benefits of high-flow nasal cannula in treating hypoxia and tactics to prevent ventilator-acquired pneumonia. A must-listen for healthcare enthusiasts!
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Starting Settings for NPPV
- Start inspiratory positive airway pressure at 10 cm H2O and expiratory at 5 cm H2O for NPPV.
- Adjust settings by 1-2 cm H2O based on patient tolerance and clinical response.
Using RAS for Sedation
- Use the Richmond Agitation Sedation Scale (RAS) to titrate sedation in ventilated patients.
- Target RAS scores between -2 and 0 to avoid over or under sedation.
Sedation and Analgesia Post-Intubation
- Manage post-intubation analgesia with opioids like fentanyl, preferring fentanyl if renal impairment exists.
- Use sedatives like lorazepam, midazolam, or propofol; reserve paralytics for poor ventilator synchrony.
