Mechanical ventilator

Mechanical ventilator

1. Mechanical ventilationMechanical ventilation

2. MECHANICAL MECHANICAL
VENTILATIONVENTILATION
‘ ‘When you cannot breathe, nothing else When you cannot breathe, nothing else
matters.’matters.’
Its not a Magic, but simple Logic.. Its not a Magic, but simple Logic..

3. The BASICS!!The BASICS!!
AnatomyAnatomy
•Upper Respiratory TractUpper Respiratory Tract
–Humidifies inhaled gasesHumidifies inhaled gases
–Site of most resistance to airflowSite of most resistance to airflow
•Lower Respiratory TractLower Respiratory Tract
–Conducting zone/airways (Anatomic dead Conducting zone/airways (Anatomic dead
space)space)
–Respiratory zone/ bronchioles and alveoli Respiratory zone/ bronchioles and alveoli
(Gas exchange)(Gas exchange)

4. The BASICS!! (Cont’d)The BASICS!! (Cont’d)
PhysiologyPhysiology
Negative pressure circuitNegative pressure circuit
–Gradient between mouth and pleural Gradient between mouth and pleural
space is the driving pressurespace is the driving pressure
–need to overcome resistanceneed to overcome resistance
–maintain alveolus openmaintain alveolus open

5. The BASICS!! (Cont’d)The BASICS!! (Cont’d)
•Ventilation?Ventilation?
•Respiration?Respiration?
•External Respiration?External Respiration?
•Internal Respiration?Internal Respiration?
O2CO2

6. DefinitionDefinition
Mechanical ventilator is an Mechanical ventilator is an
apparatus which can replace apparatus which can replace
normal mechanism of breathing normal mechanism of breathing
either by providing intermittent either by providing intermittent
or continuous flow of oxygen or or continuous flow of oxygen or
air under pressure, which is air under pressure, which is
connected to the patient by a connected to the patient by a
tube inserted through mouth, tube inserted through mouth,
the nose or an opening in the the nose or an opening in the
trachea.trachea.

7. Mechanical VentilationMechanical Ventilation
1.1.Indications for Intubation and VentilationIndications for Intubation and Ventilation
2.2.Principles of Mechanical VentilationPrinciples of Mechanical Ventilation
3.3.Modes & Patterns of VentilationModes & Patterns of Ventilation
4.4.Ventilator Dependence: Complications Ventilator Dependence: Complications
5.5.Liberation from Mechanical Ventilation: WeaningLiberation from Mechanical Ventilation: Weaning
6.6.TroubleshootingTroubleshooting
7.7.Arterial Blood GasesArterial Blood Gases

8. Indications for Mechanical Indications for Mechanical
VentilationVentilation
“….An opening must be attempted in the “….An opening must be attempted in the
trunk of the trachea, into which a tube or trunk of the trachea, into which a tube or
cane should be put; You will then blow into cane should be put; You will then blow into
this so that lung may rise again….And the this so that lung may rise again….And the
heart becomes strong….”heart becomes strong….”
Andreas Vesalius (1555)Andreas Vesalius (1555)

9. INDICATIONSINDICATIONS
•Primary IndicationsPrimary Indications
•Prophylactic IndicationsProphylactic Indications
•Therapeutic IndicationsTherapeutic Indications

10. Primary IndicationsPrimary Indications
•Acute Respiratory Failure (66%)Acute Respiratory Failure (66%)
–Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome
–Heart Failure (through pulmonary edema/hypertension)Heart Failure (through pulmonary edema/hypertension)
–PneumoniaPneumonia
–SepsisSepsis
–Complications of SurgeryComplications of Surgery
–TraumaTrauma
•Coma (15%)Coma (15%)
•A/c Exacerbation of COPD(13%)A/c Exacerbation of COPD(13%)
•Neuromuscular Disease (5%)Neuromuscular Disease (5%)

11. Prophylactic IndicationsProphylactic Indications
•ShockShock
•PostoperativelyPostoperatively
»Extreme obesityExtreme obesity
»Possibility of sepsisPossibility of sepsis
»COPD with upper abdominal COPD with upper abdominal
surgerysurgery
»Cardiovascular and neurological Cardiovascular and neurological
surgeries surgeries
•Acid aspiration syndromeAcid aspiration syndrome

12. Therapeutic IndicationsTherapeutic Indications
•Resuscitation from cardio respiratory Resuscitation from cardio respiratory
arrestarrest
•Hypoventilation /ApneaHypoventilation /Apnea
•Drug over dosageDrug over dosage
•Neurological dysfunctionNeurological dysfunction
•Trauma to chest and lacerated Trauma to chest and lacerated
diaphragmdiaphragm

13. Objectives of Mechanical Objectives of Mechanical
VentilationVentilation
•Improves pulmonary gas exchangeImproves pulmonary gas exchange
•Relieves respiratory distressRelieves respiratory distress
•Alter pressure-volume relationsAlter pressure-volume relations
•Permit lung and airway healingPermit lung and airway healing
•Avoid complicationsAvoid complications

14. TerminologiesTerminologies
•Respiratory RateRespiratory Rate
•Tidal VolumeTidal Volume
•Minute Ventilation (MV=RR x TV)Minute Ventilation (MV=RR x TV)
•FiO2FiO2
•Peak PressurePeak Pressure

15. Main Determinants!!Main Determinants!!
•Oxygen inOxygen in
L­­ FFIIOO22
L­­ mean alveolar mean alveolar
pressurepressure
–PEEPPEEP
•Re-open alveoli Re-open alveoli
and and ¯¯ shunt shunt
•Carbon dioxide Carbon dioxide
outout
L­­ ventilationventilation
"­­ RRRR
"­­ tidal volumetidal volume

16. Modes of VentilatorModes of Ventilator
•Controlled modeControlled mode
RR and TV by VentilatorRR and TV by Ventilator
•Assist Control Mode (Mixed Mode)Assist Control Mode (Mixed Mode)
Both got their RoleBoth got their Role
•Spontaneous modeSpontaneous mode
RR and TV by PatientRR and TV by Patient

17. CONTROLLED MODE VENTILATIONCONTROLLED MODE VENTILATION
•Pressure Controlled VentilationPressure Controlled Ventilation
•Volume Controlled VentilationVolume Controlled Ventilation
•Time Controlled VentilationTime Controlled Ventilation

18. Pressure Controlled VentilationPressure Controlled Ventilation
•Pressure cycled breathing, fully ventilator Pressure cycled breathing, fully ventilator
controlledcontrolled
•Suited for patients with neuromuscular Suited for patients with neuromuscular
diseasesdiseases
•Inspiratory phase stops when preset Inspiratory phase stops when preset
inspiratory pressure is reachedinspiratory pressure is reached

19. Volume Controlled VentilationVolume Controlled Ventilation
•Volume targeted VentilationVolume targeted Ventilation
•Inspiratory Cycle ends when TV is Inspiratory Cycle ends when TV is
delivereddelivered
•Ventilator generates sufficient pressure to Ventilator generates sufficient pressure to
deliver set volumedeliver set volume

20. Time Controlled VentilationTime Controlled Ventilation
•Normal I:E ratio -> 1:2Normal I:E ratio -> 1:2
•Prolonged Expiratory phase according to Prolonged Expiratory phase according to
the underlying pathology i.e. up to 1:3 or the underlying pathology i.e. up to 1:3 or
1:41:4
Inverse Ratio VentilationInverse Ratio Ventilation
•Helps prevent alveolar collapseHelps prevent alveolar collapse
•Hyperinflation, Auto-PEEP and decreased Hyperinflation, Auto-PEEP and decreased
cardiac outputcardiac output
•Use: ARDS with refractory hypoxemia or Use: ARDS with refractory hypoxemia or
hypercapniahypercapnia

21. ASSIST CONTROL MODE / MIXED ASSIST CONTROL MODE / MIXED
MODEMODE
•Intermittent Mandatory Ventilation (IMV)Intermittent Mandatory Ventilation (IMV)
-- Mandatory Breaths-- Mandatory Breaths
•Synchronized Intermittent Mandatory Synchronized Intermittent Mandatory
Ventilation (SIMV)Ventilation (SIMV)
-- Synchronized Breaths-- Synchronized Breaths
•SIMV + Pressure SupportSIMV + Pressure Support
-- Pressure Support too along with-- Pressure Support too along with

22. SPONTANEOUS MODESPONTANEOUS MODE
•Pressure Support Ventilation (PSV)Pressure Support Ventilation (PSV)
-- Spontaneous inspiratory efforts trigger the -- Spontaneous inspiratory efforts trigger the
ventilator to provide a variable flow of gas in order ventilator to provide a variable flow of gas in order
to attain a preset airway pressure. to attain a preset airway pressure. Machine assist Machine assist
and augment the spontaneous breathing efforts of and augment the spontaneous breathing efforts of
patientpatient
•Continuous Positive Airway Pressure (CPAP)Continuous Positive Airway Pressure (CPAP)
No machine breaths delivered No machine breaths delivered
Allows spontaneous breathing at elevated baseline Allows spontaneous breathing at elevated baseline
pressurepressure
Patient controls rate and tidal volumePatient controls rate and tidal volume

23. CMVCMV

24. ACV/SIMVACV/SIMV

25. PSVPSV

27. Setting a VentilatorSetting a Ventilator
Settings vary with Age, Weight Settings vary with Age, Weight
and underlying Pathology of the and underlying Pathology of the
patientpatient

28. The required Ventilator settings The required Ventilator settings
are :-are :-
•Tidal volumeTidal volume
•FiOFiO
22
•Respiratory RateRespiratory Rate
•Minute VolumeMinute Volume
•I:E RatioI:E Ratio
•Pause timePause time
•PEEP, ZEEP & NEEPPEEP, ZEEP & NEEP
•Trigger sensitivityTrigger sensitivity

29. Tidal Volume (VTidal Volume (V
TT))
Tidal volume Tidal volume
8-10ml/Kg8-10ml/Kg
Small tidal volume inSmall tidal volume in
ARDSARDS
BronchospasmBronchospasm
Large tidal volume causesLarge tidal volume causes
Increased airway pressureIncreased airway pressure
BarotraumasBarotraumas

30. FiOFiO
22
FiOFiO
22 (Oxygen concentration) (Oxygen concentration)
Expresses as percentage or decimalsExpresses as percentage or decimals
Settings from 21% to 100% (0.21 to 1.0)Settings from 21% to 100% (0.21 to 1.0)
FiOFiO
22 of 0.5 or less –minimize oxygen of 0.5 or less –minimize oxygen
toxicitytoxicity
Target PaO2 isTarget PaO2 is
60mm of Hg or 60mm of Hg or
SpO2 90% in ABG , SpO2 90% in ABG ,
SpO2 95% in pulse oximeter SpO2 95% in pulse oximeter
With minimum possible FiOWith minimum possible FiO
22

31. Respiratory Rate (RR)Respiratory Rate (RR)
Respiratory Rate (RR) or FrequencyRespiratory Rate (RR) or Frequency
> Set rate depends on age of patient> Set rate depends on age of patient
Newborn - 30-40/mtNewborn - 30-40/mt
Children - 20-30/mtChildren - 20-30/mt
Adult - 10-15/mtAdult - 10-15/mt
Reduce rate in patients with COPDReduce rate in patients with COPD

32. Minute Volume [MV]Minute Volume [MV]
Minute volume = Tidal volume X R.R.Minute volume = Tidal volume X R.R.

33. I:E RatioI:E Ratio
Inspiratory time and I:E ratioInspiratory time and I:E ratio
•Determines duration of inspiration Determines duration of inspiration
and oxygenation and oxygenation
Newborn Newborn 0.3-0.5 sec0.3-0.5 sec
Infant and childrenInfant and children 0.5-0.8 sec0.5-0.8 sec
AdultAdult up to 1.5 up to 1.5
secsec

34. I:E Ratio (Cont’d)I:E Ratio (Cont’d)
Normal I:E - 1:2 (is physiological)Normal I:E - 1:2 (is physiological)
COPDCOPD - 1:3 to 1:4 - 1:3 to 1:4
1:1 or 2:1 or more is called 1:1 or 2:1 or more is called
Inverse Ratio VentilationInverse Ratio Ventilation

Used in ARDS and in Used in ARDS and in
Refractory HypoxemiaRefractory Hypoxemia

35. Trigger sensitivityTrigger sensitivity
•How does the Ventilator know when to give a How does the Ventilator know when to give a
breath??? breath??? “Trigger”“Trigger”
–Patient effortPatient effort
•The patient’s effort can be “sensed” as a The patient’s effort can be “sensed” as a
change in pressure or a change in flow (in the change in pressure or a change in flow (in the
circuit)circuit)
Helps to the initiation of breath by patientHelps to the initiation of breath by patient
- Ventilator sense the pressure drop in the - Ventilator sense the pressure drop in the
systemsystem
- Set between -2 to -20 cm of H- Set between -2 to -20 cm of H
22OO
- Start from -2, incrementally increase- Start from -2, incrementally increase

36. Flow rateFlow rate
Flow rateFlow rate
Speed with which the Tidal Volume is Speed with which the Tidal Volume is
delivereddelivered
An important determinant of patient An important determinant of patient
comfortcomfort
Normal rateNormal rate - 40-60 L/ Mt - 40-60 L/ Mt
- 4X Minute Ventilation- 4X Minute Ventilation

37. End Expiratory PressuresEnd Expiratory Pressures
•PEEP (Positive End Expiratory PEEP (Positive End Expiratory
Pressure) Pressure)
•ZEEP (Zero End Expiratory Pressure)ZEEP (Zero End Expiratory Pressure)
•NEEP (Negative End Expiratory NEEP (Negative End Expiratory
Pressure) Pressure)

38. Initial Ventilatory setting Initial Ventilatory setting
for an adultfor an adult
ModeMode PCV/ VCV PCV/ VCV
FiO2FiO2 0.7-1 decrease to 0.5 or 0.7-1 decrease to 0.5 or
less less
Tidal Volume (VT) 10ml/KgTidal Volume (VT) 10ml/Kg
RRRR 10-15 breaths/mt 10-15 breaths/mt
TriggerTrigger -2 cm of H2O -2 cm of H2O
Flow rateFlow rate 40-60 L/mt 40-60 L/mt
I:E I:E 1:2 to 1:3 1:2 to 1:3
PEEPPEEP 5 cm of H2O 5 cm of H2O
Analyze Arterial Blood Gas 20 minutes later Analyze Arterial Blood Gas 20 minutes later
and adjustand adjust

39. General rules of General rules of
Ventilator ManipulationVentilator Manipulation
To improve oxygenationTo improve oxygenation
Apply PEEPApply PEEP
Increase Insp. TimeIncrease Insp. Time
Increase FiOIncrease FiO
22
To improve COTo improve CO
22 removal removal
Increase RateIncrease Rate
Increase Tidal VolumeIncrease Tidal Volume

40. Care during Mechanical Care during Mechanical
VentilationVentilation
- Sedation and muscle paralysis- Sedation and muscle paralysis
- Humidification- Humidification
- Chest physiotherapy- Chest physiotherapy
- Suctioning Event- Suctioning Event
- Nutritional support- Nutritional support
- Other general care- Other general care
- Prevention of infection- Prevention of infection

41. Sedation and Muscle Sedation and Muscle
paralysisparalysis
Sedation and Muscle paralysisSedation and Muscle paralysis
•To relieveTo relieve
AwarenessAwareness
AnxietyAnxiety
Pain and Pain and
Patient discomfortPatient discomfort
•Drugs for Analgesia, Sedation, and Muscle Drugs for Analgesia, Sedation, and Muscle
relaxationrelaxation

42. HumidificationHumidification
HumidificationHumidification
Process of addition of moisture and heat to Process of addition of moisture and heat to
inspiratory gasesinspiratory gases
Methods of humidificationMethods of humidification
Heated humidifiersHeated humidifiers
Nebulizers Nebulizers
Heat and Moist Exchangers (HME’s)Heat and Moist Exchangers (HME’s)
In normal breathing humans, In normal breathing humans,
Temperature of upper trachea 30-33Temperature of upper trachea 30-33
oo
CC

43. Chest PhysiotherapyChest Physiotherapy
Chest PhysiotherapyChest Physiotherapy
Used to mobilize the secretionUsed to mobilize the secretion
Techniques Includes Techniques Includes
Postural drainagePostural drainage
PercussionPercussion
Rib SpringingRib Springing
Vibration etc.Vibration etc.

44. Suctioning EventSuctioning Event
Clearing of secretion (Suctioning)Clearing of secretion (Suctioning)
- Most common procedure done in ICU- Most common procedure done in ICU
- Should be done when needed, not on time - Should be done when needed, not on time
basisbasis
Suction cathetersSuction catheters
Should be made of clear materialsShould be made of clear materials
Size not greater than half the diameter of ETTSize not greater than half the diameter of ETT
Should be longer than ETTShould be longer than ETT

45. Suctioning Event (Cont’d)Suctioning Event (Cont’d)
Suction techniquesSuction techniques
•Open Open
Disconnecting the patient from the Disconnecting the patient from the
ventilatorsventilators
• Closed Closed
Allow the catheter to suck without Allow the catheter to suck without
disconnecting from ventilatorsdisconnecting from ventilators

46. Suctioning Event (Cont’d)Suctioning Event (Cont’d)
ComplicationsComplications
•Cardiac arrhythmias Cardiac arrhythmias
•Vagal stimulationVagal stimulation
•Cardiac arrestCardiac arrest
•Mucosal trauma Mucosal trauma
•AtelectasisAtelectasis
•Hypoxemia Hypoxemia
•Infection Infection
•Raised Intracranial tensionRaised Intracranial tension

47. Nutritional supportNutritional support
•Nutritional support is very important in Nutritional support is very important in
ventilator patientsventilator patients
•Acute loss of 30-40% Body weight is lethalAcute loss of 30-40% Body weight is lethal
•Poor nutrition leads to ventilator muscle Poor nutrition leads to ventilator muscle
weakness and delay Weaningweakness and delay Weaning

48. Other General Care – Other General Care –
Mobilization of PatientMobilization of Patient
•Seven days bed rest leads to loss of Seven days bed rest leads to loss of
muscle bulk up to 30%muscle bulk up to 30%
•Patient may require active, assisted Patient may require active, assisted
or passive movementor passive movement
•The joints should be maintained and The joints should be maintained and
protected in neutral positionprotected in neutral position

49. Other General Care – Other General Care –
Pressure soresPressure sores
- Dependent areas of immobile patient- Dependent areas of immobile patient
- Tissues over the bony prominence- Tissues over the bony prominence
- Trauma, Diabetics Burn patients – High Risk- Trauma, Diabetics Burn patients – High Risk
Preventive measuresPreventive measures
•Regular turning and repositioning every 2-4 Regular turning and repositioning every 2-4
hourshours
•Special mattress and beds should be used to Special mattress and beds should be used to
relieve pressure over susceptible areasrelieve pressure over susceptible areas
•Regular inspection of skin integrityRegular inspection of skin integrity
•Early nutritional supportEarly nutritional support

50. Other general care –Other general care –
Eyes and mouth careEyes and mouth care
- Commonest problems are Dry eyes and - Commonest problems are Dry eyes and
Exposure keratopathyExposure keratopathy
- Protective mechanisms are lost- Protective mechanisms are lost
- Decreased tear production- Decreased tear production
- Decreased resistance to infection- Decreased resistance to infection
PreventionPrevention
Artificial eye drops, hydrogel padsArtificial eye drops, hydrogel pads

51. Other general care - Other general care -
Oral hygieneOral hygiene
Oral Ulcers and Infection are commonOral Ulcers and Infection are common
Decreased Oral fluid intakeDecreased Oral fluid intake
Mucosal DehydrationMucosal Dehydration
Decreased saliva productionDecreased saliva production
Presence of Orotracheal tubePresence of Orotracheal tube

52. Prevention of InfectionPrevention of Infection
ICU patients are 4 times more prone to ICU patients are 4 times more prone to
develop to nosocomial infectionsdevelop to nosocomial infections
Common sites Common sites
LungLung
Catheter sitesCatheter sites
Urinary tractsUrinary tracts
WoundWound

53. Prevention of InfectionPrevention of Infection
(Cont’d)(Cont’d)
•As many as 40% of infections are As many as 40% of infections are
transmitted by the hands of Hospital stafftransmitted by the hands of Hospital staff
•Most important preventive measure against Most important preventive measure against
the spread of infection is Hand Washingthe spread of infection is Hand Washing
Infections can be decreased byInfections can be decreased by
Using Antibiotics, Isolation techniquesUsing Antibiotics, Isolation techniques
Use of Disposable components-Use of Disposable components-
ETT, Catheters, Ventilator tubing and ETT, Catheters, Ventilator tubing and
fittingsfittings

54. ALARMSALARMS
•Look from whereLook from where
•Do not switch alarm off until cause Do not switch alarm off until cause
of alarm trigger is identified and of alarm trigger is identified and
correctedcorrected

55. Discontinuing Mechanical Discontinuing Mechanical
VentilationVentilation
•DeathDeath
•WeaningWeaning
–Up to 25% of patients have Respiratory Up to 25% of patients have Respiratory
distress severe enough to require distress severe enough to require
reinstitution of ventilator.reinstitution of ventilator.
•ExtubationExtubation
–10 - 20 % of Extubated patients who 10 - 20 % of Extubated patients who
were successfully weaned require were successfully weaned require
reintubation.reintubation.

56. THE WEAN (Liberation from THE WEAN (Liberation from
MV)MV)
Weaning is the gradual withdrawal fromWeaning is the gradual withdrawal from
Mechanical Ventilation.Mechanical Ventilation.
•Hemodynamically stableHemodynamically stable
•Correction of underlying lung diseaseCorrection of underlying lung disease
•Correction of acid-base/electrolyte disordersCorrection of acid-base/electrolyte disorders
•Adequate nutritionAdequate nutrition
•Mentally alertMentally alert
•Avoidance of sedationAvoidance of sedation

57. THE WEAN (Cont’d)THE WEAN (Cont’d)
Techniques to Wean!! Techniques to Wean!!
•SIMV WeanSIMV Wean
•PS WeanPS Wean
•T- Piece TrialT- Piece Trial

58. TroubleshootingTroubleshooting
Is it working or not?Is it working or not?
–Look at the patient !!Look at the patient !!
–Listen to the patient !!Listen to the patient !!
–SaOSaO
22, ABG, EtCO, ABG, EtCO
22
–Chest X rayChest X ray
–Look at the Ventilator (PIP; Expired TV; Look at the Ventilator (PIP; Expired TV;
Alarms)Alarms)

59. TroubleshootingTroubleshooting (Cont’d) (Cont’d)
•When in doubt, DISCONNECT THE PATIENT When in doubt, DISCONNECT THE PATIENT
FROM THE VENTILATOR, and begin AMBU FROM THE VENTILATOR, and begin AMBU
Bag Ventilation.Bag Ventilation.
•Ensure you are bagging with 100% O2.Ensure you are bagging with 100% O2.
•This eliminates the Ventilator circuit as the This eliminates the Ventilator circuit as the
source of the problem.source of the problem.
•Bagging by hand can also help you gauge Bagging by hand can also help you gauge
patient’s compliancepatient’s compliance

60. TroubleshootingTroubleshooting (Cont’d) (Cont’d)
•Airway firstAirway first!!!!!!
•Breathing nextBreathing next !!!!

•Circulation!Circulation!

61. COMPLICATIONSCOMPLICATIONS
•Ventilator Induced Lung InjuryVentilator Induced Lung Injury
–Oxygen toxicityOxygen toxicity
–Barotraumas / VolutraumasBarotraumas / Volutraumas
•Peak PressurePeak Pressure
•Plateau PressurePlateau Pressure
•Shear Injury (Tidal Volume)Shear Injury (Tidal Volume)
•PEEPPEEP

62. COMPLICATIONSCOMPLICATIONS (Cont’d) (Cont’d)
•Cardiovascular ComplicationsCardiovascular Complications
–Impaired venous return to RAImpaired venous return to RA
–Bowing of the Interventricular SeptumBowing of the Interventricular Septum
–Decreased left sided afterload (good)Decreased left sided afterload (good)
–Altered right sided afterloadAltered right sided afterload
•Sum Effect…..Sum Effect….. Decreased Cardiac Output Decreased Cardiac Output
(usually, not always and often we don’t (usually, not always and often we don’t
even notice)even notice)

63. COMPLICATIONSCOMPLICATIONS (Cont’d) (Cont’d)
•Other ComplicationsOther Complications
–Ventilator Associated Pneumonia Ventilator Associated Pneumonia
(VAP)(VAP)
–SinusitisSinusitis
–SedationSedation
–Risks from associated devices Risks from associated devices
(Central Lines, Arterial Lines)(Central Lines, Arterial Lines)
–Unplanned ExtubationUnplanned Extubation

64. Related TerminologiesRelated Terminologies
•Auto PEEPAuto PEEP
•Alveolar RecruitmentAlveolar Recruitment
•Prone VentilationProne Ventilation

65. Please Do Please Do
Remember!!Remember!!
WHEN IN ANY DOUBT ABOUTWHEN IN ANY DOUBT ABOUT
THE ADEQUACY OF THE ADEQUACY OF
MECHANICAL VENTILATION...MECHANICAL VENTILATION...
MANUALLY VENTILATE THE MANUALLY VENTILATE THE
PATIENT WITH AN AMBU BAG,PATIENT WITH AN AMBU BAG,
WITH THE AVAILABLE WITH THE AVAILABLE
MAXIMUM OMAXIMUM O
22

66. ??
??
??
DOUBTSDOUBTS ????