Doctor insights on:
Patient Mechanical Ventilation
Indefinitely: Until a ventilator is available or the person is breathing on their own. ...Read more
Indefinitely: If you are able to continue bagging with reasonable volumes you could continue for an indefinite amount of time. ...Read more
Bagging: If performed properly, there is no time limit. ...Read more
What are the benefits of a sigh breath during mechanical ventilation (v-simv). What is the normal calculated sight breath for a vented patient?
Sigh breath: The purpose of the sigh breath is to increase gas gas exchange and improve lung compliance. There are several studies looking at the addition of a sigh breath. One sigh breath every 60 to 90 seconds is what I customarily order. ...Read more
When is it required to switch from endotrach tube to tracheostomy for an IPF patient who is on long term mechanical ventilation?
Trach and Vent mgt: It depends on the ICU and medical history and settings of the ventilator. One to two weeks on the ventilator is the usual time period before discussing tracheostomy. The tracheostomy has its own benefits and complications. Optimally, trying to wean off the vent and using BiPAP or CPAP may be considered. ...Read more
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Many possible: Not just peep-peak and mean pressures also must be considered. High pressure can indicate inappropriately high volumes, leading to volutrauma/ventilator associated lung injury. Increased intrathoracic pressures can impair heart function (decrease preload), impair kidney function (decrease renal blood flow), and contribute to higher intracranial & intra-abdominal pressures. ...Read more
Simply: Intubation is placement of a tube in the trachea (wind pipe), mechanical ventilation is the process by which a patient receives oxygen using artificial means (a ventilator). Almost always, intubation is followed by mechanical ventilation and mechanical ventilation is performed most times after intubation. ...Read more
Why consider a tracheostomy if anticipated prolonged ventilatory support >2 wks? Why not continue mechanical ventilation? How is nutrition addressed?
Comfort: Tracheostomy is more comfortable for patient and may allow better pulmonary clearing, and should be considered if prolonged vent necessary. Feeding may be via IV of via soft tube through nasal passage down into stomach or small bowel or can also place feeding tube percutaneously into stomach or small bowel through abdominal wall. Nutrition key to weaning off vent. ...Read more
Artificial respiratn: Simply put 'ventilating' or breathing for the patient 'mechanically'. These machines are getting more and more sophisticated and have a lot of settable and measurable data points. ...Read more
It happens: Pneumonia, heart failure, stroke, & serious injury are some of the more common reasons; it's important to consider the goals of care & realistic expectations. Patients/family/power of attorney should make it clear what level of support they feel is acceptable. It's ok to make comfort a priority & say "no" to the ventilator. It's also ok to say "yes". Best to discuss this before the crisis. ...Read more
Baclofen overdose: Although 80 mg per day is a commonly accepted maximum, dosing up to 200 mg per day has been used safely and effectively. Baclofen is a great drug, but is also extremely deadly. The highest dose of baclofen ever recorded, 2 grams in a suicide attempt, btw patient has recovered. For Baclofen intoxication supportive care including mechanical ventilation is required. See your PCP ASAP. ...Read more
Mechanical ventilation - if you're old and don't want to be on a machine, what papers do carry on you?
Advance Directive: Advance directives & living wills are legal documents for you to instruct healthcare providers about what life-support measures you do or don't want. Your regular doctor can help you fill one out, or you can also get the forms from any hospital admitting office (you don't have to be a patient at the hospital, just ask for the form). Also talk with friends/family so they know what you want. ...Read more
Do pts on long term mechanical ventilation (at a vent home) have to be sedated during ventilation hrs? If not, why sedated in hospital setting?
Depends on Pt., etc.: Sedation for the ventilated patient is dependent upon the patient (level of cognitive/ physical function and level of anxiety), the pt's comorbidities/active medical problems, and vent mode regardless of the setting. No two patients and their hospital courses are alike. Therefore, sedation and comfort plans should be pt.-specific with frequent assessment for appropriate modification if needed. ...Read more
Yes: Mechanical ventilation is dangerous for a large variety of reasons, but the alternative is not pretty. Long term mechanical ventilation is associated with a well defined risk for ventilator associated pneumonia and close adherence to established protocols has been shown to dramatically lower that risk. ...Read more
My father is in ICU under mechanical ventilation because of pneumonia and severe COPD. Anything we can do? IAnything I can suggest to his doctors?
Hopefully you trust: The doctors at the iCU taking care of your dad. I would just make sure he has good care and attentive nurses! And visit frequently. Tell him you love him and need him to get better! ...Read more
Is it possibe that ef improves from 42% to 52% within 4 days for a 58 yr female patient suffered from ami, ptca, ventilation and temporary pacing?
If the patient is on a ventilation machine, can the hospital pull the plug without the family/friends consent?
Depends: If the patient has given an "advanced directive" the hosptial and physicians are obligated to adhere to the patients wishes even if this is against the wishes of the family or friends. ...Read more
Can bipap ventilation be used at home to mantain a normal pco2 after hypercapneic bout in a COPD patient?
Remember: Usually once at the acute insult has been addressed in COPD patients - in this case, whatever cased the hypercapneic bout - noninvasive positive pressure ventilation continued at home isn't usually necessary. Home BiPap is often used in sleep apnea patients for whom CPAP isn't optimal or in someone with CO2 retention and sleep apnea or in people with neuromuscular disease who need help breathing. ...Read more
If a patients blood pressure drops after putting them on assist control ventilation, what would you do and why?
What is the PEEP?: This suggests intravascular volume depletion. Turn peep off if not needed for oxygenation. Also, check for intravascular volume depletion. ...Read more
Probably not: A patient who is still breathing implies a functional heart rhythm, which is the primary reason to do mechanical cpr. So if one is still breathing, then supportive care to ensure a good, open airway, and calling for help asap, should be the priorities. If the patient stops breathing and no pulse is detected, and no AED device is readily available, then CPR needs to be instituted. ...Read more
What does it mean if a patient can't start breathing again on their own after being under general anesthesia?
Many things: It could be too much pain medicine, other anesthetics, inadequate paralytic reversal, other physiolog abnormality (electrolytes off, hypothermia), or problem with the central nervous system. A review of medications given, clinical evaluation, and possible imaging should reveal the cause. ...Read more