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7 - Sorasak Respiratory Care HFMD
7 - Sorasak Respiratory Care HFMD
. .
Continuousmonitorofhemodynamicstatusfor
cardiopulmonaryfailure
WhenANSdysregulation
HR,RR,BP,SpO2,ABG
arterialBP(arterialline)
CVP
echocardiography
Intubationwithmechanicalventilator
support
Airwaymanagement:mentalchange
Hyperventilation:encephalitis
Decreasedcardiacworkload:heartfailure
ApplyPEEP:pulmonaryedema
(ExpertReviewofAntiInfectiveTherapy2009;7:73542.)
CriticalmanagementinsevereEV71
IVIG :neutralizingAb,immunomodulatoryeffect
Midazolam,phenytoin:myoclonicjerk,seizure
Inotropes (milrinone,doputamine,dopamin,
p p
)
,
epinephrine):heartfailure,shock
ECMO :cardiopulmonaryfailure
: cardiopulmonary failure
(ExpertReviewofAntiInfectiveTherapy2009:7:73542.)
(Pediatr Int 2006;48:25056.)
CriticalmanagementinsevereEV71
Conclusion:
1) IVfluidadjustedaccordingtoCVPandBP
2) Earlysupportwithventilatorandlowdoseinotropic
E l
t ith
til t
dl d
i t i
drugs:Milrinone,dobutamine
g
,
3) Hemodynamicfunctionmonitoredby
Echocardiography,CPVandarterialline
4) Cardiopulmonaryfunctionreturnedtonearnormal
in 3 5 days
in35days.
(Pediatr Int 2006;48:25056.)
ALI/ARDS
Ventilatorstrategiesfor
VentilatorstrategiesforARF
ARF
Acute
Acutehypoxemicrespiratoryfailure:hypoxiafrom
hypoxemic respiratory failure : hypoxia from
intrapulmonaryshunt(consolidation,atelectasis),
refractory hypoxemia small lung volume
refractoryhypoxemia,smalllungvolume
Ventilatorstrategy:decreaseshuntandoxygen
toxicity
,
yg
InitialPEEP8cmH2O,titratePEEPforthebestoxygen
saturationandkeepplateaupressure<30cmH2O
Figure9
Figure
9:
:(Top
(Topdown)flow
down)flowtime,pressure
time,pressuretimeandvolume
timeandvolumetimeinconstantflow(VCV)
whencomparedwithexponentialdeceleratingflow(PCV,PRVC)
h
d ith
ti l d l ti fl (PCV PRVC)
PIPindeceleratingflow<PIPinconstantflowwiththesameTV
Optimum
OptimumPEEP:2cmH
PEEP : 2 cmH2O>lowerinflectionpointof
O >lower inflection point of
inflationpressurevolumecurve(openlungapproach)
Fi
Figure:
P
Pressure-volume
l
curve show
h
lower
l
and
d
upper inflection points (LIP and UIP)
LIP: opening pressure,
pressure PEEP >LIP
UIP: overdistension,
TV <UIP
PIP
(cmH2O)
TV
(mL)
Heart rate
(min)
BP
(mmHg)
SpO2
(%)
20
35
200
100
90/60
96
18
33
220
100
90/60
96
16
31
220
95
90/60
97
14
29
230
95
90/60
98
12
27
230
90
90/60
98
10
25
190
85
90/60
95
23
190
90
90/60
90
21
180
87
90/60
88
19
170
89
90/60
90