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Lecture Anwar Ventilation Managment COVID
Lecture Anwar Ventilation Managment COVID
Lecture Anwar Ventilation Managment COVID
The Type H pattern, 20–30% of patients in our series, fully fits the severe ARDS criteria:
hypoxemia, bilateral infiltrates, decreased the respiratory system compliance,
increased lung weight and potential for recruitment.
Type L Type H
Type L lung weight (1192 g), gas volume (2774 ml), percentage of non-aerated tissue (8.4%), venous admixture (56%),
P/F (68), and respiratory system compliance (80 ml/cmH2O).
Type H lung weight (1441 g), gas volume (1640 ml), percentage of non-aerated tissue (39%), venous admixture (49%),
P/F (61), and respiratory system compliance (43 ml/cmH2O).
Type L ( Type 1) patients:
PEEP levels should be kept lower in patients with high pulmonary
compliance.
Tidal volume thresholds should not be limited at 6 ml/kg.
Respiratory rate should not exceed 20 breaths/min.
Patients should be left “quiet”; avoiding doing too much is of higher
benefit than intervening at any cost.
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GAP: Escalation to invasive ventilation
G: Gas exchange abnormality:
COVID-19 respiratory failure is usually hypoxemic, not hypercarbic.
Worsening oxygenation: PaO2/FIO2 or SpO2/FiO2 <150.
NIV with FIO2 >0.6 and can’t maintain SpO2 >90%.
Oxygenation unresponsive to HFNC therapy.
Hypercapnia with acidosis, pH <7.3.
Increased work of breathing suggests deterioration of respiratory function.
A: Airway protection:
Altered mental status attributed to respiratory failure.
Neurological dysfunction.
P: Pulmonary toilet:
Increased airway secretions.
Indication of intubation:
Worsening hypercarbia.
Acidemia.
Altered mental status.
Fatigue.
Hemodynamic instability.
Indications of mechanical ventilation:
Respiratory exhaustion.
Refractory severe hypoxemia (PaO2
<50-60 mmHg) on maximal oxygen
therapy.
Progressive CO2 retention with
academia.
Failure of NIV.
Non-respiratory indications
especially refractory hemodynamic
compromise and Deep coma.
Intubation protocol
PaCO2 40-65 / end-tidal carbon dioxide (ETCO2) 35-60 mm Hg ARDSNet low PEEP/ FIO2 Chart
Pulmonary Mechanics
Plateau pressures of ≤30 cm H2O (reflects respiratory system compliance)
Peak inspiratory pressure <35 cm H2O
Modes of ventilation
Primary ventilator modes
Assist/control (A/C) mode: The ventilator delivers a set minimum number of
mandatory breaths each minute. A/C mode can be used with either pressure
control or volume control.