![]() The left ventricle can therefore pump blood ‘downhill’. This is because, when the thorax is exposed to positive pressure, the left ventricle is ‘above’ the rest of the body by an amount similar to the mean airway pressure. It also off-loads the left ventricle (at the expense of the right). PEEP physically pushes pulmonary alveolar oedema into the capillaries and so improves work of breathing. The big exception to the principle #1 is cardiac causes for respiratory distress. That said there are some exceptions – ventilation allows bronchoscopy, physical secretion clearance, sample collection and instillation of agents such as DNase, which can be used for persistent collapse. This might be mitigated to some extent by good physiotherapy, good nursing care, but its hard to find anything but personal experience and small trials looking at this. The reverse is probably true – poor secretion clearance, and a suppressed cough – necessary evils accompanying ventilation – will impair clearance of secretions. This isn’t quite true, although there is no evidence that pneumonia, bronchiolitis, aspiration or any other respiratory problem resolves faster when the patient is ventilated. PRINCIPLE #1: Ventilation’s only purpose is to keep the patient alive while something good can happen to allow them to breathe for themselves. Carbon dioxide is removed by establishing adequate minute ventilation.Įverything to do with ventilation lives within these four principles, which can now be examined in turn. Oxygenation occurs because there is adequate alveolar-capillary gas transfer.Ĥ. Although ventilation cannot cure the patient, it can damage.ģ. Ventilation’s only purpose is to keep the patient alive while something good can happen to allow them to breathe for themselves.Ģ. These are mostly true in all situations:ġ. There are just a few very basic principles governing decision making for ventilation. The principles it covers are applicable to any mode or type of ventilator ever used or that has yet to be invented. This short article is for those who would like to be somewhere in between these two positions. The thinking about ventilation over the last 20 years has two distinct polarities… academics with PhDs in ventilation science who really understand the physiology, the trials and are right up to date with the latest gadgets and the protocol followers, those who realize that understanding what might be going on beyond the ETT is not going to happen, so are content with turning this or that knob when the blood gas result is put in front of them. ![]()
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