Improving Oxygenation and Management of Acute Respiratory Distress Syndrome:
1.Calculate the desired fractional inspired oxygen (FIO2) needed to achieve the desired partial pressure of oxygen in the arteries (PaO2), based on current ventilator settings and blood gases.
2.Calculate a patient’s pulmonary shunt fraction.
3.Identify indications and contraindications for CPAP and PEEP.
4.List the primary goal of PEEP and the conditions in which high levels of PEEP are most often used.
5.Describe the most appropriate method establishing an optimum level of PEEP for a patient with acute respiratory distress syndrome (ARDS) using a recruitment-de recruitment maneuver and the deflection point (lower inflection point during deflation or de recruitment).
- 6.Explain the effects of PEEP/CPAP therapy on a patient with a unilateral lung disease.
7.Describe the problems associated with initiating PEEP in a patient with an untreated pneumothorax.
8.Recommend adjustments in PEEP and ventilator settings based on the physical assessment of the patient, ABGs, and ventilator parameters.
9.Compare static compliance, hemodynamic data, and ABGs as indicators of an optimum PEEP.
10.Identify from patient assessment and the ABGs when it is appropriate to change from CPAP to mechanical ventilation with PEEP.
11.Identify the severity of ARDS using the PaO2/FIO2 ratio.
12.Recommend an appropriate tidal volume (VT) setting for a patient with ARDS.
13.Identify the maximum Pplateau value to use for patients with ARDS.
14.Identify the criteria that should be used to liberate a patient from PEEP or CPAP.
15.Recommend a PEEP setting based on the inflection point on the deflation curve using the pressure-volume loop for a patient with ARDS.
16.Describe the procedure for prone positioning in ventilated patients with adult respiratory distress syndrome.
17.List potential problems associated with placing the patient in a prone position during mechanical ventilation.
18.Discuss several theories that describe how prone positioning improves ventilation-perfusion in adult respiratory distress syndrome.
- Hypoxia and HypoxemiaThe terms hypoxia and hypoxemia are often used interchangeably.
Hypoxia is defined as a reduction in oxygen in the tissues.
Hypoxemia refers to a reduction in the partial pressure of oxygen in the blood (i.e., PaO2 <80 mm Hg and SaO2 <95%).
- Types of HypoxiaHypoxemic hypoxia (lower than normal PaO2, ascent to altitude, hypoventilation)
ØTreatment—have the person breathe an enriched oxygen mixture; increase minute ventilation
Anemic hypoxia (lower than normal red blood cell count [anemia], abnormal hemoglobin, carbon monoxide poisoning)
ØTreatment—administration of blood products; hyperbaric oxygen therapy .
