Management of Respiratory Failure

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        - ABG
        - Bronchospasm
        - Clinical Conditions
        - Criteria for Intubation
        - Criteria for Extubation
        - COPD
        - Fat Embolism Syndrome
        - Inverse I:E Ratio
        - Minute volume
        - Modes of Ventilation: IMV/CMV/ACMV
        - PEEP > 12 cm H2O
        - PIP
        - Pre Op Pulmonary Management
        - Priorities for Weaning from Ventilatory Support
        - Oxygenation in the Ventilated Patient:
        - Rate/Tidal Volume/PEEP/Compliance/PIP/CPAP
        - Resp Acidosis
        - Shunt
        - Swan Ganz catheters: Indications:
        - Ventilator Types
        - References

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- Initial Adult Vent Settings:
        - use PEEP to wean FiO2; - maintain Hb Sat > 90%
        - tidal volume 10-12 ml/kg
        - intermittent mandatory ventilation 10-12 breaths/min;
        - inspired oxygen fraction 0.6
        - positive end expiratory pressure 5 cm H2O
        - pressure limit:
              - this limit should be set at 10 cm H2O higher than the pressure generated by the delivered tidal volume;
              - excessively high pressures should be avoided so as to avoid barotrauma;
        - tube suctioning q 1-2 hrs;
        - humidifer set at 36 deg and 1/2 NS delivered for 10 min/hr;

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- Pediatric Vent Settings:
                              Normal Lungs             RDS
        - PIP             12-18 cm H2O           20-25 cm H2O
        - PEEP           2- 3 mc H2O               4- 5 cm H2O
        - Frequ         10-20 /   min                   20-40 /   min
        - I/E ratio         1:2 to 1:10                       1:1 to 1:3

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Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study

Oropharyngeal decontamination decreases incidence of ventilator- associated pneumonia. A randomized, placebo-controlled,

Determinants of early adult respiratory distress syndrome. A retrospective study of 220 patients with major fractures.

Serum antioxidants as predictors of adult respiratory distress syndrome in patients with sepsis.

High-dose corticosteroids in patients with ARDS

Blood transfusion related adult respiratory distress syndrome.

Inhaled nitric oxide for the adult respiratory distress syndrome

Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization [see comments.

The relationship between ARDS, pulmonary infiltration, fluid balance, and hemodynamics in critically ill surgical patients.

The use of pressure-controlled inverse ratio ventilation in the surgical intensive care unit.

Airway pressure release ventilation during acute lung injury: a prospective multicenter trial.

Inverse ratio ventilation in ARDS. Rationale and implementation.

Ventilatory management of ARDS: can it affect the outcome .

Serum oncotic pressure and oncotic-hydrostatic pressure differences in critically ill patients.

Early extubation versus prophylactic ventilation in the high risk patient: a comparison of postoperative management in the prevention of respiratory complications.

Inhaled nitric oxide for the adult respiratory distress syndrome [see

Does positive end-expiratory pressure significantly reduce airway blood flow .

Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial [see comments.

High-Level Positive End-Expiratory Pressure Management in Trauma-Associated Adult Respiratory Distress Syndrome.

Effect of different levels of positive end-expiratory pressure on lung water content.

Negative Pressure Pulmonary Edema: a complication of shoulder arthroscopy.
      P. Langan MD and R. Michaels MD.   American Journal of Orthopedics.   Jan 1999. p 56.

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