Category: Critical Care Nursing Minimal sedation (anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive functions and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.
Category: Critical Care Nursing Strategies for managing intubated patients with COPD focus on improving gas exchange while minimizing iPEEP. Reduction of iPEEP is achieved by decreasing airway resistance with bronchodilators and corticosteroids.
Category: Critical Care Nursing The initial evaluation of a decompensating vented patient should begin by confirming the position and patency of the endotracheal tube before other diagnoses are investigated, including evaluation of the tracheal balloon.
Category: Critical Care Nursing Patients with hemodynamic compromise or acute hypoxia on the ventilator should be auscultated and chest examined to ensure breath sounds. Changes in breath sounds may indicate a pneumothorax or migration of the endotracheal tube.
Category: Critical Care Nursing Patients with acute hemodynamic compromise or acute hypoxia on the ventilator should be bagged manually on 100% oxygen. Tension pneumothorax, increased iPEEP and accidental extubation are the most life-threatening concerns.
Category: Critical Care Nursing When a patient's condition suddenly deteriorates during mechanical ventilation, a systematic approach should be applied to assess for life-threatening conditions. The first step in evaluation includes assessing the patient and vital signs.
Category: Critical Care Nursing A potential complication of positive pressure ventilation is the development of iPEEP. iPEEP is the accumulation of end-expiratory volume and end-expiratory pressure that occurs when exhalation cannot be fully completed.
Category: Critical Care Nursing Positive pressure ventilation has a direct impact on the lungs. Whether delivered as a set volume or set pressure, invasive positive pressure ventilation forcibly distends the lung. It can be injurious causing volutrauma and barotrauma.
Category: Critical Care Nursing Propofol's ability to penetrate the blood-brain barrier rapidly and distribute into peripheral tissues is responsible for the rapidity and short duration of its clinical effect. Propofol can precipitate hypotension by increasing venous capacitance.
Category: Critical Care Nursing After intubation, additional neuromuscular blocking agents should generally be used only when poor ventilator synchrony interferes with ventilation sedation and analgesia. This may be particularly true in patients with ARDS.
Category: Critical Care Nursing Intubation, mechanical ventilation and paralysis are a significant cause of pain and anxiety for patients, and analgesia and sedation are required to promote patient comfort and patient-ventilator synchrony.
Category: Critical Care Nursing CPAP provides constant positive pressure throughout the respiratory cycle, whereas BiPAP alternates between higher pressure during inspiration (IPAP) and lower pressure during expiration (EPAP).
Category: Critical Care Nursing PEEP increases intrapulmonary and intrathoracic pressures and may affect pulmonary and cardiovascular physiology. Potential adverse effects of PEEP include decreased cardiac output, lung overdistention and pneumothorax.
Category: Critical Care Nursing During acute respiratory failure, lung volumes are typically decreased. The application of PEEP increases functional residual capacity, improves oxygenation and decreases intrapulmonary shunting.
Category: Critical Care Nursing Regardless of the ventilatory mode chosen, PEEP is often used during invasive mechanical ventilation. PEEP refers to the maintenance of positive airway pressure after the completion of passive exhalation.
