Mechanical Ventilation | Most COMPREHENSIVE Explanation!

let's start with the respiratory rate if you increased the respiratory rate too much, too bad, why obstructive lung disease, asthma or COPD, what is the definition of obstructive lung disease? I can't get the air out, please leave me alone, give me some time to get every drop of air out because I'm struggling to exhale, if the respiratory rate increases, the patient didn't have time to empty his lung completely, but the second cycle and the next cycle came before the patient could empty his lung and the next cycle and the next cycle is called breath accumulation. you're stacking air on top of air on top of air on top of air they also call it Oh, to see the positive end expiratory pressure for their Oh, so that the payment was made to themselves, it's not really the patient, it's the stupid one. doctor, but this is the name of if I owe too much it is also bad, why have you heard of hyperbaric oxygen?

Andrews called baby barotrauma because Baro means pressure because it causes bronchitis and in premature babies, when they are given too much oxygen, it can cause retinopathy of prematurity and Branko's Pulmonary Dysplasia, which is horrible, pros and cons of PEEP. Advantages: it keeps the alveolar open at the end of expiration, therefore, there is more oxygenation, but everything disappears. It makes the intrapleural pressure positive instead of negative, which will decrease venous return, decrease cardiac output, and decrease. blood pressure as I told you in my previous videos, so when you decrease venous return and blood starts to drop, can you expect ankle edema?

Absolutely yes, too much of anything can be bad for you. Too much respiratory rate, air or O2 accumulation, be careful with patients. with asthma COPD if the tidal volume increases too much the alveoli will become like this and like this and like this this increase in inflammation use an RDS if I o2 oxygen injury maybe it can cause bronchitis too much noise decreased venous return decreased cardiac output and hypotension There are no solutions in life only compensations said the great dr. Ole Thomas, I was talking about

mechanical

ventilation

. Hey, you give your order for

ventilation

. I need assist control as my mode and IO control for parameters, let's say respiratory volume is 14, 500 fio2 is 40%, roles 5 1 to control. p co 2 3 and 4 country po2 what if you have a patient with increased respiratory acidosis 1 2 or if you have a patient with hypoxemia, increase 3 and 4, especially if the patient has CHF because in CHF the heart has failed, the heart is overwhelmed and you're trying to tweet increase tweet increase people decrease venous return in this case, it's actually good because the heart is already overwhelmed, don't push blood into it.

Its struggle to decrease venous return is actually beneficial in a patient with congestive heart failure. It is beneficial for the heart. Yes, you will suffer from ankle edema, but who cares. It's more important than the little toe, but. increasing the tweet too much, as you know, is bad if you have hypotension, therefore you should get your vitals before ordering. Q if you're stupid, dumb, my favorite part of the lecture during individual intubation, the doctor extends the neck, be careful with a custard to the balls or subluxation. A history of rheumatoid arthritis registration is necessary. Whoa, stop activating the vent.

It is a phrase that means controlling the work of the brain. When we say that the patient is activating the vent, it means that the patient is starting to breathe on his own by writing the vent means that the patient is sedated and the vents are actually doing the work of breathing and the patient is simply taking advantage of the tidal respiratory frequencies. Spontaneous is the respiratory rate or the respiratory rate when the machine is doing the work in CHF the heart is not pumping The blood is pulling behind the overwhelmed heart. Peep is actually good because it decreases venous return and decreases too much overwhelm.

In English in this lecture, if a patient has RDS restrictive lung disease with low compliance, the peep should be increased and the tidal volume should be decreased if a patient has emphysema. you need to increase the inspiratory flow rate, make sure the flow reaches zero at the end of expiration to avoid buildup of respiration or automatic peep, okay, we understand this part why increase the inspiratory flow rate normally, here there's the inspiration, here's the scan, this is 1/3 and this is 2/3, usually in a patient with an obstructive lung disease, like a patient with emphysema, there's a problem, they can't get the air out, there's an expiration prolonged and they need it to get the air out, so don't increase the speed is too much, but you can increase this inspiratory flow rate so that they can inhale from here to here.

It will deliver all the air from here to here vigorously to leave the patient with plenty of time to empty every last drop. before the next genius cycle begins, as you know, everything in life has compensations, there are no solutions, complications of

mechanical

ventilation, barotrauma, ventilator-associated lung injury, ventilator-associated pneumonia or VAP translation, it is a pneumonia that develops after 48 to 72 hours after being intubated and mechanically ventilated if it started within an hour after the ventilator and you have pneumonia this is not ventilator associated do not blame them a scene what organisms caused ventilator associated pneumonia depends on how soon after admission the patient was intubated is ok if the intubation took place within one to four days after admission to the hospital the same organism as community-acquired pneumonia because it is community-acquired pneumonia not blame the hospital you didn't blame the machine then it is Tripta Kaushal pneumoniae Haemophilus influenzae Klebsiella etc. and these organisms are generally not drug resistant, which is incredible more than five days after admission, organisms are found in the hospital, now you blame the hospital, not the community, Pseudomonas staph aureus MRSA, etc., these They are generally drug resistance called MRSA Methicillin-resistant Staph aureus, those bacteria are communist, there is a test. question for the important patient was frequently intubated and mechanically ventilated then three days later he developed a new fever 104 leukocytosis pulmonary infiltrates in radiology a productive cough of purulent sputum diagnosis classic case of ventilator associated pneumonia organism look at the time period three days Okay , so blame the community, this is a community, a type of silent pneumonia, but we call it that it is similar to community acquired pneumonia, so take away the pneumonia, who knows what our predisposing factors are to Klebsiella?

Malnutrition in the ICU is the

most

common predisposing factor and which samples are the best. to culture if you want to get the deeper organism, the deeper you go into the patients, the better culture you will get was the best modality to get cultures called protected sample brush or p SB using bronchoscopy, why is it good? is good, better culture, unlikely to be contaminated by flora how to treat ventilator associated pneumonia empirically before culture results come in depends on schedule within one to four days after admission. I'm thinking strep pneumonia and against those beta lactam guys plus a respiratory fluoroquinolone, but if more than five days is fine, I'm thinking Pseudomonas and mersa and all these ugly things add up to the anti-property antibiotics, just like go all inclusive plus vancomycin.

Orlin is forced to cover for stupid Mercer. I hope you learn. something in this video thank you very much for watching, subscribe, press the bell to receive notifications, follow me on Facebook. I have more than a hundred cases there and I like it. By the way, you can get my Dropbox notes that have the slides from this video organized. PDF notes case notes audio notes and they are organized in beautiful Dropbox folders just go to patreon.com/scishow sister thank you so much for watching as always stay safe stay happy and study hard this is doctors nails perfect for medicine makes a lot of sense