Mandatory Ventilatory Case Study

Suctioning resulted in moderate to large amounts of white sputum. The patients wife stated that he had been suffering from a cold for one week prior to admission. Therefore an increase in PEEP (Hi and Lo) was required to recruit the alveoli and aid in good gas exchange. (Dellinger at al, 2007) It is recommended that positive end expiratory pressure is set to avoid extensive lung collapse on expiration. (Dellinger et al, 2007) Maintaining pressure and spontaneous breathing resulted in an increase in arterial oxygenation and helped prevent a deterioration in pulmonary gas exchange. (Putensen et al 2006) Studies have been carried out to determine whether high PEEP increases patients outcomes. These include the ALVEOLI study and the Lung Open Ventilation (LOV). These studies do not show an improvement on mortality with the increase in PEEP however show a decrease in days on the ventilator. (Mercat et al 2008) The patients right side was worse than the left on the CXR and auscultation. Therefore he was being positioned right side up and his back on pressure area cares. Repositioning patients not only protects the patients skin but it also improves gas exchange and decrease the risk of ventilator acquired pneumonia. (Deutschmann and Neligan, 2010) Positioning the patient with the good lung down may improve paO₂ and aid in the drainage of secretion. (Deutschmann and Neligan, 2010) Elevating the head of

Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.

Allen here to speak to you about the most common diseases we see here in the Pediatric Pulmonary Department. I will start by telling you what they are and I am sure you have heard them before. First there is Acute Bronchiolitis (inflammation of the bronchioles). Acute Bronchiolitis is usually accompanied by tachypnea (rapid breathing), chest retraction (sinking in of soft tissues of the chest), and wheezing (whistling or rattling sound on the chest). Next is Tuberculosis (bacterial infection spread through lymph nodes and blood stream into other part of the body). TB is very contagious due to the fact it is airborne. Children are most susceptible to this disease. They can get it by being in contact with someone who has active TB. This disease is very fatal to children as it can result in death. The bad thing about TB is that it can not be detected and it can sometimes lay dormant in the system and never be active, so sometimes we wont ever know if a child has it until they appear sick and get tested for the disease. The last condition we will discuss is Sleep Apnea (interruptions of breathing while sleep). Sleep Apnea occurs when the muscles in the mouth and your tongue relax to the point of blocking your air way, sometimes it causes you to make noise like snoring and other times and blocks your breathing completely to where you can not

Karen Meunier, is the education consult for New Orleans’s Childrens Hospital Ventilator Assisted Care Program (VACP). Mrs. Meunier educated the audience on the history of ventilators. Next, Mrs. Meunier stated the criteria for the children who are enrolled in the Ventilator Assisted Care Program. Overall, these children either have a neuromuscular, brain and/or spinal cord injury, and/or birth related diagnosis. The children in the program live at home in Louisiana, under the age of 26, Medicaid eligible, and require daily mechanical support of respiratory efforts. Lastly, Mrs. Meunier informs the audience about each member in the VACP staff. The VACP staff includes an education consultant, respiratory therapist trainer, two case managers,

J., Cormier, S., & Meyer, T. (2012). Reduction in the Incidence of Ventilator Associated Pneumonia: A Multidisciplinary Approach. Respiratory Care, 57(5). 688-696. DOI: 10.4187/respcare.01392

Sometimes when a patient is on the more common form of mechanical ventilation for an extended time or if the patient has undergone respiratory failure, their respiratory muscles have a tendency to become weak. With the use of this biphasic cuirass ventilation method they can have the opportunity to build and strengthen those muscles which, in return, can allow them to be weaned from the ventilator

One of the most common causes of an airway obstruction in unconscious patient's is their tongue. This problem can be overcome by the use of an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). These airway adjuncts are inserted into the patient's mouth or nostril, and are designed to hold the tongue in a position that prevents it from occluding the airway. Another skill authorized for BLS providers is the use of a bag-valve-mask (BVM). This tool allows EMS personnel to deliver positive pressure ventilations to a patient who is not breathing sufficiently on their own. However, this skill is commonly performed improperly. When using a BVM, an EMS provider must make certain that his patient's airway is patent, and that his head is positioned properly. Furthermore, it is critical that an EMS provider ensures that the mask is maintaining a complete seal around his patient's nose and mouth. Otherwise, pressure needed to force air into the lungs escapes through the unsealed portion of the mask, reducing the effectiveness of the ventilation. Another, more advanced skill used by EMS providers is the performance of an endotracheal

Please note that it is our responsibly as the therapist to check the orders in the EPIC and review our patients charts for accuracy. We must deliver and abide by our physicians orders.

All patients were followed with pulmonary artery catheters and invasive blood pressure. After orotracheal intubation, patients were ventilated with intermittent positive pressure with a tidal volume of 8 mL / kg, final expiratory positive pressure of 5 to 8 cmH2O and FiO2 of 60 to 100% to maintain arterial oxygen saturation above 95%.

Mr. Boza has been counseled on the need for non-invasive positive pressure ventilation for his obesity hypoventilation, however continues to defer at this time as he feels he is unable to sleep with the device, once again, thus making treatment of his sleep disordered breathing nearly impossible. I have counseled Mr. Boza to decrease his fluid intake to less than 2L per day. He should continue his current diuretic regimen. He does have prior pulmonary function tests that showed reversible airflow obstruction and therefore he should continue his ProAir on an as needed basis. It does seem that he was recently evaluated by Daniel Davies, DO and was given a prescription of prednisone, which he is finishing up the taper at this

During the 1930s there was extensive use of this technology in caring for victims of the polio epidemic. These iron lungs were cumbersome, and provided little access to provide patient care. Recent advancements however, have made negative pressure ventilation a viable option in non-invasive mechanical ventilation. The “modern” iron lung consists of a flexible cuirass, or shell, which is designed to fit over the anterior of the chest. On inspiration, a negative pressure helps to pull the rib cage up and forward, increasing the space in the thoracic cavity, facilitating better air flow and ventilation. Expiration is achieved by passive recoil. These latest devices offer many of the same ventilatory modes as positive pressure vents do, as well as, high frequency chest wall oscillation and cough assistance. The HFCWO assists patient in mobilizing secretions much the same way the vest works in chest physiotherapy. The cuirass can also provide peep by providing a continuous negative distending pressure baseline. This negative extrathoracic pressure provides a new functional reserve capacity (FRC) from which the patient can breathe from. Biphasic cuirass ventilation can also provide a positive pressure to assist in assist in exhalation. This positive phase decreases the potential for large end expiratory lung volumes which may facilitate gas trapping or barotrauma to compromised lung

There has been a public health emergency! The air has been contaminaited by a chemical toxin and in order to survive, all citizens must wear a ventilator. At this time we have no further leads onto what cuased this outbreak to happen but first responders are trying to figure the problem as we speak. All we know is that this toxin is contagious and some of these affects can make you turn against people. Docters and scientists are saying that this outbreak must’ve came from out of the country we don’t know who had it first but we know that the ventilators are helping out with this toxin. Kids 10 and under will receive a ventilator first in order for your kid to get one you must bring birth certificate or SSN after that if your family needs more

The CCAMs do not participate in normal gas exchange although there are connections to the tracheobronchial tree. It can lead to air-trapping and respiratory distress in the newborn period.

In this article, the authors emphasise the use of noninvasive methods of providing ventilation to neonates as they were introduced to do away with the mechanical ventilation techniques. De Winters and Vries claim that the use of noninvasive techniques reduces the incidences of bronchopulmonary dysplasia in neonates, a complication most common with standard ventilatory techniques. The article discusses the best ways in which the modern noninvasive respiratory support techniques should be administered to neonates.

After a review of the clinical information provided by Hampton Homecare Incorporated, the Medical Director has determined that Continuous Positive Air Pressure Device (midair pressure to keep airway open), Humidifier (add cool or warm moist air to passages to keep from drying out), and face mask (mask covers mouth and nose and delivers moist air) is not medically necessary. Based on the InterQual guideline criteria (a decision based program to determine medical need) for a Continuous Positive Air Pressure Device (midair pressure to keep airway open), the clinical guidelines were not met because there was no proper mask fitting or selection and appropriate pressure settings. You have not used a continuous positive airway pressure device for