The Ventilation Strategies For Acute Respiratory Distress Syndrome

VAP prolongs the need for mechanical ventilation that may keep patients with a poor prognosis from their underlying commodities in the ICU. Both these factors would increase the probability of death rates in the ICU among patients who have developed VAP. 17

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Respiratory therapists have one of the most exciting and gratifying careers within the medical field. Unfortunately as with any other job or career, it doesn’t come without having challenging times. Respiratory therapists work along-side physicians and are highly trained to treat patients with any sort of lung concern or breathing complications. This job requires hands on care, and deals with life and death daily. One specific scope of this field involves caring for patients (of all ages) attached to mechanical ventilation. It is the respiratory therapists’ responsibility to remove assistive ventilation to patients with written order from the doctor; which ultimately results in death of the patient (Keene, Samples, Masini, Byington).

According to the American Lung Association, “Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease occurring in critically ill patients.” ARDS is an extreme manifestation of a lung injury that can be associated with an acute medical problem. This occurs as a result of direct or indirect trauma to the lungs. With nearly 200,000 cases in the United States each year, ARDS is not extremely common (“Acute Respiratory Distress Syndrome”). Most people who acquire this disease are critically ill patients within the hospital. The most common predisposing medical problems of ARDS consist of: shock, trauma, pulmonary infections, sepsis, aspiration, and cardiopulmonary bypass (Ignatavicious, 2013). ARDS is a severe syndrome and even with prompt and aggressive medical treatment, almost fifty percent of those diagnosed do not survive. Those who survive have a longer hospital stay along with recurring hospital admissions throughout their lifetime (“Acute Respiratory Distress Syndrome”). Acute respiratory distress syndrome is a rapidly progressive disease which requires thorough assessment, rapid diagnosis, and emergency treatment measures in order to successfully respond to the disease process.

Ventilator-associated pneumonia (VAP) remains a big drawback within the hospital setting, with terribly high morbidity, mortality, and cost. Some people tend to perform an evidence-based review of the literature that specializes in clinically relevant pharmacological and non-pharmacological interventions to prevent VAP. Thanks to the importance of this condition the implementation of preventive measures is predominant within the care of mechanically ventilated patients. There is proof that these measures decrease the incidence of VAP and improve outcomes within the intensive care unit. A multidisciplinary approach, continuing

In this review, external validity was increased as all patients were assessed for eligibility (Rothwell 2005). However, over half the patients assessed for eligibility were excluded which limited external validity. Exclusion bias was used as the trial did not involve children. Exclusions are not explained and are not indicative of selection bias. Selection bias was reduced by including quasi-randomised and randomised controlled trials of protocolized weaning verses non-protocolised weaning from mechanical ventilation in critically ill adults. It is important to add that the trial was double blinded, minimizing performance bias. The patient’s baseline characteristics were similar. The lower ad-verse events, mortality, quality of life, weaning duration and ICU LOS could reduce the risk of bias benefiting protocolized weaning over standardized

Acute respiratory distress syndrome, also known as ARDS, is the abrupt collapse of the respiratory system. It can advance in anyone 1 year and older who is critically ill. An individual with ARDS has accelerated breathing, difficulty getting adequate air into the lungs and decreased blood oxygen levels. ARDS normally develops in people who have major injuries or already ill with another disease. ARDS is usually a hospital acquired disease. ARDS is normally grouped with an almost indistinguishable condition called acute lung injury, but people with ARDS have much decreased oxygen in their blood, the condition is more dangerous. ALI can progress into ARDS if the oxygen levels continue to decrease.

The first assessment I performed for my patient, C.P., was during a day shift on February 23, 2016. Upon receiving her into my care at approximately 0730hrs, I noticed that she was extremely difficult to rouse awake as she was drowsy and could not seem to keep her eyes open. On top of this, she was exhibiting unusually slow respirations while laying supine on her bed, with many blankets around her. For the purpose of this paper, I will be focusing on my respiratory assessment. During this event, performing a thorough respiratory assessment was challenging because C.P. was unable to fully participate due to her current cognitive state.

TBI is the leading cause due to high incidence, complexity and the presence of challenging clinical management situations such as intracranial hypertension, thoracic trauma and intra-abdominal hypertension. The most common manifestation of a TBI is acute RDS with a high mortality rate. Respiratory failure paired with high PEEP setting and low tidal volumes make patients with increased intracranial hypertension harder to manage. It is hard to maintain these patient’s PaCO2 within a normal range causing protective ventilation strategies to be more difficult. The protective ventilations strategies recommend the mechanical ventilation include maintaining plateau pressures lower than 30cm H2O independently of ARDS severity. However, in patients with a TBI are at greater risk for pulmonary injury, which depends on the trauma severity, even in patients with a TBI and no RDS. In both patient types, TBI with and without RDS, the protective mechanical ventilation strategies are aimed at protecting the lungs and the lung function. Because of the variety of disease causes, there is speculation as to whether ARDS should be described as a single entity, or whether for each special situation it could all be described as a specific class of ARDS, with different management of the ventilation. The aim of this study

1.16. Explain the standard set of nursing observations that are completed on an individual who is in respiratory distress? Blood pressure, L&S manual or machine, SPo2 used on finger, ear or nose, Respirations for full minute, HR manual or through machine, neurovascular observation and capillary refill, pain scale, alert scale (Chrisp & Taylor, 2011)

Keywords: Normal saline, Endotracheal, Tracheostomy, ARDS, Meconium Aspiration, Pneumonia, VAP, Bronchiolitis, Chest Physiotherapy, Intubated, Mechanical ventilation, Bronchoscopy, Bronchoalveolar Lavage

Weaning is a critical element in the care of intubated patients that deals with the entire technique of liberating the patient from mechanical ventilatory support as well as from the endotracheal tube. It is the transition of ventilatory support to spontaneous breathing (30). Although it can be achieved easily in many patients, it may prove to be difficult in up to 25% of critically ill patients who have been on ventilation for a prolonged period of time (31–33). Shorter the time in MV, lesser would be the complications associated with it by as much as 50%, with decrease in number of re-intubation as well (34). Study by Esteban et al. suggested that mortality rate is related to increased duration of mechanical ventilation wherein weaning period accounted for 40% of the ventilatory time (2). Similarly study by Coplin further shows the relevance of timely extubation by relating the delayed extubation with increased mortality rate of 27% against the rate of 12% in timely extubated patients (3).

In clients with acute respiratory distress syndrome, the first thing to assess is airway, breathing, and circulation. The cardinal features are persistent hypoxemia, decreased pulmonary compliance, shortness of breath, noncardiac-related bilateral pulmonary edema, and dense pulmonary infiltrates on a chest x-ray. Some symptoms

Mechanical ventilation is the treatment for patients who show the sign of acute respiratory failure. Patients would get acute respiratory distress from inadequate oxygenation or ventilation that associated with hypoxemia without or with hypercapnia. Mechanical ventilation is used for these patients based on when the patients’ partial pressure of oxygen in arterial (PaO2) is less than 50 mm Hg and partial pressure of carbon dioxide (PaCO2) greater than 50 mm Hg.1 Under normal condition, when patients are breathing normal or spontaneous the diaphragm contracts on inhalation, moving toward the abdomen, and the chest wall expands.1 As one can see breathing through mechanical ventilation is fundamentally different from normal breathing. Therefore,

oxygenation of a patient suffering from COPD can result in patient fatality (National Patient Safety Agency 2009a). My mentor briefly explained how some patient’s respiratory drive depends on their level of hypoxia rather than the normal dependency on hypercapnia and this is why patient’s with COPD should be given oxygen with caution as it can