Airway management and Mechanical Ventilation

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Airway Management and Mechanical Ventilation John Angelo Perez St. Luke’s Medical Center International Institute of Neurosciences October 21, 2015

Transcript of Airway management and Mechanical Ventilation

Page 1: Airway management and Mechanical Ventilation

Airway Management andMechanical Ventilation

John Angelo PerezSt. Luke’s Medical Center

International Institute of NeurosciencesOctober 21, 2015

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Management of ICP is multi-modal

Increased ICP

Head Positioning

Osmotherapy

Sedation and Analgesia

Seizure ControlHypothermia

BP Control

Ventilation

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Questions for today

• What makes neurologic patients special?

Some considerations

• What are the steps for intubation?

Intubation as a life-saving intervention

• What is the role of ventilation in neurocritical care?

Ventilation in the NCCU

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Part 1: Some considerationsWhat makes neuro patients special?

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More patients require intubation in the NCCU

Bhardwaj and Mirski. Handbook of Neurocritical Care 2nd Ed. 2011

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The airway is divided into parts

Butterworth et al. Morgan and Mikhail's Clinical Anesthesiology 5th Edition. 2013

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Cranial nerves supply the airway

Butterworth et al. 2013

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Conditions Requiring Intubation

• Strokes• TBI• Status epilepticus• Encephalopathies• CNS Infections• Hydrocephalus• Cerebral Edema• Neuromuscular disorders

Bhardwaj and Mirski. Handbook of Neurocritical Care 2nd Ed. 2011

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Three principles guide intubation

Failure to Protect or Maintain Airway

Failure to Oxygenate or

Ventilate

Anticipate a deteriorating

course

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Conditions Requiring Intubation

• Strokes• TBI• Status epilepticus• Encephalopathies• CNS Infections• Hydrocephalus• Cerebral Edema• Neuromuscular disorders

Failure to Protect or Maintain Airway

Failure to Oxygenate or

Ventilate

Anticipate a deteriorating

course

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Part 2:A life-saving intervention

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RapidSequenceIntubation

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RapidSequenceIntubation

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PLAN: use LEMON to evaluate difficult airways

L – Look!E – Evaluate the 3-3-2 ruleM – Mallampati ScoreO - ObstructionsN – Neck mobility

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Butterworth et al. 2013

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POSITION: Extend the neck to align the oro-pharyngo-tracheal axis

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PRE-OXYGENATE: An ill patient has 6 minutes to be intubated

Torbey, Michael. Neurocritical Care. 2010

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PREPARE: Keep everything within reach

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Patients must intubated within 60 seconds

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RapidSequenceIntubation

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RapidSequenceIntubation

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PARALYZE: three classes of drugs are used in RSI

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Part 3:Ventilation in the NCCU

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Hyperventilation

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Hyperventilation induces hypocapnea

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Hypocapnea decreases CBF

30

Butterworth et al. . 2013

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Decreased CBF decreases ICP

Hyperventilation

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How long? How fast?How deep? Which diseases?

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Secondary infarction is the most important complication of hyperventilation

Normal: 50mL/100g/min

Stochetti et al. Hyperventilation in Head Injury: A Review. Chest 2012

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The meta-analysis did not find sufficient evidence of improved outcomes

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What have we learned today?Failure to Protect or

Maintain Airway

Failure to Oxygenate or

Ventilate

Anticipate a deteriorating

course

Increased ICP

Head Positioning

Osmotherapy

Sedation and Analgesia

Seizure ControlHypothermia

BP Control

Ventilation

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Questions?Failure to Protect or

Maintain Airway

Failure to Oxygenate or

Ventilate

Anticipate a deteriorating

course

Increased ICP

Head Positioning

Osmotherapy

Sedation and Analgesia

Seizure ControlHypothermia

BP Control

Ventilation


Airway Management, Ventilation, Oxygen Therapy

Airway Management, Ventilation, Oxygen Therapy

AIRWAY MANAGEMENT AND VENTILATION - … · D3 Basic airway management and ventilation Objectives • Causes of airway obstruction • Recognition of airway obstruction • Basic techniques

AIRWAY MANAGEMENT AND VENTILATION - … · D3 Basic airway management and ventilation Objectives • Causes of airway obstruction • Recognition of airway obstruction • Basic techniques

Chapter 9 Airway Management and Ventilation

Chapter 9 Airway Management and Ventilation

Airway Management. Outline Review of airway anatomy Airway evaluation Mask ventilation Endotracheal intubation The difficult airway.

Airway Management. Outline Review of airway anatomy Airway evaluation Mask ventilation Endotracheal intubation The difficult airway.

Mechanical Ventilation - KSUfac.ksu.edu.sa/sites/default/files/mechanical20ventilation.pdf · Mechanical Ventilation Common indications for mechanical ventilation • Bradypnea or

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Ventilation Patterns Influence Airway Secretion Movementrc.rcjournal.com/content/respcare/53/10/1287.full.pdf · Ventilation Patterns Influence Airway Secretion Movement ... Retention

Ventilation Patterns Influence Airway Secretion Movementrc.rcjournal.com/content/respcare/53/10/1287.full.pdf · Ventilation Patterns Influence Airway Secretion Movement ... Retention

Airway releasing ventilation

Airway releasing ventilation

Mechanical ventilation

Mechanical ventilation

Preemptive mechanical ventilation can block progressive ... · protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway

Preemptive mechanical ventilation can block progressive ... · protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway

Basic Airway & Ventilation Management - Aurora Health … · Basic Airway & Ventilation Management . Peter Brierton and Aurora EMS staff . Airway management is an overlooked skill

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Airway/Breathing - brooksidepress.org · Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid, assessment and management of airway and ventilation are critical

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Emergency Neurological Life Support: Airway, Ventilation ...

Emergency Neurological Life Support: Airway, Ventilation ...

Airway/ Ventilation & Shock

Airway/ Ventilation & Shock

Airway pressure release ventilation (APRV) in PICU ...msic.org.my/sfnag402ndfbqzxn33084mn90a78aas0s9g/asmic2017/Chor Yek Ke… · Airway pressure release ventilation (APRV) in PICU:

Airway pressure release ventilation (APRV) in PICU ...msic.org.my/sfnag402ndfbqzxn33084mn90a78aas0s9g/asmic2017/Chor Yek Ke… · Airway pressure release ventilation (APRV) in PICU:

AIRWAY MANAGEMENT &V - Instructional Resources · Airway Management &Ventilation 1 of 14 Veterinary Surgery I, VMED 7412 AIRWAY MANAGEMENT &VENTILATION Lyon Lee DVM PhD DACVA Introduction

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Emergency Airway and Ventilation—The Difficult Airway By: Darryl Jamison NREMT-P.

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Adjunct Therapies During Mechanical Ventilation: Airway ...rc.rcjournal.com/content/respcare/58/6/1053.full.pdf · Adjunct Therapies During Mechanical Ventilation: Airway Clearance

Adjunct Therapies During Mechanical Ventilation: Airway ...rc.rcjournal.com/content/respcare/58/6/1053.full.pdf · Adjunct Therapies During Mechanical Ventilation: Airway Clearance

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Emergency Airway and Ventilation—The Difficult Airway

Emergency Airway and Ventilation—The Difficult Airway

Airway: 2 Airway Management and Ventilation: 1

Airway: 2 Airway Management and Ventilation: 1