Hemodynamic Monitor

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    JOSEPH OMAR S. APOLINAR,RN,MANJOSEPH OMAR S. APOLINAR,RN,MAN

    Davao Doctors CollegeDavao Doctors College

    HemodynamicHemodynamicMonitoring SystemsMonitoring Systems

    HemodynamicHemodynamicMonitoring SystemsMonitoring Systems

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    HemodynamicHemodynamic

    Monitoring SystemsMonitoring Systems

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    Mechanical VentilatorsMechanical Ventilators

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    Mechanical VentilatorsMechanical Ventilators

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    Mechanical Ventilators areMechanical Ventilators are

    indicated for the following patients :indicated for the following patients :

    1. Patient who has a continuous decrease in Oxygenation (PaO2), increased in1. Patient who has a continuous decrease in Oxygenation (PaO2), increased inarterialarterial carbon dioxide levels (PaCO2), persistent acidosis (decreased pH), persistentcarbon dioxide levels (PaCO2), persistent acidosis (decreased pH), persistentacidosis (decreased pH).acidosis (decreased pH).

    2. Conditions such as thoracic or abdominal surgery, drug overdose,2. Conditions such as thoracic or abdominal surgery, drug overdose,

    neuromuscular disorders, inhalation injury, COPD, multiple trauma, shock,neuromuscular disorders, inhalation injury, COPD, multiple trauma, shock,

    multisystem failure, and coma all may lead to respiratory failure.multisystem failure, and coma all may lead to respiratory failure.

    3. Indications for Mechanical Ventilation :3. Indications for Mechanical Ventilation : PaO2 < 80 mm Hg with FiO2 > 0.60PaO2 < 80 mm Hg with FiO2 > 0.60 PaO2 > 80 mm Hg with pH < 7.25PaO2 > 80 mm Hg with pH < 7.25 Vital Capacity < 2 times tidal volumeVital Capacity < 2 times tidal volume Negative inspiratory force < 25 cm H2ONegative inspiratory force < 25 cm H2O Respiratory rate > 35/minRespiratory rate > 35/min

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    The Positive-Pressure Ventilators -The Positive-Pressure Ventilators - inflate the lungs by exerting positiveinflate the lungs by exerting positivepressure on the airway, similar to a bellows mechanism, forcing the alveoli to expandpressure on the airway, similar to a bellows mechanism, forcing the alveoli to expand

    during inspiration.during inspiration.

    a. Pressure-Cycled Ventilatorsa. Pressure-Cycled Ventilators -- these ventilators ends inspiration when athese ventilators ends inspiration when apreset pressure has been reached. In other words, the ventilator cycles on, deliverspreset pressure has been reached. In other words, the ventilator cycles on, delivers

    a flow of air until it reaches a predetermined pressure, then cycles off. The mosta flow of air until it reaches a predetermined pressure, then cycles off. The most

    common type is the IPPB machine.common type is the IPPB machine.

    b. Time-Cycled Ventilatorsb. Time-Cycled Ventilators -- these ventilators terminate or control inspirationthese ventilators terminate or control inspirationafter a preset time. The volume of air the patient receives is regulated by the lengthafter a preset time. The volume of air the patient receives is regulated by the lengthof inspiration and the flow rate of the air. These ventilators are used in newbornsof inspiration and the flow rate of the air. These ventilators are used in newborns

    and infants.and infants.

    c. Volume-Cycled Ventilators c. Volume-Cycled Ventilators these ventilators are by far the most commonlythese ventilators are by far the most commonlyused positive-pressure ventilators today. The volume of air to be delivered with eachused positive-pressure ventilators today. The volume of air to be delivered with each

    inspiration is preset. Once this preset volume is delivered to the patient, the ventilatorinspiration is preset. Once this preset volume is delivered to the patient, the ventilatorcycles off and exhalation occurs passively.cycles off and exhalation occurs passively.

    d. Noninvasive Positive-Pressure Ventilation - can be given via facemasks that coverd. Noninvasive Positive-Pressure Ventilation - can be given via facemasks that cover

    the nose and mouth, nasal masks, or other nasal devices. This eliminates the need forthe nose and mouth, nasal masks, or other nasal devices. This eliminates the need for

    endotracheal intubation or tracheostomy and decreases the risk for nosocomialendotracheal intubation or tracheostomy and decreases the risk for nosocomial

    infections such as pneumonia. The most comfortable mode for the patient is pressure-infections such as pneumonia. The most comfortable mode for the patient is pressure-controlled ventilation with pressure support.controlled ventilation with pressure support.

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    Positive-Pressure VentilatorsPositive-Pressure Ventilators

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    a. Controlled Ventilation - A preset volume of gas is delivered to the patient undera. Controlled Ventilation - A preset volume of gas is delivered to the patient under

    positive pressure while spontaneous patient respiratory effort is locked out.positive pressure while spontaneous patient respiratory effort is locked out.

    bb. Assist/Controlled Ventilation (A/C) in this mode, a preset volume of gas is delivered. Assist/Controlled Ventilation (A/C) in this mode, a preset volume of gas is deliveredto the patient at a preset rate, but the patient may trigger a ventilator breath withto the patient at a preset rate, but the patient may trigger a ventilator breath with

    negative inspiratory effort.negative inspiratory effort.

    c. Synchronized Intermittent Mandatory Ventilation (SIMV) Mode - a preset minimumc. Synchronized Intermittent Mandatory Ventilation (SIMV) Mode - a preset minimumnumber of breaths are synchronously delivered to the patient but the patient may alsonumber of breaths are synchronously delivered to the patient but the patient may also

    take spontaneous breaths of varying volumes. Note how inspiratory and expiratorytake spontaneous breaths of varying volumes. Note how inspiratory and expiratory

    pressures differ between spontaneous and ventilator breaths.pressures differ between spontaneous and ventilator breaths.

    The Ventilator is adjusted so that the patient is comfortable andThe Ventilator is adjusted so that the patient is comfortable and

    breathes in sync with the machine.breathes in sync with the machine.

    d. Positive End Expiratory Pressure (PEEP) - Airway pressure with varying levels ofd. Positive End Expiratory Pressure (PEEP) - Airway pressure with varying levels of

    positive end-expiratory pressure (PEEP). Note that at end expiration, the airway is notpositive end-expiratory pressure (PEEP). Note that at end expiration, the airway is not

    allowed to return to zero. (FRC: functional residual capacity).allowed to return to zero. (FRC: functional residual capacity).

    e. Continuous Positive Airway Pressure (CPAP) - This ventilatory adjunct is used onlye. Continuous Positive Airway Pressure (CPAP) - This ventilatory adjunct is used only

    with spontaneous ventilation; the patient breathes spontaneously through thewith spontaneous ventilation; the patient breathes spontaneously through the

    ventilator at an elevated baseline pressure throughout the breathing cycle.ventilator at an elevated baseline pressure throughout the breathing cycle.

    f. Pressure Support (PS) - Spontaneous ventilation with pressure support (PS). Thef. Pressure Support (PS) - Spontaneous ventilation with pressure support (PS). The

    patient breathes spontaneously with pressure assistance to each spontaneouspatient breathes spontaneously with pressure assistance to each spontaneous

    inspiration.inspiration.

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    Controlled Ventilation - A preset volume of gas is delivered to theControlled Ventilation - A preset volume of gas is delivered to the

    patient under positive pressure while spontaneous patient respiratorypatient under positive pressure while spontaneous patient respiratory

    effort is locked out.effort is locked out.

    Assist/Controlled Ventilation (A/C) in this mode, a preset volume of gas isAssist/Controlled Ventilation (A/C) in this mode, a preset volume of gas isdelivered to the patient at a preset rate, but the patient may trigger a ventilatordelivered to the patient at a preset rate, but the patient may trigger a ventilator

    breath with negative inspiratory effort.breath with negative inspiratory effort.

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    Positive End Expiratory Pressure (PEEP) -Positive End Expiratory Pressure (PEEP) -

    mobilize bronchial secretions therapy withmobilize bronchial secretions therapy with

    small volume nebulizer aerosols.small volume nebulizer aerosols.

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    Continuous Positive Airway Pressure (CPAP)Continuous Positive Airway Pressure (CPAP) is a treatment that

    delivers slightly pressurized air during the breathing cycle. This

    keeps the windpipe open during sleep and prevents episodes of

    blocked breathing in persons with obstructive sleep apnea and

    other breathing problems.

    http://doctorshosp.adam.com/content.aspx?productId=39&pid=1&gid=000811http://doctorshosp.adam.com/content.aspx?productId=39&pid=1&gid=000811
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    Synchronized IntermittentSynchronized Intermittent

    Mandatory Ventilation (SIMV) Intensive Care UnitMandatory Ventil