00:00
Now, treatment, all depends.
I mean, this could be all over the place.
00:04
If your patient is suffering from
issue such as asthma or COPD,
then maybe you’re
thinking about steroids.
00:11
But, if it’s pneumonia that’s
resulting in chronic type of issues,
maybe it’s antibiotics and with
acute respiratory distress syndrome,
here once again, well,
ventilatory support,
which is a highly hot topic
for you on the boards.
00:27
Becomes important for at least,
introduce a few ventilatory
support assisted
control type of
modes of respiration.
00:37
You’ll see.
00:38
Continue.
00:39
Options include the following.
00:41
Oxygen, it’s not really
ventilatory support,
so you want to be careful here.
00:47
With oxygen, remember, if your patient
is already accustomed to low oxygen
and is breathing normally,
and then all of a sudden, you introduce
more oxygen, that could be a problem.
00:57
Be very careful.
00:58
Non-invasive.
We’ll talk about in great detail.
01:01
These include your BiPAP or
non-invasive type of ventilator.
01:04
NIV, it’s non-invasive
ventilation here.
01:07
And intubation, of
course, will be your mode,
we’ve talked about that child
who had respiratory muscles
that then became
tired and fatigued
and therefore,
resulted in retention of carbon dioxide
and perhaps the
death of the child.
01:22
So, we’ll talk about
endotracheal ventilation,
but mechanical ventilation
becomes important.
01:27
Okay. Now, what are the indications
for ventilatory support?
What are they?
Hypoxia.
01:33
PO2 of what? A 60.
01:35
Oxygen.
01:37
Next, hyperbaric or hypercarbic
ventilatory support,
when PCO2 is greater than
50 with the decreased pH.
01:44
You wanna be careful with that
carbon dioxide being elevated.
01:46
Not a good thing.
01:48
So this is indications for various
types of ventilatory support
that we shall walk through.
01:53
Shock, major trauma,
airway protection
and much more important
than any cut-off
is your clinical
impression of the patient.
02:01
But, that’s more about practice.
02:03
Let’s make sure that you are completely
clear about what kind of gas values
are the cut-off point
for you to seriously
start thinking about
next step of management.
02:13
Ventilatory support.
02:18
Now, what about these
non-invasive ventilations
that you wanna be familiar with?
We’ll walk through here a few
and then, we'll take a little
break from some of our modes
and then when we get
into our next topic,
what we’ll do is we’re
gonna hit that hard.
02:35
We’ll hit the modes especially,
we’ll talk about the
terminology and what it means.
02:39
But, here, let’s first begin
by laying down the foundation.
02:42
So, CPAP is something that you
wanna be extremely familiar with.
02:45
It’s continuous positive
airway pressure.
02:52
A positive on purpose,
because here, physiologically it’s
important for you to understand.
02:56
Why? For the following reasons.
02:59
Normal breathing mechanics.
03:01
Tell me quickly, what happens to diaphragm
upon contraction when you wanna inhale?
Contract, moves downwards.
03:08
Good.
03:09
What’s your next step?
The pleural pressure,
which is how much?
To begin with, you are at FRC.
03:16
Oh, boy.
03:18
Pleural pressure was
negative, approximately -5.
03:21
With the diaphragm
contracting and then now,
the pleural pressure
becomes more negative.
03:25
The more that your pleural
pressure becomes negative,
what happens to your lung?
It expands.
03:32
Is that clear?
In the meantime, there are a couple
of things that this then causes.
03:37
So,
upon let’s say from -5 to -8,
your pleural pressure
becomes negative.
03:42
Do you remember
that from physio?
Bring that here.
03:45
Next, as it does so,
then what happens to alveoli?
Its pressure becomes negative.
03:50
You’re gonna suck in the
air, like a straw.
03:54
Clear?
Clear.
03:55
In the meantime,
what about that recoil force?
The recoil force
has to then equal
that increased negative
pleural pressure.
04:03
That’s just simple
lung mechanics.
04:06
Think of it as being a straw
sucking in all the different things
that has to occur in
order for that to happen.
04:13
That’s a negative pressure
that’s doing what to alveoli?
Expanding. And that’s my point.
04:19
In physio, you know that you have
to cause a negative pressure, right?
In order for your
alveoli to expand.
04:27
Let’s say that the lungs cannot.
04:29
Say there is some kind of indication,
maybe it’s the PCO2 being above 50,
the PO2 being less than 60 mmHg.
04:36
Maybe there’s an indication or maybe your
patient has obstructive sleep apnoea.
04:42
And at this point,
you have to get ventilatory support.
04:46
This is going to come in the way of
continuous positive airway pressure.
04:51
Keep that in mind.
04:52
You understand the significance now
and how different this is than physio.
04:57
You will see the
consequences coming up.
04:58
Used acutely more for hypoxic
failure, CHF especially.
05:03
Commonly used chronically to stent
open upper airway obstruction,
especially sleep apnea.
05:10
Think of obstructive
sleep apnoea,
but the only way that
you can keep it open
is literally introducing
positive pressure.
05:17
We’ll talk a little bit more.
05:19
BiPAP is bi-level
positive airway pressure.
05:22
Used acutely for hypoxic
and hypercarbic failure,
very effective in COPD.
05:28
This would be the next step
of management in terms of
really being able to control
the breathing of your patient.
05:34
Good evidence of support its use
and how common is
immunosuppressed patient?
Quite common.
05:42
So, immunocompromised,
immunosuppressed patients,
let it be something like HIV,
or, of course,
on immunosuppressive therapy.
05:49
And you see more and more
and more of these patients,
so this becomes incredibly
important for you.
05:53
This is known as BiPAP.
05:55
Bi-level positive
airway pressure.