What are commonly accepted indications for intubation?
BiPAP or CPAP is commonly used in patients suffering from an acute exacerbation of COPD, prior to intubation.
How does BiPAP help in this situation?
What is the approximate number needed to treat to prevent one intubation?
Besides its use in acute on chronic respiratory failure (i.e., COPD exacerbations), what are the clinical settings in which CPAP and/or BiPAP have been studied and shown to be potentially advantageous?
After intubation, what ventilator settings would you recommend? Why?
Mode: _____________
TV: _____________
PEEP _____________
Rate: _____________
FIO2: _____________
Describe the difference between pressure-cycled and volume-cycled ventilators.
How would know if the tidal volume you chose was too large? Or too small?
What would be your explanation if immediately after intubation the patient's BP were?
High ?
Low ?
What type of respiratory failure is a patient with COPD most likely to develop and why?
What is the underlying mechanism of hypoxemia in patients with COPD? Is the hypoxemia typically easily responsive to supplemental oxygen or relatively refractory?
Based upon the available data, what is the static compliance?
Is the peak to plateau pressure gradient most consistent with increased airways resistance or diminished lung compliance?
What is the most likely explanation for the drop in blood pressure?
What ventilator adjustments would be expected to reduce auto-PEEP (intrinsic Peep or dynamic hyperinflation) if present?
What is the patient's calculated statis compliance?
What are the clinical criteria for ARDS?
What general type of respiratory failure do patients with ARDS suffer from?
What is the underlying mechanism of hypoxemia in patients with ARDS? Is the hypoxemia typically easily responsive to supplemental oxygen or relatively refractory?
What might you do to increase the pO2 in this patient?
Discuss an overall approach to weaning. List the standard “weaning parameters” and the values for each which predict successful weaning. Describe key components of the Loyola weaning protocol (see attached). Finally, discuss the results of studies comparing the use of SIMV, Pressure Support, and T-Piece Trials in weaning from mechanical ventilation.