28
Oct
2016

Hypoxic Respiratory Failure — ICU AM Report

Etiologies

  • Low inspired FiO2
  • Impaired Diffusion
  • Alveolar Hypoventilation
  • Shunting
  • V/Q Mismatch

Low Flow Devices

  • NC (Up to 6L)
    • FiO2 Estimation = L/min x 4 + 20
  • Oxymyzer 10-15L (max FiO2 (50-60%, use the formula above)
  • Venti Mask (Up to 15L, max FiO2 60%)
  • Nonrebreather Mask (85%-90%)

High Flow Devices

  • Blender (Max 100%)
  • Noninvasive Ventilation
    • CPAP
    • BiPAP
      • IPAP
      • EPAP
      • The difference between these two is called “pressure support”
    • Patient Scenarios (BiPAP vs CPAP)
      • A: 7.35/32/50 — CPAP because this guy is just hypoxic, note that he is not retaining CO2
      • B: 7.25/72/60 — BiPAP, not the retaining of CO2
      • C: 7.23/60/40 — BiPAP, he does have both retaining of CO2 and hypoxia, placing him on CPAP would not help is retention of CO2
      • D: 7.36/70/65 but is chronic — Nothing! This is a chronic retainer (probably OSA/COPD who has compensated with high bicarb overtime) — if you put him on BIPAP he will crash because his respiratory drive is based on hypercapnia.

Contraindications to noninvasiveĀ 
– Do not use noninvasive ventilation in pneumonia patients (you want to encourage coughing up sputum)
– Altered Mental Status
– Hemodynamic Instability (you expect drops in blood pressure)
– Severe acidosis (below pH 7.1)
– Facial injuries/trauma/abdominal surgery
– Massive secretions

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