Hypoxemia, Hypercapnia, Hypoxia - Hypoxemia: reduced partial pressure of oxygen in blood o Normal PaO2: 80 - 100 mmHg · Less than 80 is clinical hypoxemia Less than 60 is respiratory failure / acute situation · Can be measured via ABG o Causes: altitude, hypoventilation, mismatch alveoli to arterial level (pneumonia, COPD), vasoconstriction · Lead to metabolic acidosis, cyanosis, clubbing · Compensation: 1 HR, BP, diaphoresis, 1 RBC, hyperventilation - Hypercapnia o Definition: increase in CO2 in blood o Range: more than 45 mmHg . Normal: 35 - 45 mmHg - Hypoxia: reduced oxygen level at tissue o Cannot measure hypoxia (tissue level) o Causes: decreased cardiac output / hypoxemia cause tissue to die / anemia (less RBC to transport oxygen to tissue) - Ischemia o Reduced blood flow to tissues (blood vessels) o Cause: trauma that cut off blood supply -+ hypoxia -+ tissue death Ventilator - Mechanical ventilation is a machine that takes over the work of breathing when a person is not able to breathe enough on their own. o Indications: inability to protect airway, increased work of breathing, to facilitate suctioning of the bronchial tree - High pressure alarm (DOPE) o Interventions for each problem o D: dislodged or displaced tube o O: obstruction of tube (mucus plug, kink) o P: pneumothorax o E: equipment malfunction oHigh pressure alarm: kink tubing, pt biting ETT/oral airway ( sedation), secretion (suction), coughing, foreign body (mucus plug), pulmonary edema, pneumothorax · NSG: auscultate lung for pulmonary edema . Two PB sandwiches can make you SICK - Pulmonary edema, pneumothorax - Bronchospasm, biting - S: secretion - C: cough - K: kink Functions of settings - Modes: settings that control how a ventilator delivers breaths to pt o Low pressure alarm: vent disconnected from ET (reconnect), cuff leaking (notify MD), extubate (initiate bag valve mask / ambu bag) o Selected based on respiratory needs - VT - Tidal volume: volume intake o Normally pt needs 300 mL so try not give too much volume o Volume of air set to be delivered with each breath o 500 - 800 ml of air typically normal o 4-8 mL/kg ideal body weight / 6 mL/kg commonly used - f/RR o Frequency of respiratory rate (# of breaths / min) - 12 -20 RR o Calculated based on ABG - FiO2 o Oxygen concentration (21 - 100%) · Higher more severe o 50 % - 0.5 - documented in decimal points oWhen SpO2 is abnormal (hypoxemia), adjust FiO2 - PEEP (Positive End-expiratory Pressure) o Ideal target is 5 (range: 5 - 30) oWhen you PEEP alveoli expand o Can cause hypotension (4 cardiac output) o Pressure you need during expiratory pressure to maintain alveoli open o Keeps alveoli open with positive pressure at the end of respiration (expiration) o Improves gas exchange - keep alveoli open to push oxygen & expel CO2 out · Especially with ARDS - fluid in alveoli blocking gas exchange · PEEP Pushes open alveoli · Excessively high levels