TEST - Book of PDFs-01_Bowton_IIS Hypoxemic Resp Failure Bowton -CHEST 2016

01_Bowton_IIS Hypoxemic Resp Failure Bowton -CHEST 2016_CMS PC.pptx

Pdf Summary

This document is a presentation on the topic of PEEP (Positive End Expiratory Pressure) and its effects on cardiovascular and pulmonary function. It discusses the different clinical settings in which PEEP can have positive or negative effects on the cardiovascular and pulmonary systems. The presentation also covers strategies for titrating PEEP in order to optimize outcomes in patients.<br /><br />The case presented in the document involves a 54 year old man with severe hypoxemic respiratory failure due to influenza. Despite being placed on mechanical ventilatory support and having his PEEP increased from 12 to 17 cm H2O, the patient becomes hypotensive. The most likely explanation for his hypotension is reflex vasodilation.<br /><br />The document goes on to discuss the hemodynamic effects of PEEP, including its impact on RV (Right Ventricle) preload and afterload, as well as LV (Left Ventricle) preload and afterload. It also covers the effects of PEEP on RV dysfunction in patients with ARDS (Acute Respiratory Distress Syndrome) and its protective effects on lung injury.<br /><br />The document highlights the fact that ARDS is a non-homogenous lung condition and that CXR (Chest X-ray) appearance is not always concordant with CT (Computed Tomography) findings. The implications of CT patterns on lung recruitment and susceptibility to overdistension are discussed.<br /><br />The presentation also covers the titration of PEEP and TV (Tidal Volume) and the importance of keeping plateau pressure within a safe range. It discusses the relationship between driving pressure and mortality in ARDS patients.<br /><br />A stress index is also mentioned, which can help guide PEEP and TV adjustments. The document provides an illustration and example of how to use the stress index to determine the most appropriate PEEP and TV settings.<br /><br />Overall, the document provides valuable information on the effects of PEEP in various clinical settings and offers strategies for titrating PEEP to optimize patient outcomes.

Keywords

PEEP

cardiovascular function

pulmonary function

clinical settings

titrating PEEP

RV preload

RV afterload

LV preload

LV afterload

ARDS