Page 543 - Clinical Application of Mechanical Ventilation

Critical Care Issues in Mechanical Ventilation 509

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Cerebral Blood Flow ml/100g/min 50

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0
22.5 45 67.5 90
PaCO 2 (mm Hg)
Figure 15-3 Cerebral blood flow in relation to the arterial carbon dioxide tension. There is no
significant reduction in cerebral blood flow below a PaCO 2 of 26 mm Hg.

lower cerebral blood flow and intracranical pressure. The PaCO may be titrated
2
to a level as low as 26 torr during the first 24 hours of mechanical ventilation.
Hyperventilation should not cause the PaCO level to go below 26 mm Hg (3.5
To maintain minimal 2
cerebral oxygenation, the kPa) because there is no additional beneficial effect on the ICP with a PaCO below
2
PaO 2 and SaO 2 should be kept 26 mm Hg (Figure 15-3) (trauma.org , 2011).
2
above 60 mm Hg and 90%,
respectively. Arterial oxygen saturation should be monitored, and the PaO and SaO should
2
2
be kept above 60 mm Hg and 90%, respectively (Brain Trauma Foundation, 2011).

SUMMARY

Mechanical ventilation is a common procedure in the ICU and other nontraditional
settings. ALI/ARDS, VAP, HIE, and TBI are some critical care issues that are frequently
encountered by respiratory therapists. This chapter provides a review of these issues.
Management of critically ill patients can be complicated and tedious. Weaning from
mechanical ventilation is not possible until the patients are free from ALI/ARDS and
VAP. For the best patient care, readers are encouraged to keep abreast of current
ventilator-related critical care topics.

Self-Assessment Questions

1. A PaO /F O of #200 mm Hg is a characteristic of patients with:
2
2
I
A. ventilator-associated pneumonia. C. hypoxic-ischemic encephalopathy.
B. acute lung injury. D. acute respiratory distress syndrome.

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