RT Book, Section A1 Schmidt, Gregory A. A1 Hall, Jesse B. A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107718504 T1 Management of the Ventilated Patient T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accesssurgery.mhmedical.com/content.aspx?aid=1107718504 RD 2024/03/28 AB Effective preventive measures in ventilated patients include raising the head of the bed, employing measures to prevent venous thromboembolism, avoiding unnecessary changes of the ventilator circuit, reducing the amount of sedation, and providing oral care with chlorhexidine.Even patients with normal lungs may benefit from limited tidal volumes to reduce the risk of ventilator-induced lung injury causing progression to acute respiratory distress syndrome.Critical illness and mechanical ventilation combine to impair strength of respiratory muscles and produce atrophy. This tendency can be reduced by setting the ventilator in a way as to preserve inspiratory muscle contraction.Whenever the adequacy of oxygen exchange is in question, the initial fraction of inspired oxygen (FiO2) should be 1.0; this will be diagnostic as well as therapeutic, since failure to achieve full arterial hemoglobin saturation identifies a significant right-to-left shunt.The choice of ventilator mode is relatively unimportant: more relevant is to use the ventilator with full understanding of the principles of lung protection, ventilator-induced diaphragm dysfunction, autoPEEP, and patient-ventilator synchrony.The patient with severe airflow obstruction often develops hypoperfusion after institution of positive-pressure ventilation as a result of autoPEEP; this responds to temporary cessation of ventilation and vigorous volume resuscitation, while measures are employed to reduce airflow obstruction and reduce the total minute ventilation.The patient with acute hypoxemic respiratory failure (AHRF) resulting from pulmonary edema benefits from lung-protective ventilation (6 mL/kg ideal body weight and rate approximately 30 breaths/min). The initial FiO2 of 1.0 can be lowered to nontoxic levels by raising positive end-expiratory pressure (PEEP), guided by pulse oximetry or measures of recruitment.