We have done a cheat sheet for ventilating ICU patients on anaes machines
This is the basic outline
I thought I should explain the points in a little more detail!
*Thread*
1/n
This is the basic outline
I thought I should explain the points in a little more detail!
*Thread*
1/n
1. Problems with machine should be escalated to consultant, registrar or ODP: self explanatory. These are people likely to have more experience using these machines
2. Leave machine in ventilator mode rather than bag: the bag is pure spont. With no backup.
So makes sense 2/n
2. Leave machine in ventilator mode rather than bag: the bag is pure spont. With no backup.
So makes sense 2/n
3. Do not fiddle with APL valve: the APL valve is for manual/spont ventilation. Should not need to use it for ARDS/ COVID patients. If recruitment is needed: use the ventilator
3/n
3/n
4. Leave total gas flow at 6L/min.
During an anaes, I’d go to 0.5L. But that is for short durations of time- Not days
Higher flows help preserve soda lime- some CO2 clearance happens by flow
Also, because of flowmeters, can’t just dial up FiO2. So look at machine for FiO2
4/n
During an anaes, I’d go to 0.5L. But that is for short durations of time- Not days
Higher flows help preserve soda lime- some CO2 clearance happens by flow
Also, because of flowmeters, can’t just dial up FiO2. So look at machine for FiO2
4/n
4. Contd
Also, higher Gas flow introduces higher bias flow, which is useful when patient is on a synchronised mode.
So they can actually initiate a breath without feeling like they’re breathing against a closed valve
5/n
Also, higher Gas flow introduces higher bias flow, which is useful when patient is on a synchronised mode.
So they can actually initiate a breath without feeling like they’re breathing against a closed valve
5/n
5. & 6. Change HME daily: the license for our HMEs is 24 hours.
Also, they tend to get waterlogged and introduce high resistance in the circuit. If ventilation is difficult, first step should be to clamp the tube (preserve recruitment), and change HME
6/n
Also, they tend to get waterlogged and introduce high resistance in the circuit. If ventilation is difficult, first step should be to clamp the tube (preserve recruitment), and change HME
6/n
7. If there’s visible water in the circuit, drain it.
This condensate will have high viral load. So be careful
8. Change soda lime when it changes colour: so it continues to be effective
7/n
This condensate will have high viral load. So be careful
8. Change soda lime when it changes colour: so it continues to be effective
7/n
9. ICU patients need in line closed suctioning regularly. ICU ventilators compensate for this.
But most anaes machines will have the bellows emptied.
Turn up flow rates to 10L/min to fill the bellows
8/n
But most anaes machines will have the bellows emptied.
Turn up flow rates to 10L/min to fill the bellows
8/n
10. Oxygen flush button:
We have recommended this is Never used. It can fill bellies quickly, but can subject lungs to 4bar pressure. And flow of upto 60L/min
This can cause barotrauma and volutrauma.
Do not use.
9/n
We have recommended this is Never used. It can fill bellies quickly, but can subject lungs to 4bar pressure. And flow of upto 60L/min
This can cause barotrauma and volutrauma.
Do not use.
9/n
11. Anaes machines are designed to be rebooted and calibrated daily (generally). So they will alarm when this doesn’t happen
We have confirmation from GE that our machines can run for 49 days.
Please check your manufacturer instructions
10/n
We have confirmation from GE that our machines can run for 49 days.
Please check your manufacturer instructions
10/n
12. We have identified best ventilator modes for our machines.
Your decision would be based on what machines and ventilators you have. And the mechanism: bellows/bag in bottle or piston
11/n
Your decision would be based on what machines and ventilators you have. And the mechanism: bellows/bag in bottle or piston
11/n
13. Because anaes machines aren’t designed to be used with awake patients, most have a synchronisation lag- so there’s appreciable time between patient initiating a breath, and ventilator responding with support
This can manifest as dys-synchrony, ‘sucking’ or ‘air hunger’
12/n
This can manifest as dys-synchrony, ‘sucking’ or ‘air hunger’
12/n
13 contd
To avoid this (depending on your anaes machine), we are recommending patients are kept deeper than usual on our ICU
Patients MUST be deeply sedated before you paralyse them
13/n
To avoid this (depending on your anaes machine), we are recommending patients are kept deeper than usual on our ICU
Patients MUST be deeply sedated before you paralyse them
13/n
14. Anaes machine ventilators are not as sophisticated (generally) as modern icu vents.
They’re designed for short duration, low flow, vapour efficient anaesthesia ventilation. Not ARDS
Please try and put patients that are easier to ventilate on Anes machines
14/n
They’re designed for short duration, low flow, vapour efficient anaesthesia ventilation. Not ARDS
Please try and put patients that are easier to ventilate on Anes machines
14/n
This has been an education for me!
Using a machine is so much easier than producing instructions for novices!
I had great support from the twitter #FOAMED community
Thank you. 15/15
Using a machine is so much easier than producing instructions for novices!
I had great support from the twitter #FOAMED community
Thank you. 15/15
Loading suggestions...