Ventilation Specifics: Obstructive Lung Disease (COPD / Asthma)
Ventilation is frequently commenced in the Emergency Centre following intubation. The following suggested principles for specific medical conditions are based on the pathophysiology of the condition and settings should be tailored to each patient individually.
Ventilation is frequently commenced in the Emergency Centre following intubation.
The following suggested principles for specific medical conditions are based on the pathophysiology of the condition and settings should be tailored to each patient individually.
Two large groups of patients will be ventilated in the EC, the patient with obstructive lung disease (COPD / Asthma) and patients with lung injury or patients susceptible to lung injury (Pneumonia / ARDS.) For each of these groups basic ventilator principles are suggested.
Obstructive lung disease (COPD / Asthma)
Aim is to limit intrinsic PEEP (auto PEEP / air-trapping) and allow optimal expiratory time. iPEEP ↓ venous return, impairs expiration & spontaneous ventilation.
| Mode | Assist Control (A/C) |
| Vt | 6 ml/kg |
| RR | 10 (Aim I:E ratio of 1:3 to 1:5; Titrate rate accordingly can decrease to 6 bpm) Permissive hyper-capnoea to pH 7.20 |
| IFR | 80 - 100 litre per minute (increase to facilitate I:E ratio) |
| PEEP | 0 – 3 cmH2O |
| FiO2 | 0.4 (40%) titrate according to requirements. (COPD can decrease to 0.28) |
Patients will need appropriate sedation / opioids.