Electrolyte Imbalances During Mechanical Ventilation

Numerous factors contribute to ventilator dependence. However, one should focus on identifying factors that are potentially reversible. Electrolyte imbalances have a direct relationship to weaning from mechanical ventilation. 

Below is a summary of different electrolytes and how their imbalances may prolong mechanical ventilation. 

Inhaled Nitric Oxide Set-up for Cardiac Surgery

Another use for inhaled nitric oxide is for lowering pulmonary vascular resistance during cardiothoracic surgery. Administration is common during mitral valve replacements, heart transplants, and implantation of left ventricular assist devices.   

One concern is interfacing the INOVent with the anesthesia machine, primarily preventing "Nitric Dioxide" build up.

Here are the steps to interface the INOVent with the anesthesia machine:

The Worst Modes of Mechanical Ventilation

IMV one of the worst ventilator modes in regards to patient comfort. 

Many will argue the best mode of mechanical ventilation and prefer the mode that is most commonly used in their patient populations. Strict believers of the ARDS net protocol will favor VC-CMV to ensure lower tidal volume delivery. Pediatric centers will insist on Pressure targeted modes to limit high pressures, and trauma centers may favor biphasic modes of ventilation to obtain higher mean airway pressures.

However, some institutions use the worst modes of ventilation that directly impede on patient comfort. Promoting patient comfort is one of the main goals of mechanical ventilation [1] and not providing comfort may lead to over sedation, over ventilation, ventilator induced diaphragmatic dysfunction, and increased length of stay.

So what are the worst modes of ventilation specifically in regards to patient comfort?

Inhaled Nitric Oxide Set-up for Nitric Oxide Challenge

One off label use of inhaled nitric oxide is to use it to see if a patients pulmonary hypertension is responsive to vasodilator therapy. 

Due to inhaled nitric oxides quick onset and extremely short half life the "nitric oxide challenge" can be performed safely and efficiently in a cardiac cath lab.  

There are a few standard protocols which I will not go over, however I will go over device and patient interface setup for performing a nitric oxide challenge.