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Monday, February 3, 2014

A Synopsis of Strategies in Difficult Intra-Operative Ventilation


Image from: http://www.esicm.org

“Strategies in Difficult Intra-Operative Ventilation” was a continuing education course originally presented at the 2012 American Academy of Anesthesiologist convention. 

Now the course is available online through the ASA website for continuing education units. I would not recommend this course for the ICU practitioner because it overviews strategies that we practice daily or weekly, however for the anesthesia provider that is not familiar with lung protective strategies the course may be beneficial. 

Below is a synopsis of the course and a hyperlink to the website. 


This course is divided into four separate lectures;

WHAT DO PEOPLE ACTUALLY DO?

Summary
Overviewed current strategies for management of mechanical ventilation in the OR.
Conclusion
-During hypoxic episodes practitioners increase the FiO2, set tidal volume, and then lastly PEEP. 
-In the OR, patients’ with ARDS are ventilated with higher tidal volumes, higher FiO2’s, & lower PEEP. Compared to ICU ventilation strategies.
Significance
Anesthesia Practitioners are still behind in regards to lung protective ventilation, and techniques to improve oxygenation.


STRATEGIES for MONITORING MECHANICAL VENTILATION

Summary
-Presented what happens in regards to pulmonary mechanics during general anesthesia.
-Overview of common monitoring devices (including- SPO2, capnography, & ventilator waveforms) that are currently in use to assess the patient and optimize ventilator settings.
Conclusion
Use monitoring to facilitate in optimize settings & identify potential complications.
Significance
Anesthesia providers can utilize these monitoring techniques in their daily practice to optimize ventilator settings.


INTRA-OPERATIVE VENTILATION in PATIENTS’ with ARDS

Summary
Presented the definition of ARDS, differentiated between extra-pulmonary versus pulmonary ARDS and over-viewed the significance of various techniques in ventilating the patient with ARDS.
Conclusion
Target goals when ventilating the patient with ARDS.
  1. Spo2 low to mid 90's.
  2. Use PEEP, especially in patients with high abdominal pressures.
  3. Avoid hyperventilation.
  4. Monitor Dead space ventilation
  5. Avoid over-distention
Significance
Anesthesia providers may have to provide anesthesia for the ICU patient with ARDS. Lung protective strategies are very different then standard techniques.


GETTING it DONE

Summary
Presented a case study of an ICU patient with sepsis (question and answer format). Overviewed clinical pearls and potential pitfalls.
Conclusion
Always evaluate your patient thoroughly before just merely transporting the patient and switching ventilator modes. Current ICU ventilator settings may not provide the entire picture of the patient’s clinical status.
Significance
The anesthesia ventilator may work differently than the ICU ventilator.

Course Link: http://education.asahq.org/2012-highlights/DIV

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