Ventilator Troubleshooting Summary High PIP, nl Pplat: - DDx: Tubing problem, Bronchospasm, Secretions - Next Steps: Check for kinks, Nebs, Suction High PIP, high Pplat: - DDx: Mainstem intubation, PTX, Alveolar filling, Obesity/Distention - Next Steps: BS, CXR, Bowel reg, Para, etc. Auto-PEEP: - DDx: Obstructive lung disease, Insufficient expiratory time - Next Steps: ↓ RR, ↓ I:E ratio, ↑ IFR, PEEP = 2/3 auto-PEEP, Bronchodilators/Steroids Hypoxemia: - DDx: Vent issue, PTX, Alveolar filling, PE - Next Steps: Bag, BS, CXR, CTPE Fighting the vent: - DDx: Pain, Dynamic hyperinflation, Ischemia, Distention, Undersedation - Next Steps: Treat underlying cause, ↑ Sedation Dr. Nicky Singh @nickysinghmd via MGH IM Residents @mghmedres #Ventilator #Troubleshooting #diagnosis #management #pulmonary #mechanical #ventilation
