SPONT - Spontaneous Breathing = Pressure Support Ventilation Summary Basic Set Parameters: 1) Pressure Support (PS) 2) PEEP 3) FiO2 4) Can adjust the trigger type and sensitivity What's Happening: - The pt initiates the breath & must do some of the work of breathing (↓PS means the patient ↑work). Thus, the pt determines the rate and tidal volume. - Pressure support is additive to the PEEP! Ex: PS 12/6 means that in inspiration the patient receives 18 cmH2O of support. 0/6 = CPAP Best for: For awake patients that have no significant pulm pathology Downside: Only can be used in pts that have resp drive and participate What's RSBI? Rapid Shallow breathing index. Marker of lung "strength" see Purple Card Patient apneic? Most common cause is they had been hyperventilated (ASV the usual culprit). Decrease min vent & try again later Who is ready for Extubation? - The reason they got intubated has improved. - Should be awake and mimicking commands - Can pull consistent Vt > 8cc/kg at 6/6. - Have passed a true SBT (pulling good tidal volumes @ 0/6) +/- cuff leak depending on circumstance - Good neck strength - a surrogate marker of diaphragm strength Casey Albin, MD @caseyalbin #Spontaneous #Breathing #Pressure #Support #mechanical #Ventilation #pulmonary
