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Tài liệu Mechanical Ventilation for children with Lung Disease: ALI, ARDS, and Hypoxemic Respiratory
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Mô tả chi tiết
Mechanical Ventilation for
children with Lung Disease
ALI, ARDS, and Hypoxemic Respiratory
Failure.
How should I manage these patients in
the OR?
Roby Khemani MD MsCI
USC Keck School of Medicine
Childrens Hospital Los Angeles
Case Presentation
• 9 year old male with Leukemia with respiratory
failure from Adenovirus pneumonia.
• 3 days into ICU course develops acute upper GI
bleed.
• Several attempts at endoscopic control of
bleeding unsuccessful.
• Has received 8 units of PRBCs over past 24 hours
and still having ongoing losses.
• Surgical team wishes to take child to OR for
exploratory laparatomy to control bleeding.
Current Support
• Conventional Mechanical Ventilation
– SIMV Pressure Control + Pressure Support
• Rate 20; Peak Inspiratory Pressure 32; PEEP 12; FiO2 0.6
• Last ABG; 7.28/62/60/+3
• Lung Disease Severity Indicators
– PaO2
/FiO2 Ratio : 100
– Oxygenation Index (MAP *FiO2
/PaO2
) *100 = 19
• Fentanyl, Midazolam, Octreotide Infusions
• No inotropes or Vasopressors
Questions?
• How do I identify who is at high risk for
worsening lung injury or poor outcome?
• What type of ventilator management strategy
should I employ for this patient in the
operating room?
• Any other adjuvant therapies/management I
should be considering when managing this
patient interoperatively