tailieunhanh - Oxford Handbook of Critical Care, 2nd Edition

A smal l proportion of patients in chronic Type II (hypoxaemic, hypercapnic) respi ratory fai lure wi l l develop apnoea i f their central hypoxic drive is removed by supplemental oxygen. However, this is seldom (if ever) abrupt and a period of deterioration and increasing drowsiness wi l l alert medical and nursing staff to consider ei ther (i) FIO2 reduction if overal l condition al lows, (i i) non-invasive or invasive mechanical ventilation if fatiguing or (i i i) use of respiratory stimulants such as doxepram. The corol lary is that close supervision and moni toring is necessary in al l critically. | Editors Singer Mervyn Webb Andrew R. Title Oxford Handbook of Critical Care 2nd Edition THE INDISPENSABLE GUIDE TO CRITICAL CARÈ MtCHClNE CRITICAL CARE Coven the daily management SECOND EDITION of problem in the ICU Problem orientated Detailed and authoritative Mervyn Siryffir Andrew R Webb Copyright 1997 2005 M. Singer and A. R. Webb c Ovid Oxford Handbook of Critical Care Editors Singer Mervyn Webb Andrew R. Title Oxford Handbook of Critical Care 2nd Edition Copyright 1997 2005 M. Singer and A. R. Webb 1997 2005. Published in the United States by Oxford University Press Inc Table of Contents Respiratory Therapy Techniques Respiratory Therapy Techniques Oxygen therapy All critically ill patients should receive additional inspired oxygen on a more not less is best philosophy. Principles High flow high concentration oxygen should be given to any acutely dyspnoeic or hypoxaemic patient until accurate titration can be performed using arterial blood gas analysis. In general maintain SaO2 90 though preferably 95 . Compromises may need to be made during acute on chronic hypoxaemic respiratory failure or prolonged severe ARDS when lower values may suffice provided tissue oxygen delivery is maintained. All patients placed on mechanical ventilation should initially receive a high FIO2 until accurate titration is performed using arterial blood gas analysis. Apart from patients receiving hyperbaric O2 therapy . for carbon monoxide poisoning diving accidents there is no need to maintain supranormal levels of PaO2. Cautions A small proportion of patients in chronic Type II hypoxaemic hypercapnic respiratory failure will develop apnoea if their central hypoxic drive is removed by supplemental oxygen. However this is seldom if ever abrupt and a period of deterioration and increasing drowsiness will alert medical and nursing staff to consider either i FIO2 reduction if overall condition allows ii non-invasive or invasive mechanical ventilation if fatiguing or iii use of .

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