We go through some basic concepts of respiratory mechanics, starting from the goals of ventilation therapy. Actually, I have never found this clearly stated in any of the books, so here is what I think the respirator is for in our NICU-patients (who either have increased ICP, in which case they are deeply sedated, or not, in which case they should be as awake as possible as long as they tolerate the tube [this means analgesia or dexmedetomidine or clonidine]):
- Monitor the patient’s respiratory efforts – this is only diagnostic!
- Compensate for the increased effort of breathing through a tube (which is necessary b/c the patient has no gag or swallowing reflex)
- Get in the oxygen (oxygenation)
- Get out the CO2 (ventilation)
- Keep the lung open (avoid dystelectasis) – this is best achieved by letting the patient breathe on his own.
My main goal in this task is not to make all of my colleagues respiratory experts but to have them understand the settings in a ventilator of a patient they have to gauge clinically.