The airway in obese patients

Slides:



Advertisements
Similar presentations
Non-invasive Ventilation
Advertisements

Respiratory Physiologist Dr Bruce Thompson Head, Physiology Service.
Improving Oxygenation
Mechanical Ventilaton Ramon Garza III, M.D.. Indications Airway instability Most surgical patients or trauma Primary Respirator Failure Mostly medical.
Educational Resources
CPAP Respiratory therapy EMT-B. CPAP Overview  Applies continuous pressure to airways to improve oxygenation.  Bridge device to improve oxygenation.
DAS Guidelines update April 2015
Basic Airway Management: Bag-Mask Ventilation Pat Melanson, MD.
ESPCOP 14 nov 2009 Ostend JPM Sint Jan Brugge-Oostende “The sea” from Georges Gerard Better known as “fat Mathilde.
Dr Tristan GR Dyer RCSEd Fellow in Pre-hospital Emergency Medicine.
Continuous Positive Airway Pressure in the Neonatal Intensive Care Level 1 Mark A. Willing, RRT-NPS.
Airway obstruction Trauma foreign bodies inflammation hematomas CNS disease secretions Drug overdose Infections glottitis Obstructive sleep apnea.
New Orleans EMS Airway Lecture Series: Lecture 2 Oxygenation and Bag-Mask Ventilation Jeffrey M. Elder, M.D. Deputy Medical Director.
Obesity in obstetrics Tom Archer, MD, MBA UCSD Anesthesia.
Respiratory Changes Oxygen consumption increase 25-35%  100% in labor Minute ventilation ↑ in excess of CO2 mainly due to increased TV not RR  tachypnea.
Objectives Discuss the principles of monitoring the respiratory system
Copyright 2008 Society of Critical Care Medicine Mechanical Ventilation 2.
Ventilator.
OXYGENATION AND ACID-BASE EVALUATION
Respiratory system. Mechanism of lung ventilation.
Pathophysiology of Respiratory Failure Fern White & Annabel Fothergill.
Non-Invasive Ventilation Neonatal Best Evidence & BIDMC Applications
Ventilation / Ventilation Control Tests
Mechanical Ventilation
Respiratory Failure Sa’ad Lahri Registrar Dept Of Emergency Medicine UCT / University of Stellenbosch.
Principles of Mechanical Ventilation
GSACEP core man LECTURE series: Airway management Lauren Oliveira, DO LT, MC, USN Updated: 01MAR2013.
Anesthesia and Obesity Lauren Hojdila, MSA, AA-C.
Mechanical Ventilation: The Basics and Beyond
MECHANICAL VENTILATION
Respiratory Function, Breathing, Respiration
Respiratory Therapy! Just breathe!.
Ventilators All you need to know is….
Dr Chaitanya Vemuri Int.Med M.D Trainee.  The choice of ventilator settings – guided by clearly defined therapeutic end points.  In most of cases :
Respiratory Physiology Part I
AIRWAY MANAGEMENT AND VENTILATION. Assess Breathing Look for chest movementLook for chest movement Listen for breath soundsListen for breath sounds Feel.
Extubation Process Andy Higgs Warrington Hospitals Cheshire UK.
SPM 200 Skills Lab 6 Nasogastric Tube (NGT) / Oral and Nasal Airways / O2 Delivery Devices Daryl P. Lofaso, MEd, RRT Clinical Skills Lab Coordinator.
INTERNAL AND EXTERNAL. CELLULAR METABOLISM ANAEROBIC GLYCOLYSIS AEROBIC OXIDATIVE METABOLISM IN THE MITOCHONDRIA.
Basic Life Support (BLS) Advanced Life Support (ALS) Dr. Yasser Mostafa Prof. of Chest Diseases Ain Shams University.
Without reference, identify principles about volume/pressure and high frequency ventilators with at least 70 percent accuracy.
CPAP Murila fv. Respiratory distress syndrome 28% of neonatal deaths are due to prematurity The most common respiratory disorder in the preterm is Respiratory.
Rapid Sequence induction. Why Intubate? Airway protection – pre-transfer, burns Decreased GCS – Caution! Patient requires ventilatory assistance Need.
DR MUHAMMAD BILAL NON INVASIVE VENTILATION. DEFINITION : - DELIVERY OF MECHANICAL VENTILATION TO THE LUNGS THAT DON’T REQUIRE ET.T. OR TRACHEOSTOMY IRON.
Effect of different cycling off criteria and positive end-expiratory pressure during pressure support ventilation in patients with chronic obstructive.
Respiratory failure 31/08/2011 Vivian Ho. Contents Definition Types Pathogenesis Effects Blood gases Management.
Lung Mechanics Lung Compliance (C) Airway Resistance (R)
Respiratory complications of obesity. Obesity has significant effects upon the pulmonary mechanics. BMI has a direct relationship with the degree of airways.
Respiratory Function, Breathing, Respiration BI 233 Exercise 40.
FEATURES: Pa O2 < 6O mm of Hg Pa Co2 – normal or low (< 50 mm Hg) Hydrogen Ion conc. - normal Bicarbonate ion conc. - normal.
Pandemic [H1N1] 2009 RT Education Module 2 Lung Protection.
Respiratory Respiratory Failure and ARDS. Normal Respirations.
นพ. ธรรมศักดิ์ ทวิช ศรี หน่วยเวชบำบัด วิกฤต ฝ่ายวิสัญญีวิทยา รพ. จุฬาลงกรณ์
Mechanical Ventilation Mary P. Martinasek BS, RRT Director of Clinical Education Hillsborough Community College.
Ventilator Management James Eakins, MD FACS Director, Trauma and Surgical Critical Care Hahnemann University Hospital.
Respiratory Physiology Diaphragm contracts - increase thoracic cavity vl - Pressure decreases - causes air to rush into lungs Diaphragm relaxes - decrease.
BY: NICOLE STEVENS.  Primary objective of mechanical ventilation is to support breathing until neonates own respiratory efforts are sufficient  First.
Airway. Learning Objectives At the end of this session you will be able to Describe the main aims of airway management in trauma Predict specific difficulties.
Complex Respiratory Disorders N464- Fall Ventilator-Associated Pneumonia (VAP) Aspiration of bacteria from oropharynx or gastrointestinal tract.
Endotracheal Intubation – Rapid Sequence Intubation
PRESSURE CONTROL VENTILATION
Morbid Obesity M Pearson 12/3/16. BMI 19-24: Normal BMI > 30: Obesity BMI > 40: Extreme obesity.
Mechanical Ventilation Dr Rob Stephens
Ventilators for Interns
Invasive Mechanical Ventilation
Ventilation Sam Petty Clinical Specialist Physiotherapist
Mechanical Ventilation
Catherine Jones Practice Educator
Physiology of the Respiratory System
Oxygen, carbon dioxide, breathing and hypoxia
Presentation transcript:

The airway in obese patients

Pulmonary physiology Diminished lung capacity Diminished vital capacity Decreased chest wall compliance Increased abdominal cavity contents Increased airways resistance Relative room air hypoxia and hypercapnia VQ mismatch from collapse of small airways Decreased FRC Increased O2 consumption and CO2 production

Resulting in: Decreased Oxygen Reserve Rapid desaturation during periods of apnoea

Gastrointestinal physiology Increased intra abominal pressure Hiatus hernias Reflux Larger gastric volume Lower pH of gastric contents INCREASED RISK OF ASPIRATION AND LUNG INJURY POST ASPIRATION

Predicting difficult airway Obesity does not necessarily predict difficult laryngoscopy and intubation - other factors may be more important than BMI Obesity does reliably predict DIFFICULT MASK VENTILATION If time allows consider awake intubation by an anaesthetist

Preoxygenation Elevate patient’s head to 25 degrees during preoxygenation prolongs time to desaturation Preoxygenation with 100% O2 via CPAP at 10cm H2O will give you an extra 1 minute Consider the use of NIV to avoid intubation Dangers - increased risk of gastric insufflation and aspiration Nasal prongs

Drugs Renal blood flow Volume of distribution Liver metabolism

In general Hydrophilic drugs should be dosed on ideal body weight Lipophilic drugs should be based on total body weight

Positioning Head and shoulders should be elevated about the chest such at the external auditory canal is level with the sternal notch Ramped position - multiple folded blankets under head and neck

Intubation Limit the number of conventional laryngoscopy attempts to 3 Consider other advanced airway techniques Video laryngoscopy Bougie Supraglottic devices

Surgical airway Landmarks obscured by excessive soft tissue and a short neck Longer tracheostomy tube with more acute angle Size 6 ETT Under ideal circumstances cricothyroidotomy requires greater than 100 seconds to achieve ventilation

Mechanical ventilation Respiratory mechanics and gas exchange impaired Lung volumes should be based on ideal body weight (often overestimated) PEEP 10 Reverse Trendelenburg