Internal Medicine Board Review
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Internal Medicine Board Review
ARDS lung protective strategies
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Let's simply set up a lung protective strategy for R's ventilation. Now, the pieces of data we need are the patient's biological sex and height, and we use that to calculate the ideal body weight. From the ideal body weight, we times that by six to eight roughly. We'll start at six because we want to have the slowest tidal volume that we possibly can have. And this is a very tall patient. And the reason why is more distension of the lungs during with a higher tidal volume causes lung injury and it can cause inflammation. So for example, this patient we calculate their ideal body weight and they happen to be 100. Their ideal body weight is 100 kilograms. So we times it times six. We're gonna make this really simple. So our tidal volume would be 600. They're a very tall person. And the PEEP we want to keep, we can say anywhere from 8 to 12. This helps keep the LVOA open. Now remember, PEEP settings, when we set our PEEP, it helps with our oxygenation, improves oxygenation. So from this strategy, we reduce mortality in inflammation. So the higher PEEP improves our oxygenation, and our decreased tidal volume, the lower we can have to ventilate this patient, reduces inflammation. And this helps us in our RS patients. Now, what is the side effect of this strategy? There's a risk of hypotension because high PEEP will decrease the venous return to the heart, potentially lowering blood pressure. Now, the old strategy, and so this is very easy to set up. Now let's talk about the old strategy and the reason why, so you're aware of it. For bored questions and also too for life, where we used a high volume and a low PEEP. Using high tidal volumes can lead to overstretching of the lung tissue. And this lung stretching causes ventilator-induced lung injury and cause a higher risk of atelect trauma and volume trauma from a cyclic aviar opening and closing because this we're having a low peep and a high tidal volume. So this lungs can extend out and shrink back in. From there is we can have almost a it will have an inflammatory response and almost makes the lungs fibrotic, hard, stiff, things we do not want the lungs to do. And we are associated with worse outcomes. And this was abandoned because patients were harmed by this. So we've created a very simple way to ventilate a patient in hearts.