Key messages

• In the presence of severe hypoxemia search for the etiology and pathogenesis, and establish the dominant damage: consolidation in direct lung injury, compression atelectasis in indirect lung injury, and perfusion alterations in vascular disease.

• Immediately after intubation, open the lung by a recruitment maneuver. Consider that the transmural pressure for full opening is approximately 30 cmH 2O. Remember that in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) caused by an indirect insult the chest wall elastance is higher than normal; consequently the airway pressure to reach a transmural pressure of 30 cmH2O will be higher than in ALI/ARDS caused by a direct insult.

• Target the blood gases to the values that the patient is assumed to have had before the acute insult (consider age and previous respiratory diseases).

• Consider lung injury secondary to mechanical ventilation (fractional inspired oxygen (FiO 2), plateau pressure, tidal volume, intratidal collapse and decollapse), and remember that positive end-expiratory pressure (PEEP) seems to have a protective effect.

• Set the mechanical ventilation with PEEP adequate to keep open compression atelectasis and tidal volume adjusted according to the end-expiratory lung volume. Accept hypercapnia if plateau pressure (or transmural pressure) is excessively high. Always remember that a tidal volume that is too low may result in reabsorption atelectasis.

Healthy Fat Loss For A Longer Life

Healthy Fat Loss For A Longer Life

What will this book do for me? A growing number of books for laymen on the subject of health have appeared in the past decade. Never before has there been such widespread popular interest in medical science. Learn more within this guide today and download your copy now.

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