|
| If there is marked global or regional atelectasis, consider: | |
|
| (i) Increasing PEEP to improve end-expiratory lung volume | |
| (ii) Increasing PIP to recruit atelectatic lung units | |
| (iii) Increasing inspiratory time to facilitate the recruiting effect of PIP | |
| (iv) Use of HFOV with sufficient distending pressure to recruit atelectatic lung units | |
| (v) Use of HFJV with sufficient PEEP to maintain FRC and conventional breath PIP to recruit atelectatic lung units | |
| (vi) Exogenous surfactant | |
| (vii) Lung lavage | |
|
| If there is obvious gas trapping, consider: | |
|
| (i) Decreasing PEEP (but may lose recruitment of areas prone to atelectasis) | |
| (ii) Decreasing inspiratory time and increasing expiratory time | |
| (iii) Use of HFJV with low PEEP, low frequency (240–360 bpm), and minimal CMV breaths | |
| (iv) Use of HFOV with relatively low and low frequency (5-6 Hz) | |
|
| If there is pulmonary hypertension, consider: | |
|
| (i) Correction of potentiating factors—hypoglycaemia, hypocalcaemia, hypomagnesaemia, polycythaemia, hypothermia, pain | |
| (ii) Bolstering systemic blood pressure to reduce right to left ductal shunt—volume expansion, pressor agents | |
| (iii) Improving right ventricular function—inotrope infusion | |
| (iv) Selective pulmonary vasodilators—inhaled nitric oxide | |
|
