Severe Atelectasis with resultant Refractory Hypoxemia and Severe Systemic Hypotension … Mechanism of Action (MoA).
Mechanisms of Action (MoA)
Patient walked into hospital comfortably.
During surgery, blood pressure dropped. (Picture is not the patient).
Aggressive fluid resuscitative initiative undertaken.
Answer to be posted tomorrow.
Patient stabilized intra-operatively.
Pre-operatively : 100% alveoli are patent.
Aggressive fluid resuscitative initiative is swishing around the blood vascular system and starting to weep into the lun … specifically into the pulmonary interstium… and will eventually crush alveoli into an atelectatic state.
Alveoli progressively becoming atelectatic.
“Vt vs. time scalar” is trending upward …indicative that the lung is slowly regaining atelectatic alveoli … demonstrating that the applied PEEP and mean airway pressure is therapeutically efficacious.
“Vt vs. time scalar” is trending upward …indicative that the lung is EXONENTIALLY regaining atelectatic alveoli … demonstrating that the applied PEEP and mean airway pressure is therapeutically efficacious.
Pre-operative lung in great physiologic state.
Intra-operative aggressive fluid resuscitative initiative. Pulmonary capillaries now full of 20L of fluid …represented now as dark yellow.
Now, the 20L of fluid is seeping into the pulmonary interstium and the pulmonary interstitial is also demonstrated as dark yellow.
The pulmonary capillary pressure rose from capillary pressure=CVP=2 to 20.
The pulmonary interstitial tissue pressure rose from 0 to 20 cmH2O.
The alveoli with a PEEP=14 cmH2O is trying to avoid the crushing pulmonary interstial pressure=20.
Some alveoli are losing the fight of PEEP =14 vs. pulmonary interstitial and becoming atelectatc …seen in dark blue as an atelectatic alveolus.
Please enjoy this presentation on BiVent.
As with any discussion, please discuss enacting BiVent with your medical director, resp dept director, supervisors, managers, coordinators, resp peers, medical attending, medical resident, icu intensivist, physician’s assistant, nurse practioner, and nurse.
We present it as a differentially diagnosing tool to keep amidst our armamentarium of tools.
The beauty of this paradigm is that while awaiting any other tool required to diagnose or “rule-in” another diagnosis, the diagnosis of “run away atelectasis” can be ruled-in or ruled-out starting immediately.