LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Libro Blanco de las ACES Pediátricas 2024 196 ❚ 1. Appreciate the potential effects of altering the I:E ratio on arterial blood gas values in various disease states 2. Appreciate the potential impact of altering the I:E ratio on air trapping 3. Be able to calculate inspiratory time from rate and I:E ratio during mechanical ventilation f. PEEP and CPAP 1. Understand the mechanisms of action of positive end-expiratory pressure 2. Understand the physiologic effects of positive end-expiratory pressure 3. Understand the mechanisms of the side effects of positive end-expiratory pressure 4. Know the methods available for the application of positive end-expiratory pressure to patients who are receiving ventilation, as well as to those who are not 5. Home mechanical ventilation a. Chronic respiratory failure 1. Understand that ventilatory muscle power must be sufficient to overcome the respiratory load in chronic respiratory failure 2. Know that respiratory failure occurs when normal ventilatory muscles cannot overcome increased respiratory loads and/or weak ventilatory muscles cannot overcome normal respiratory load 3. Understand that central respiratory drive must be sufficient to overcome the respiratory load in chronic respiratory failure 4. Know that combined ventilatory muscle weakness and central drive make respiratory failure more likely b. Initiating home mechanical ventilation 1. Know that home mechanical ventilation is best initiated electively when the need can be predicted, such as in neuromuscular disease patients with CO2 retention shown on polysomnography 2. Know that candidates for home mechanical ventilation must have a stable respiratory disorder that does not require frequent changes in ventilator settings 3. Know that candidates for home mechanical ventilation include children who cannot be weaned from assisted ventilation following consistent weaning attempts when the child is otherwise stable c. Positive pressure ventilation via tracheostomy 1. Know that positive pressure ventilation via a tracheostomy is the most common method of home mechanical ventilation and that it can be used in children requiring full-time or part-time assisted ventilation 2. Know that small, uncuffed tracheostomy tubes are preferred to prevent tracheomalacia and to permit speech in patients undergoing positive pressure ventilation via tracheostomy tube 3. Know that small, uncuffed tracheostomy tubes have large variable leaks that must be compensated for using ventilator techniques in patients receiving positive pressure ventilation via tracheostomy tube 4. Know that ventilators are often used in a pressure-control or time-cycled pressure-limited mode to compensate for variable leaks around uncuffed