...for an otherwise nonmoving relatively sedated patient?
Also, does the ventilator at all cause edema to the extremities or is it entirely due to preexisting cardiac myopathy?
Do you know of any guides on the internet that I can read on the ventilator...it's not an easy bit of good information to find. I don't know of any brand names, so if you could suggest that, that would help me search the web. Thanks. I appreciate your reply Fred F... I don't know how many people actually have worked with the ventilator to even reply...(sigh) but your reply is helpful. Periodic limb movements are commonly seen in patients who have recently started cpap. This happens most likely because they are not used to it and it is a fighting mechanism. Once on optimal pressures the Plm's usually subside. However if they do not, there is generally an underlying cause that the doctor would then research into further. I have yet to see cpap cause edema in a relatively healthy individual but I have encountered cases of increased edema in preexisting cardiac patients, but this is not generally common.
Try googling Periodic limb movements and Cpap the same with edema. Good luck My W key is sticking, so if adding one makes sense go ahead.
In reverse order, simple first --
Search "mechanical ventilation". Answers can be simple, accurate, or short - pick any two. Some questions require a depth of knowledge and integration that prevents simple "look-up" answers. A brand name would probably just confuse things, since different manufacturers use different terms for nearly identical functions. Feel free to e-mail me if you have a specific question.
Some edema in the extremeties is expected with conventional mechanical ventilation for a couple of reasons. ADH (AntiDiuretic Hormone) production is increased during prolonged mechanical ventilation. The second reason is more complex and would aggravate problems associated with cardiac myopathy. Normal breathing is negative pressure ventilation - air is drawn into the lungs because the pressure in the thorax drops below atmospheric when the diaphragm contracts. The negative pressure "helps" the venous return of blood from the extremities. Most mechanical ventilation currently in use is positive-pressure ventilation. Air in the system is pushed into the lungs at pressures above the atmospheric pressure pressing on the outside of the body. This creates a positive pressure in the chest which blood returning from the extremeties must work against. The result is about like swollen ankles from standing for a long time, the force is just intrathorcic pressure instead of gravity. There is more, the cardiovascular system also reacts to the increased pressure in the chest, but unless you find my writing utterly fascinating ...
<rant>I hate "relatively". Deeply, lightly, adequately, inadequately, appropriately sedated for an appropriate indication. </rant> The following is opinion, not doctrine.
The first question is almost impossible to answer without knowledge of the patient's neurological status, reason for ventilation, other illnesses, response to previous sedation. Short answer, no. There -should- be some method of sedation that allows adequate respiratory drive without excessive agitation. There is always a "but", though.
Mechanical ventilation and artificial airways are always less safe than the body's normal function. They allow new complications, routes for infection, mechanical failure, airay obstruction and displacement, etc. etc. etc. Weaning should not be <the> priority, but certainly <a> priority.
For some patients sedation is just very difficult to manage. The scenario you describe, so sedated they don't move at all on the assisted ventilation but still show agitated movement during weaning certainly sounds like one. Perhaps a change in the medication could help, maybe it's already been tried.
The decision on the scene may be that it will be managed as well as possible, the patient is not suffering from pain related to the procedure, other vital signs do not indicate an unacceptable level of stress, and freeing the patient from the mechanical devices is important. |
