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Ramping Position to Aid Non-invasive Ventilation (NIV) in Obese Patients in the ICU

The Journal of Critical Care Medicine
Volume 9 (2023): Issue 1 (January 2023)
By:
Open Access
|Feb 2023

Figures & Tables

Fig. 1

Chest X-ray of Case 1: Bi-basal atelectasis and small bilateral pleural effusion.
Chest X-ray of Case 1: Bi-basal atelectasis and small bilateral pleural effusion.

Fig. 2

Chest X-ray of Case 2: Hazy opacification of both lungs’ mid and lower zones. Infection versus congestion.
Chest X-ray of Case 2: Hazy opacification of both lungs’ mid and lower zones. Infection versus congestion.

Fig.-3

Case 2 on NIV lying on Oxford HELP pillow. The external auditory meatus (Line A) and the sternal notch (Line B) are aligned.
Case 2 on NIV lying on Oxford HELP pillow. The external auditory meatus (Line A) and the sternal notch (Line B) are aligned.

Fig. 4

Case 2 lying at 30 degrees up of the thorax. The external auditory meatus (line A) and the sternal notch (Line B) are not aligned.
Case 2 lying at 30 degrees up of the thorax. The external auditory meatus (line A) and the sternal notch (Line B) are not aligned.

Medications for Case 1_

MedicationDose and routeDuration
-Co-amoxiclav1.2 g Intravenous twice daily3 days
-Clarithromycin500 mg Intravenous twice daily3 days
-Doxycycline100 mg Oral twice daily4 Days
-Pantoprazole40 mg Intravenous once daily5 days
-Prednisolone30 mg Oral once daily5 days
-Enoxaparin40 mg Subcutaneous once daily5 days
-Amlodipine5 mg Oral once dailyRegular medication
-Paracetamol1g Intravenous every 6 hours5 days
-Oxycodone2.5 mg Oral every 4 hours5 days as per request
-Salbutamol5 mg nebuliser every 6 hours5 days
-Ipratropium Bromide500 mcg nebuliser every 6 hours5 days

ABG, Blood results, and ventilation of Case 2

AdmissionAfter ramping12 hrs24 hrs overnightDay 3Day5
ABG*
PH7.177.227.437.467.447.43
PCO2** (Kpa)15.313.28.68.687.6
PO2*** (Kpa)26.810.914.99.58.911.7
HCO3**** (mmol/l)31.531.736.63935.533.6
Lactate (mmol/l)0.80.81.30.81.21.1
Ventilation
Oxygen deliveryNIV mask Drager Evita V800NIV mask Drager Evita V800Face maskNIV mask Drager Evita V800Nasal cannulaRoom air
Ventilator moodBIPAPBIPAP BIPAP
Airway adjunctNaturalNaturalNaturalNaturalNaturalNatural
FIO2*****100 %60 %40%40 %24 %21%
PEEP****** (cmH2O)55 7
Pressure support (cmH2O)2525 14
Actual tidal volume (ml)170507 480
Peek inspiratory pressure (cmH2O)3926 27
Respiratory rate382922182022
WOB scale6/75/72/71/71/72/7
Blood results
Haemoglobin (g/l)118 106112116
Leukocytes (x10 g/l)15.9 99.810.2
Platelets (x10 g/l)368 302299296
C-Reactive Protein (mg/l)76.2 52.826.726.2

ABG, Blood results, and ventilation of Case 1

AdmissionAfter ramping12 hrs24 hrsDay 3Day 5
ABG*
PH7.157.287.467.437.427.41
PCO2** (Kpa)16.910.977.17.57.4
PO2 ***(Kpa)9.59.79.28.58.98.3
HCO3****30.831.33331.832.232.4
(mmol/l)
Lactate (mmol/l)1.10.91.31.50.81.1
Ventilation
Oxygen deliveryNIV mask Drager Evita V800NIV mask Drager Evita V800NIV mask Drager Evita V800Nasal cannulaNasal cannulaRoom air
Ventilator moodBIPAPBIPAPCPAP
Airway adjunctNaso-pharyngealNaso-pharyngealNaso-pharyngealNaturalNaturalNatural
FIO2*****40%40%30%36%32%21%
PEEP****** (cmH2O)888
Pressure support (cmH2O)2323N/A
Actual tidal volume (ml)125428538
Peek inspiratory pressure (cmH2O)422423
Respiratory rate422822201817
WOB scale6/74/72/71/71/71/7
Blood results
Haemoglobin (g/l)172 165170168
leukocytes (x10 g/l)13.2 117.88
Platelets (x10 g/l)169 195209218
C-Reactive Protien (mg/l)54 22.617.511.4

Medications for Case 2_

MedicationDose and routeDuration
-Co-amoxiclav1.2 g Intravenous twice daily5 days
-Clarithromycin500 mg Intravenous twice daily5days
-Pantoprazole40 mg Intravenous once daily5 days
-Prednisolone30 mg Oral once daily5 days
-Enoxaparin80 mg Subcutaneous once daily5 days
-Furosemide40 mg Intravenous twice daily4 days
-Salbutamol5 mg nebuliser every 6 hours5 days
-Ipratropium Bromide500 mcg nebuliser every 6 hours5 days
DOI: https://doi.org/10.2478/jccm-2023-0002 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
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Language: English
Page range: 43 - 48
Submitted on: Apr 23, 2022
Accepted on: Dec 6, 2022
Published on: Feb 8, 2023
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
ramping,
obese,
non-invasive ventilation
Related subjects:
Medicine,
Clinical medicine,
Anaesthesiology,
Emergency medicine and intensive-care medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other

© 2023 Mohamed Shirazy, Christopher Gowers, Padraig Headley, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

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