Hello and welcome to the zero to finals podcast. My name is Tom and in this episode I'm going to be going to be going through respiratory support.

And you can find written notes on this topic at zero definals.com slash respiratory support or in the anaesthetics and ICU section of the zero

de finals surgery book. So let's get straight into it. There are several options for supporting a

patient's respiratory system and these can be escalated as required. From the least to the most invasive, the options are oxygen therapy,

high flow nasal cannula, non-invasive ventilation, intubation and mechanical ventilation,

and extracorporeal membrane oxygenation, or ECMO. And we're going to talk about each one of these in more detail.

Additionally, chest physiotherapy and suction can be used to help clear secretions and improve respiratory function.

Respiratory support does not fix the underlying problem. It buys time for the underlying problem to be managed.

Let's talk about acute respiratory distress syndrome.

Acute respiratory distress syndrome occurs due to a severe inflammatory reaction in the lungs,

often secondary to sepsis or trauma. There is an acute onset of

collapse of the alveoli and the lung tissue called atelectocysis, pulmonary edema, decreased lung

compliance, which is how much the lungs inflate when they're ventilated with a given

pressure,

and fibrosis of the lung tissue, which typically develops after 10 days or more.

Clinically, there is acute respiratory distress, hypoxia that's not responding to oxygen therapy,

and bilateral infiltrates seen on a chest x-ray.

Management of acute respiratory distress syndrome is supportive.

This includes respiratory support, prone positioning, lying the patient on their front,

and careful fluid management to avoid excessive fluid collection in the lungs.

In acute respiratory distress syndrome, only a small portion of the total lung volume is

aerated and has functioning alveoli. The remainder of the lungs are collapsed and non-airated.

...