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The pathophysiology of acute respiratory distress syndrome involves fluid accumulation in the lungs not explained by heart failure (noncardiogenic pulmonary edema). It is typically provoked by an acute injury to the lungs that results in flooding of the lungs' microscopic air sacs responsible for the exchange of gases such as oxygen and carbon dioxide with capillaries in the lungs. [1]
Positive end-expiratory pressure (PEEP) is the pressure in the lungs (alveolar pressure) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration. [1] The two types of PEEP are extrinsic PEEP (PEEP applied by a ventilator) and intrinsic PEEP (PEEP caused by an incomplete exhalation).
The final PEEP level should be the one just before the drop in Pa O 2 or peripheral blood oxygen saturation during a step-down trial. A large randomized controlled trial of patients with ARDS found that lung recruitment maneuvers and PEEP titration was associated with high rates of barotrauma and pneumothorax and increased mortality. [28]
This is calculated by dividing the PaO2 by the FiO2. Example: patient who is receiving an FiO2 of .5 (i.e., 50%) with a measured PaO2 of 60 mmHg has a PaO 2 / FiO 2 ratio of 120. In healthy lungs, the Horowitz index depends on age and usually falls between 350 and 450.
Fraction of inspired oxygen (F I O 2), correctly denoted with a capital I, [1] is the molar or volumetric fraction of oxygen in the inhaled gas. Medical patients experiencing difficulty breathing are provided with oxygen-enriched air, which means a higher-than-atmospheric F I O 2.
Table 1A is included in the US Navy Diving Manual Revision 6 and is authorized for use as a last resort when oxygen is not available. This table has been revised by decreasing the ascent rate from 1 minute between stops to 1 fsw per minute since the original was published in 1958. [6] Use: For treatment of pain only decompression sickness. [16]
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Venturi masks are used to deliver a specified fraction of inspired oxygen (F I O 2).Many masks are color-coded and have a recommended oxygen flow specified on them. [5] When used with this oxygen flow, the mask should provide the specified F I O 2.