In general, we believe that better outcomes may be achieved if PPV is initiated early, rather than waiting until the animal is moribund before providing aggressive respiratory support. Animals with elevated PaCO 2 (> 50 mmHg), those with PaO 2 values less than 55 mmHg on oxygen supplementation, or those with obvious ongoing respiratory distress or paradoxical respiration despite oxygen supplementation, are candidates for PPV. The decision to initiate PPV is made based on the clinical condition of the animal and the degree of dyspnea, the arterial blood gas results and response to oxygen supplementation while spontaneously breathing, the prognosis, and the wishes of the owner. As criticalists, our job is to recognize the patients who will most benefit, and then to apply positive pressure ventilation in such a way as to minimize its adverse effects and therefore optimize patient outcome. Despite all of these drawbacks, it provides a wonderful means of life support that can truly make the difference between life and death. Positive pressure ventilation (PPV) is invasive, time-consuming, often frustrating, and consumes tremendous resources, both financial and emotional.
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