Mechanical ventilation

Question 1

what is the purpose of mechanical vent

Answer 1

maintain homeostasis btw gas concentrations O2 and CO2

Question 2

indications

Answer 2

airway protection
cardiac arrest
management of ICP
airway obstruction
surgery

Question 3

FiO2

Answer 3

fraction of inspired oxygen

Question 4

tidal volume

Answer 4

normal amount of air ventilated at rest

Question 5

PEEP

Answer 5

positive end expiratory pressure

pressure at end of exhalation keeps alveoli from collapsing

Question 6

what is the vent controlling

Answer 6

respiratory rate

Question 7

invasive mechanical vent

Answer 7

• intubation of artifical airway into trachea
• endotracheal tube
• nasotracheal tube
• tracheostomy

Question 8

non-invasive vent

Answer 8

BiPAP or CPAP

- last step before intubation

Question 9

BiPAP

Answer 9

bilevel positive airway pressure

- decreases effort for pt to exhale

Question 10

CPAP

Answer 10

continuous positive airway pressure

used to prevent airways from collapsing in inhalation and exhalation

Question 11

what is a tracheostomy

when is it used

Answer 11

long term ventilation
vent placed in trachea

unable to be weaned from ventilator
difficult intubation –> severe morbid obesity
airway block or obstructed

Question 12

passy-muir valve is used for what

Answer 12

placed on trach so pt can talk

the pt will have to work harder to breath with it on so be cautious of that

Question 13

volume control

Answer 13

• preset tidal volume is delivered at a set respiratory rate
• pt has no spontaneous breathing

Question 14

pressure control

Answer 14

• predetermined amoutn of pressure at a set respiration rate
• vent determines inspiratory time
• pt has no spontaneous breathing

Question 15

what is PEEP used to do when using pressure control

Answer 15

increase arterial oxygen, improve lung compliance

makes lungs easier to inflate

Question 16

assist control

Answer 16

delivers specific amount of tidal volume
forces air down into lungs
pt or vent can trigger when breaths are taken

Question 17

pressure regulated volume control

Answer 17

PRVC
combines pressure and volume controlled ventilation
preset tidal volume is delivered at set rate, but with lowest possible pressure

Question 18

synchronous intermittent mandatory ventilation

Answer 18

SIMV
assist pt who have some but not sufficient breathing
used for weaning
delivers certain numbers of breath in coordination with effort of pt

Question 19

pressure support ventilation

Answer 19

• little bit of pressure in inhalation
• weanining off
• pt intiates all breaths
• delivers specific pressure

Question 20

volume support

Answer 20

tidal volume and PEEP are set
pt initiates breathing
vent delivers support in proportion to pt

Question 21

what do you need to know and document before touching pt on a vent

Answer 21

vent mode
PEEP
RR
FiO2

Question 22

red alarms for vent

Answer 22

high pressure
circuit disconnected
apnea

Question 23

yellow alarms for vent

Answer 23

low tidal volume
high RR
low minute ventilation
low inspiratory pressure

Question 24

what is weaning

Answer 24

decreasing or discontinuing mechanical ventilation

PT work with pts during this process

Question 25

what are the five major factors to consider during weaning

Answer 25

1. respiratory demand and ability of neuromuscular system to cope with O2 demand - dont overexert the pt
2. adequate O2 supply during activity
3. cardiovascular performance
4. psychological factors
5. adequate rest and nutrition

Question 26

what are the weaning signs of distress

Answer 26

1. tachypnea >30
2. decreased pH <7.25-7.30
3. paradoxical breathing
4. O2 saturation <90
5. HR change of >20
6. BP change of >20
7. agitation, panic, diaphoresis, cyanosis, angina, arrhythmias

Question 27

contraindications for PT

Answer 27

comatose, unresponsive, does not follow commands
severe agitation/combativeness
PEEP > 10 H2O or FiO2 >0.60
uncontrolled active bleeding

Question 28

what can prolonged vent support lead to

Answer 28

skin breakdown
joint contractures
deconditioning