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Interventions 1 (RESP 266) > Mechincal ventilation Basics > Flashcards

Mechincal ventilation Basics Flashcards

1
Q

3 methods to deliver O2

A

Face mask - non invasive

Face mask via CPAP/BiPAP - non invasive

EDT mech. ventilation - invasive

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2
Q

Benefits of CPAP and PEEP?

A

keeps intra alveolar pressure positive airways open at a PEEP at least of 5

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3
Q

CPAP is the same thing what mode, and what is their main difference?

A

CPAP has the same mode as PEEP.

The difference:

->CPAP = non-invasive

->PEEP = invasive

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4
Q

When would you consider endotracheal intubation and mechanical ventilation?

A

Think ABCs or when patients cannot breath:
-A: can the airway be maintinaed
-B: can breathing be maintained
-C: Circulation

-causes of hypoventilation

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5
Q

What is the purpose of mech. ventilation during surgery?

A

deliver anesthetic drugs

prevents aspiration syndrome (gastric-content aspiration)

controls PaO2 and PaCO2
-i.e oxygenation and pH

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6
Q

Generally describe CMV

A

Vent mode that does not allow for spontaneous breathing; the machine does all the work or gives assisted breaths.

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7
Q

Cons to CMV

A

Asynchronous breathing; the machine and pt do not match
-aka they fight

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8
Q

Generally describe IMV

A

Allows for spontaneous breathing; pt can’t trigger it whenever

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9
Q

Give an example of IMV

A

Patient can breath between set breaths; used wen pt is conscious and is able to breath regularly.

mode would hopefully be switched to pressure support.

i.e we set 12 breaths as a minimum but allow for a RR of 13. They can take an extra breath but will not fall bellow 12.

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10
Q

Describe the modes you may see on a old system

A

Assist control (AC) = CMV

Pressure control

Pressure support

CPAP/BiPAP

Synchronized interment mandatory ventilation (SIMV)

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11
Q

Flow rate describes what?

A

how FAST would you like to push volume in

Flow = volume/time

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12
Q

What is volume?

A

volume = tidal volume

aka

How much air would you like to give into the patient and out

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13
Q

Describe the relationship in lung compliance

i.e Compliance

A

Compliance = delta V/ delta P

  1. If the volume is constant, the relation between C and P is inverse
    -(one increases, other decreases)
  2. If pressure is constant, relationship between C and V is direct.
    -(both increase or decrease)
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14
Q

Lung compliance what happens when compliance decreases?

A

pressure increases to fill the airways

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15
Q

What does it mean when a lung is compliant

A

A lung is compliant when it expands a big deal (volume increases) with only a slight pressure (low pressure)

C = delta v/ delta P

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16
Q

What is volume control

A

you control (set) the volume, and keep an eye on the pressure.

If pressure increases, compliance is decreasing

when pressure increases too much -> alarms

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17
Q

What is pressure control

A

you control (set) the pressure, and keep an eye on the volume.

If volume decreases -> Compliance is decreasing

when volume decreases too much —> alarm

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18
Q

What vent. settings affect PCO2

A

RR and Vt

They both change alveolar ventilation

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19
Q

Which vent. settings determine PO2?

A

FiO2 and PEEP

manipulation of oxygenation

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20
Q

If a patient is hypoventilation; what is happening to his vitals; what is the appropriate response?

A

PCO2 increasing -> pH deceasing = resp. acidosis

Response:
Increase RR and tidal volume

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21
Q

What should you do if a patient with high hypoxemia? what is happening to his vitals?

A

PaO2 = 50 = low

response:
increase FiO2 and PEEP

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22
Q

When is a lung is considered compliant?

A

when giving a small amount of pressure, it increases its volume drastically

OR

if P is constant; lungs compliance decreases and volume decreases as a result

23
Q

What factor determines peak pressure?

A

Airway resistance

The greater the resistance the lower the pressure

24
Q

change in peak pressure = what change?

A

change in airway resistance

25
Q

What is plateau pressure?

edit
needs a check for accuracy

A

when the air stops moving in (end of inspiration), the factor that determines the pressure in compliance

26
Q

what increases inspiratory pause or plateau pressures?

A

Compliance

27
Q

What does it mean when peak pressure (PIP) increases?

edit
needs a check for accuracy

A

Airway resistance, such as secretions

28
Q

What does it mean when Pplat increases?

A

Lung compliance is decorticating

29
Q

Review: low vs high lung compliance?

A

low = stiff lungs

high = floppy

wanna be somewhere in the middle.

30
Q

If there is a problem with the peak pressure; where can you usually assume the problem lies?

A

airway issue

31
Q

if there is a problem with the Pplat; what can you assume (usually) is the problem?

A

Lung compliance issue

32
Q

edit add factors from a screen on shot on phone

A
33
Q

Pulmonary MV and Alveolar MV

A

Pulmonary MV = RR x Vt

Alveolar MV = RR x (Vt - dead space)

34
Q

If RR is increased and FiO2 is maxed out, what could be the reason as to a patient who is not improving in condition?

A

Alveolar ventilation is not necessarily increased because of Deadspace (or Shunting?) where there is no gas
-i.e hyperventilating; you’re only ventilating dead space

35
Q

How do you increase alveolar ventilation

A

Deep, slow breathing

or adding pressure (forces air into airways)

36
Q

continune watching medicos is perfctinalis vid on mech. vent

edit

A

left off at RR

37
Q

What is a normal Vt range?

A

5-8 ml/Kg of patients IBW

so somwhere between 350-700mL

38
Q

What should you set PEEP at?

A

4-6, but rule of thumb stick w/5 on the initial vent setting

39
Q

What happens when you increase inspiratory time?

A

Increase oxygenation, but may have diminishing returns because it affects the I:E ratio

40
Q

Why are is too much Ti bad?

edit

A

Stresses the body too much; normally you want a higher expiration ratio to inspiratory ratio

41
Q

Normal Ti range?

A

0.9 - 1.10

42
Q

How do you calculate MV?

A

Vt x RR

43
Q

Normally you count RR according to the patient; how do you determine the RR for a vent?

insert image from SMS

A

IBW x 6 (OR choose something between 5-8) = X

[x] take that value * 100 = Y

y/x = RR

44
Q

Normal MV range?

A

5-6 L/min

45
Q

Normal Vd/Vt ratio? aka deadspace?

A

2.2

46
Q

Why would deadspace be increased?

A

◦Increased due to ventilation of areas of lung with poor perfusion

◦Altered V/Q (increased ventilation)

Result = increased MV with PPV required to control PaCO2.

47
Q

What is the Trigger, Limit, cycle, and Baseline for: VC-CMV

A

Trigger: Time OR Patient
Limit: Flow
Cycle: Volume
Baseline: PEEP

48
Q

What is PEEP also known as?

A

Base airway pressure

49
Q

What is the Trigger, Limit, cycle, and Baseline for:
PC-CMV

A

Trigger: Time or Patient
Limit: Pressure
Cycle: Time
Baseline: PEEP or BAP

50
Q

What is the Trigger, Limit, cycle, and Baseline for:
PC-CMV Adaptative

A

Trigger: Time or Patient
Limit: Pressure
Cycle: Time
Baseline: PEEP or BAP

51
Q

On the PB980; what mode is PRVC?

A

AC-VC+

52
Q

What is driving pressure?

A

Pplat - PEEP

53
Q

How do you calculate resistance from a vent?
- What is a bad range?

A

Ppeak - Pplat > 10

Implies too much resistance (or artifact)

54
Q

What does a Ppeak - Pplat < 10 imply?

A

Compliance problem

Interventions 1 (RESP 266) (16 decks)

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