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Hemodynamics > Ch. 3 Pilbeams > Flashcards

Ch. 3 Pilbeams Flashcards

1
Q

What is the trigger variable?

A

Begins inspiration

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2
Q

What is the limit variable?

A

Limits the value of pressure, flow, or time during inspiration.

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3
Q

What is the cycle variable?

A

Ends inspiration

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4
Q

What is time triggering?

A

Vent initiates the breath after a set time

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5
Q

What is pt triggering?

A

Patient can start the breath (trigger).

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6
Q

What are the most common triggering variables?

A

Pressure and flow

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7
Q

Time triggering?

A

Drivers a breath after a set time has elapsed

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8
Q

What is the control mode (locked out)?

A

When the pt is apneic, sedated, or paralyzed and makes no effort to breathe

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9
Q

Inspiration begins if a_______________ or __________ is detected.

A

Negative airway opening pressure ; change in flow

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10
Q

What is the sensitivity setting also called?

A

Patient effort or pt triggering

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11
Q

The sensitively level for pressure triggering is usually set at?

A

-1cmH20

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12
Q

If the ventilator is too sensitive it can cause what?

A

Auto-triggering (machine takes a breath without the pt making an effort).

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13
Q

Flow triggering?

A

Occurs when the ventilator detects a drop in flow through the patient circuit during exhalation.

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14
Q

When set properly flow triggering has been shown to _______ ?

A

Require less WOB or triggering

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15
Q

Volume triggering?

A

Occurs when the vent detects a small drop in volume in the pt circuit during exhalation.

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16
Q

Manual triggering?

A

Breath is initiated by pressing a button on the machine

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17
Q

What is assist control mode?

A

When the rate control determines the minimum number of mechanical breaths delivered, the patient has the option of breathing at a faster rate.

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18
Q

Pressure limiting?

A

Allows pressure to rise to a certain value but not exceed it

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19
Q

When the vent reaches the________, excess pressure is vented through the spring loaded pressure release, or ______?

A

High-pressure limit ; pop-off

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20
Q

What are some other examples of pressure limiting modes?

A

Pressure support and pressure controlled ventilation

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21
Q

Volume limiting?

A

is controlled by an electronically operated valve that measures the flow passing through the ventilator circuit during a specific interval.

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22
Q

With volume limiting the vent may include…?

A

A bag, bellows, or piston cylinder that contains a fixed volume, which establishes the maximum volume of gas that can be delivered.

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23
Q

Flow limiting?

A

If gas flow from the ventilator to the patient reaches but does not exceed a maximum value before the end of inspiration, the ventilator is flow limited; that is, only a certain amount of flow can be provided.

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24
Q

What is maximum safety pressure?

A

When ventilators allows inspiratory pressure to reach but not exceed a maximum pressure. This maximum safety pressure is used to prevent excessive pressure from damaging a patient’s lungs.

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25
Q

What is the value for maximum safety pressure?

A

10 cmH2O above the average peak inspiratory pressure.

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26
Q

What is the variable the the vent used to end inspiration?

A

Cycle mechanism

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27
Q

What are the 4 factors that can end inspiration?

A

Volume, flow, time, pressure

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28
Q

Volume cycled ventilation?

A

Is terminated when the set volume has been delivered.

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29
Q

What is an inspiratory pause?

A

inspiration will continue until the pause has ended and expiration begins. (The inspiratory pause feature delays opening of the expiratory valve.)

30
Q

Tubing compressibility?

A

The volume of gas that leaves the ventilator’s outlet is not the volume that enters the patient’s lungs. During inspiration, positive pressure builds up in the patient circuit, resulting in expansion of the patient circuit and compression of some of the gas in the circuit The compressed gas never reaches the patient’s lungs.

31
Q

How much gas is lost to tubing compressibility that is measured by the airway pressure censor?

A

In most adult ventilator circuits, about 1 to 3 mL of gas is lost to tubing compressibility for every 1 cm H2O that is measured by the airway pressure sensor.

32
Q

How can the actual volume delivered to the pt be determined?

A

by measuring the exhaled volume at the endotracheal tube or tracheostomy tube.

33
Q

How to determine the delivered volume?

A

the volume compressed in the ventilator circuit must be subtracted from the volume measured at the exhalation valve.

34
Q

Time cycled ventilation?

A

A breath is considered time cycled if the inspiratory phase ends when a predetermined time has elapsed.

35
Q

With time-cycled, pressure-controlled ventilation what varies?

A

Volume and flow

36
Q

Volume (and flow) delivery depends on…?

A

lung compliance, airway resistance, patient effort (if present), inspiratory time, and set pressure.

37
Q

Time-cycled, pressure-controlled ventilation is commonly called _______.

A

Pressure controlled ventilation

38
Q

Time cycled ventilation is used because?

A

the inspiratory pressure can be limited, which protects the lungs from injury caused by high pressures.

39
Q

Flow cycled ventilation?

A

the ventilator cycles into the expiratory phase once the flow has decreased to a predetermined value during inspiration.

40
Q

Volume, pressure, and time vary according to what?

A

Changes in lung characteristics

41
Q

Flow cycling is the most common cycling mechanism in…?

A

Pressure support mode

42
Q

Pressure cycled ventilation?

A

inspiration ends when a set pressure threshold is reached at the mouth or upper airway.

43
Q

What is a disadvantage of pressure cycled ventilation?

A

these devices deliver variable and generally lower tidal volumes when reductions in compliance and increases in resistance occur.

44
Q

What is an advantage of pressure cycled ventilation?

A

they limit peak airway pressures, which may reduce the damage that can occur when pressures are excessive.

45
Q

Inflation hold (inspiratory pause)?

A

Is designed to maintain air in the lungs at the end of inspiration, before the exhalation valve opens.

46
Q

How does inspiratory pause work?

A

During an inflation hold, the inspired volume remains in the patient’s lung and the expiratory valve remains closed for a brief period or pause time.

47
Q

How does inspiratory pause work (2)?

A

The pressure reading on the manometer peaks at the end of insufflation and then levels to a plateau (plateau pressure).

48
Q

Inspiratory pause occasionally is used to…?

A

increase peripheral distribution of gas and improve oxygenation.

49
Q

Expiratory phase: The baseline variable?

A

The expiratory phase encompasses the period from the end of inspiration to the beginning of the next breath.

50
Q

During mechanical ventilation, ________ when ________ , the _________, and __________.

A

Expiration begins; inspiration ends; expiratory valves open; expiratory flow begins

51
Q

What can occur if expiratory time is too short?

A

Air trapping

52
Q

If an adequate amount of time is not provided for exhalation what can happen, and what can it lead too?

A

air trapping and hyperinflation can occur, leading to auto-PEEP or intrinsic PEEP

53
Q

Baseline pressure?

A

The pressure level from which a ventilator breath begins.

54
Q

What is the parameter that is basically controlled during exhalation?

A

Baseline variable

55
Q

What is the most practical choice for baseline variable?

A

Pressure

56
Q

What is zero end expiratory pressure (ZEEP)?

A

Baseline pressure can be zero (atmospheric), or it can be positive if the baseline pressure is above zero (positive end- expiratory pressure [PEEP]).

57
Q

What is NEEP?

A

Negative end expiratory pressure

58
Q

Expiratory hold?

A

It is accomplished by first allowing the patient to perform a quiet exhalation. The ventilator then pauses before delivering the next machine breath.

59
Q

When is expiratory hold performed?

A

End of exhalation

60
Q

What will happen if the patient is breathing spontaneously during expiratory hold?

A

An accurate reading of end-expiratory pressure will be impossible to obtain

61
Q

Expiratory retard?

A

When the machine adds a degree of resistance to exhalation to mimic pursed lipped breathing.

62
Q

Two methods of applying continuous pressure to the airways have been developed to improve oxygenation in patients with refractory hypoxemia?

A

CPAP and PEEP

63
Q

CPAP?

A

involves applying positive pressure to the airway throughout the respiratory cycle.

64
Q

PEEP?

A

a positive pressure at the end of exhalation during either spontaneous breathing or mechanical ventilation.

65
Q

CPAP and PEEP help what?

A

Airway closure and alveolar collapse

66
Q

What are the 2 types of breaths?

A

Spontaneous and mandatory

67
Q

Spontaneous breaths?

A

are initiated by the patient (patient triggered), and volume delivery is determined by the patient (patient cycled). the volume and flow delivered are based on patient demand rather than on a value set by the ventilator operator.

68
Q

Mandatory breath?

A

the ventilator determines the start time (time triggering) or tidal volume (or both). In other words, the ventilator triggers and cycles the breath.

69
Q

What are 2 most common pt trigger variables?

A

Pressure and flow

70
Q

What happens in ICU ventilators if the high-pressure limit is exceeded?

A

• Inspiration continues, but pressure is limited
• An alarm sounds

71
Q

A patient is on mechanical ventilation. The tidal volume is set at 600 mL and the rate at 7 breaths/min. The low exhaled volume alarm, set at 500 mL, suddenly is activated. The low-pressure alarm is also activated. The volume monitor shows 0 mL. The peak pressure is 2 cm H2O. On the volume–time waveform, the expiratory portion of the volume curve plateaus and does not return to zero. The most likely cause of this problem is:

A

Disconnection of the Y-connector

72
Q

T or F Inflation increases inspiratory time?

A

True

Hemodynamics (14 decks)

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