Mechanical Ventilation Flashcards

1
Q

What are the two types of mechanical ventilation?

A

-Negative pressure (not used in acute care setting)

-positive pressure (pushes air in)

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2
Q

What are the two subgroups of positive ventilation?

A

-Volume ventilation (predetermined tidal volume (Vt) is set. Pressure is determined by the pt and vent together and varies w/each breath.)

-pressure ventilation (peak inspiratory pressure & the volume is determined by the pt/vent w/each breath)

pressure vent is for inhale only & helps prevent alveoli collapse by keeping the pressure up

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3
Q

What are the two volume assisted vent MODES?

A

-A/C Vent (assist-control,*max support)
•preset tidal volume & RR
•Pt can initiate own breath but vent will do all work & deliver set volumes.
•used commonly in resp failure, ARDS, Paralysis

-SIMV (Synchronized intermittent mandatory vent)
•preset tidal volume & RR but Pt can initiate own breath W/own tidal volume
•commonly used for Pt weaning or strengthening lungs/WOB.

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4
Q

Pressure support vent setting

A

•won’t have preset volume
•Pt must be able to initiate own breath
•positive pressure is added to inspiration
•typically used for Pt weaning
•flow rate of + pressure is greater than the force of spontaneous breath —>
^ o2 reaches alveoli

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5
Q

Pressure control vent setting

A

PCV: gives breath w/set pressures. Pt can control RR & volume

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6
Q

Pressure control inverse ratio

A

PC-IRV:
•”last ditch effort setting”-Renteria
•extra inspiratory time than expiratory time allows for increased alveolar oxygenation
•short expiratory cycle keeps alveoli open
•need deep sedation d/t abnormal breathing pattern
•used commonly w/ARDS Pt’s who are hard to oxygenate

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7
Q

Airway pressure release ventilation

A

APRV:
•”not as much sedation/gentler setting” -Renteria
•allows spontaneous breathing but has preset CPAP
•no set Vt
•Delivers set of rapid inspiratory pressures (extra puff -think eye Dr test)
•good for Pt’s w/collapsed alveoli

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8
Q

Pressure regulated volume control

A

PRVC:
•dual modes together - full support (preset pressure & volume)
•sedation needed but it’s a gentler mode

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9
Q

Ancillary vent settings

A

“Peep those alveoli open” 🫁

-PEEP:
• + pressure applied at end expiration
•opens alveoli/prevents collapse
•range is 3-20cm h2O (5cm is natural occurring/healthy person)
•main goal of PEEP: improve oxygenation while decreasing the Fio2

  • Warning* -increased PEEP levels Can cause barotrauma to alveoli and hemodynamic instability

warning the higher the peep the higher risk for decreased BP d/t intrathoracic pressure on the heart

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10
Q

Alternatives to Vents: CPAP

A

Continuous positive airway pressure :
•similar to PEEP but delivers continued expiratory pressure
•maintains 5cm H2O
•common uses: sleep apnea, CHF, COPD exacerbation

*caution in Pt’s w/cardiac impairment

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11
Q

Alternatives to Vents: BiPAP

A

Bilevel positive airway pressure:
•two levels of support (considered life support)
•high inspiratory & low expiratory pressures
•common Pt’s: COPD, CHF, RF, sleep apnea
•last ditch effort to prevent intubation

*contraindications: need to be conscious, not vomiting, no facial trauma or recent head sx

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12
Q

Hi-flow NC

A

•fills dead space
•delivers set flow rates
•less risk of mucosal damage
•can achieve peep (1cm H2O for Q 10L)
•similar to Bi-pap w/o claustrophobia

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13
Q

Vent complications (alveolar)

A

Alveolar hypoventilation: leaking cuff, low pressures, increased secretions or obstruction

Alveolar hyperventilation: Pt hyperventilating over set rate, tidal volume set too high or rate set too fast

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14
Q

Nursing considerations: Vent

A

•pain control/sedation
•reposition Q2hr/PRN
•oral care/suction
•maintaining alarms
•trach care
•monitor trends/vitals/labs
•participate in weaning trails/sedation vacations

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15
Q

Indications for intubation

A

•Resp distress is #1 indicator
•prolonged period of apnea (TBI, sleep apnea, drugs)
•Trauma/airway obstruction
•high risk aspiration/ineffective airway clearance(overdose/drunk)

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16
Q

Risks/complications of intubation

A

•broken teeth
•spinal cord instability (make sure to use jaw thrust maneuver to protect spine)
•inability to intubate (swelling, fat, bleeding, vomit)

17
Q

ET Tube placement

A

2cm above carina
Use stethoscope; listen abdomen, lft lung, rt lung 🫁

18
Q

Pre-intubation preparation

A

Bedside: provider, 2 nurses, 2 RT
Equipment:
•wall o2/suction
•ambu bag
•ET tube, stylet, 10ml syringe, appropriate blade
•fiberoptic intubation device
•CO2 detector
•commercial stabilization device
•meds (situational. Gag reflex NEEDS meds)
•ancillary (NG/foley)

19
Q

Intubation meds : sedatives

A

•Fentanyl
•midazolam (Versed)
•propofol (Diprivan)
•Etomidate (Amidate)

20
Q

Intubation meds : paralytic

A

•Succinylcholine IVP 15secs
•Rocuronium (Zemuron) 15-30secs

21
Q

What order are intubation meds given?

A

1st Amidate + 2nd Succ

Or

1st Roc + 2nd Amidate

22
Q

Nurses role after intubation

A

•Maintain correct placement
•maintain cuff inflation
•monitor oxygenation(gas exchange. O2 to tissues). ventilation (mechanics, WOB/RR/muscles)
•maintaining tube patency
•suction only when spo2 drops, Pt coughing, resp distress, secretions or increased RR.
routine suctioning can cause tissue damage, dysrhythmias and increased ICP

23
Q

Two major complications of intubation

A

•unplanned extubation:
-can l/t death, disability
-use comfort measures
-use soft wrist restraints if needed

•Aspiration:
-Maintain cuff inflation
-suction PRN /HOB 30-45°
-NG/OG tube for intubated pts