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Advanced Clinical Procedures > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

What is Mechanical Rate:

A

Breaths per minute that will be delivered by the ventilator whether or not the patient attempts to breath or not. It can be adjusted up or down based on ABGs, patient mental status, reason for mechanical ventilation.

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2
Q

What is the first parameter weaned during attempts to liberate the patient from mechanical ventilation?

A

mechanical rate

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3
Q

What is spontaneous rate?

A

The breaths per minute that the patient initiates. This may vary widely depending on level of alertness, sedation, respiratory muscle strength, pain/aggitation, disease process

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4
Q

What is tidal volume?

A

It refers to the amount of exhaled breath or the targel tidal volume that was set for mechanical breaths.

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5
Q

What measures tidal volume?

A

The ventilator measures exhaled tidal volume

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6
Q

What is the minute ventilation?

A

= Vt x RR. Minute ventilation is ultimately what determines PaCO2, so in making ventilator adjustments for PaCO2 we are really manipulating the minute ventilation.

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7
Q

What is PEEP?

A

Positive End Expiratory Pressure, Pressure in the lungs that is maintained at the end of expiration.

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8
Q

Auto-PEEP:

A

air trapping caused by incomplete exhalation

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9
Q

Applied-PEEP:

A

amount of pressure set on the ventilator to either reduce atelectasis due to mechanical ventilation or improve alveolar recruitment due to pathological processes.

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10
Q

What is pressure support?

A

Pressure (cm H2O) above the PEEP that the ventilator delivers during a patient-initiated breath to help increase the tidal volume.

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11
Q

What is EtCO2?

A

Measure of the partial pressure of carbon dioxide in the expired air.

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12
Q

What is used as a real time guide to ventilation?

A

EtCO2

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13
Q

What is FiO2?

A

Percentage of oxygen that can be delivered in multiple ways (NC, face mask) but can be very precisely set via the ventilator.

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14
Q

What is the Assist Control mode of mechanical ventilation?

A

All breaths are fully-mechanical. Set number of breaths per minute regardless of patient initiation. Ventilator senses patient initiation and delivers a fully-mechanical breath.

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15
Q

What are the advantages of assist control?

A

Reduced work of breathing

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16
Q

What are the disadvantages to assist control?

A

Decreased patient requirement & Easier, unintended hyperventilation.

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17
Q

What is the SIMV mode of mechanical ventilation?

A

Set number of breaths regardless of patient initiation. PS (cm H2O above PEEP) delivered during patient-initiated breaths.

18
Q

What are the advantages of SIMV?

A

Patient assumes control respiratory drive and rate.

19
Q

What are the disadvantages of SIMV?

A

At times, unintended increase in work of breathing.

20
Q

What is the PSV mode of mechanical ventilation?

A

Zero fully-mechanical breaths. PS and PEEP set – basically an invasive form of BiPAP.

21
Q

What are the advantages of PSV?

A

Patient assumes drive to breathe.

Frequently more comfortable due to patient control over duration of breath and tidal volume.

22
Q

What are the disadvantages of PSV?

A

Certain patients may not tolerate due to hypoventilation.

23
Q

What are the methods of delivery for mechanical ventilation?

A

Volume control
Pressure control
VC+

24
Q

How does volume control work?

A

Ventilator delivers a set tidal volume to the patient on all mechanical breaths regardless of pressure required.

25
Q

What are the advantages to volume control?

A

Precise tidal volume delivered.

26
Q

What are the disadvantages to volume control?

A

Requires the practitioner to adjust flow rates to meet patient demand.

Potential for increased pressure to meet target tidal volume.

27
Q

How does pressure control work?

A

Ventilator delivers a set pressure (in cmH2O) regardless of the volume delivered – remember, we set that pressure.

28
Q

What are the advantages to pressure control?

A

Precise pressure delivered.

29
Q

What are the disadvantages to pressure control?

A

Can allow hypoventilation or hyperventilation if the practitioner is not vigilant.

Requires repeated adjustment/monitoring depending on patient’s compliance.

30
Q

How does VC+ work?

A

Allows the practitioner to set a goal tidal volume. The ventilator goes into VC+ startup mode where it delivers several volume control breaths to determine pressure required to meet that volume. The ventilator uses lowest pressure as pressure to be delivered but also does not restrict flow rate (more comfortable).

Breath is stopped when goal met (goal + or – 2 standard deviations of desired volume) and will automatically adjust pressure required to reach the goal (good for changing compliance).

Also allows a set maximum tidal volume and maximum pressure that it won’t go above.

31
Q

What are the advantages of VC+?

A

Allows the setting of an inspiratory time that is most appropriate for each time.

Typically more comfortable due to automatic adjustment for compliance and flow demand.

Helps guard against baro-trauma and volu-trauma via practitioner set safe guards.

32
Q

What are the disadvantages of VC+?

A

Sometimes does not allow for adequate tidal volumes in certain situations (severe inhalational injury).

33
Q 
Which of the following is the term for breaths per minute initiated by a patient (on a ventilator)?
A.Mechanical Rate
B.Minute Ventilation
C.FiO2
D.Spontaneous Rate
A

Spontaneous Rate

34
Q

Which method of ventilation uses complete fully-mechanical ventilation?
A.Synchronized Intermittent Mandatory Ventilation
B.Pressure Support Ventilation
C.Assist Control

A

Assist Control

35
Q

Which method of ventilation uses a set number of breaths regardless of patient initiation and utilizes pressure support?
A.Synchronized Intermittent Mandatory Ventilation
B.Pressure Support Ventilation
C.Assist Control

A

SIMV

36
Q

Which method of ventilation uses no fully-mechanical breaths?
A.Synchronized Intermittent Mandatory Ventilation
B.Pressure Support Ventilation
C.Assist Control

A

Pressure Support

37
Q 
What value is the real time guide for ventilation?
A.Minute Ventilation
B.Tidal Volume
C.FiO2
D.EtCO2
A

EtCO2

38
Q

Which of the following cases would you NOT use Applied PEEP in?
A.Reduce Atelectasis
B.COPD
C.Improve Alveolar Involvement in Pneumonia
D.Alveolar Recruitment in Tension Pneumothorax

A

COPD

39
Q 
What ultimately determines PaCO2?
A.Mechanical Rate
B.Spontaneous Rate
C.Auto PEEP
D.Minute Ventilation
A

Minute Ventilation

40
Q 
What is the first parameter weaned during attempts to liberate the patient from mechanical ventilation?
A.Mechanical Rate
B.Spontaneous Rate
C.Applied PEEP
D.Pressure Support
A

Mechanical Rate

Advanced Clinical Procedures (18 decks)

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