Advanced Ventilation Flashcards

(44 cards)

1
Q

Platue Pressue

A

Is defined as airway pressure during the end expiratory pause and roughly reflects the level of alveolar over distension

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2
Q

Obstructive lung diseases

A

Cystic Fibrosis
Asthma
COPD
Bronchiectasis

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3
Q

Restrictive lung diseases

A

Lungs are restricted from fully expanding, making it difficult to inhale and fully expand the lungs
Interstitial lung disease
Sarcoidosis
Neuromuscular disease
Pulmonary fibrosis
Asbestosis

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4
Q

Plateau Pressure

A

Pressure in the alveolar at the end of inspiration prior to expiration
A useful marker of lung hyperinflation and should be maintained at less than 30cmH2O- if greater than 30 there is potential for alveolar injury

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5
Q

What does it indicate If there is an increasing plateau pressure?

A

Reducing lung compliance

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6
Q

An increased Peak pressure (PIP) and normal plateau pressure indicates

A

An increase in airway resistance

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7
Q

If peak pressure (PIP) and plateau pressure and increased what does this indicate?

A

A decreased lung compliance

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8
Q

Causes of increased airway resistance

A

Bronchospasm
Excessive secretions
Mucus plug
Foreign body aspiration
Extrinsic airway compression/biting the ETT

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9
Q

Causes of decreased compliance

A

Pulmonary oedema
Pleural effusion
Pneumothorax
Right main stem bronchus intubation
Ascites or other abdominal distension

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10
Q

Shunt

A

Perfusion without ventilation

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11
Q

Dead space

A

Ventilation without perfusion

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12
Q

Restrictive disease ventilation management

A

Increase inspiratory time
Look at pt position
Reduce PIP’s
Change to pressure control
PEEP to recruit alveoli
Permissive hypercapnia

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13
Q

Inspiratory hold on MV

A

Demonstrates compliance and any airway resistance:
Plateau pressure (P.Plat)
PIP/P.Plat
Difference

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14
Q

PIP

A

Caused by inspiratory flow rates
Tidal volume
Increased airway resistance
Decreased lung compliance
Decreased chest wall compliance
Normally set to 20-30cm

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15
Q

RAW

A

= resistance

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16
Q

Permissive hypercapnia

A

Deliberate limiting of ventilation with low tidal volumes (5mls/kg), in order to decrease alveolar overdistention
Gradual increase of PaCO2 by gradually decreasing Vt/rate
Gas tracheal insufflation may be used to reduce effects

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17
Q

Advantages of permissive hypercapnia

A

Reduction of barotrauma/voluntarism
Increased PaCO2 enhances oxygen unloading at the tissue level
Adverse effects of acidosis minimised with gradual rise of PaCO2 as metabolic compensation occurs

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18
Q

Disadvantages of of permissive hypercapnia

A

Acute rises in PaCO2 causes depressive effects on the CNS and CVS
Reduces the affinity of Hb for oxygen uptake in the lungs
Rapid rise in CO2 leads to respiratory acidosis

19
Q

Prone positioning

A

May improve oxygenation and decrease the degree of shunt

20
Q

Adverse effects associated with prone position for ventilation

A

Decreased enteral nutrition
ETT obstruction or dislodgement
Increased ICP
Difficulty monitoring the pt
Labour intensive
Facial oedema

21
Q

Mechanical Ventilation in Asthma

A

Increase expiratory time:
Slow respiratory rate
Fast flows
No unnecessary inspiratory pauses
Decreased tidal volumes of plat pressure rising
Aim for MV approx 6L/min

22
Q

Asthma management

A

Bronchodilators
Corticosteroids
NIV/NIPPV
?heliox

23
Q

COPD management

A

Oxygen
NIPPV/NIV
Bronchodilators
Steroids
?heliox
Early nutrition
Physio therapy
Antibiotics if infective component

24
Q

Mechanical ventilation in COPD

A

PEEP may be helpful to:
Decrease WOB
stents collapsible airways
Increases expiratory flow

25
Extubation
Can the patient ventilate and oxygenate? Do they have a gag reflex Are vitals WNL Resolution of the process necessitating intubation Can pt be easily roused and follow commands Was it a difficult intubation
26
Minute ventilation
Vt x RR
27
PIP (peak pressure)
Is the highest pressure measured during the respiratory cycle. PIP reflects airway resistance
28
Factors that generate PIP
Inspiratory flow rate Tidal volume
29
Strategies to minimise barotrauma in obstructive lung disease
Reduce tidal volume Reduce breath rate Increase expiratory phase
30
Strategies to minimise barotrauma in restrictive lung disease
Pressure control PEEP inverse ratio ventilation Prone positioning
31
Vent settings VC
Volume control- the ventilator delivers a preset Vt
32
Vent settings - PC
Pressure control- preset maximum pressure is delivered during inspiration
33
CMV
Continuous mandatory ventilation- preset number of mandatory breaths at a preset volume/pressure
34
Volume assist/control ventilation (A/C)
Preset mandatory breaths at preset volume/pressure; patient can trigger spontaneous breaths between mandatory breaths. Spontaneous breaths are “topped up” to match volume of mandatory breath.
35
SIMV
Synchronised intermittent mandatory ventilation. Preset number of breaths of a preset volume/pressure; patient triggers spontaneous breaths which are variable
36
I:E ratio
The shorter the inspiratory time the longer the expiration time Generally set at 1:2 Eg: 1:2 means 33.33% breath cycle is inspiration and 66.66% is expiration
37
Flow Rate
Speed at which the Vt is delivered Average settings 40-60L/min High flow rate classified as >60L/min *flow rate changed by altering inspiratory time Decrease inspiratory time= increase flow rate Increasing inspiratory time = decreases flow rate
38
Pressure support
Support spontaneous breaths when SIMV used Generally set at 5-10cmH20
39
Disadvantages of Positive pressure ventilation
Decrease cerebral perfusion (CCP) Raised ICP Cerebral hypoxia
40
Lung protective strategy
Focused on low tidal volume ventilation to reduce ventilator associated lung injury such as barotrauma and volutrauma. Can be chosen on any pt except pts who have obstructive disease ( asthma, COPD)
41
High plateau pressures
Decrease the tidal volume 1ml/kg until plateau pressure of less than 30cmH2O is achieved. Tidal vols of 4ml are accepted. In such cases you will likely need to increase RR to maintain PaCO2 goals. Consider permissive hypercapnia if RR limits reached
42
Paediatric ventilation settings
Mode: PCV PEEP - 5-15 (should not exceed 15) PiP - determines the pts Vt. Can start between 15 And 20 cmH20 greater than PEEP (should not exceed 30 cmH20) Observe chest rise and fall The achieved Vt should be approx 6-8ml/kg IBW (lung protective ventilation)
43
Increased airway resistance
Asthma/bronchospasm- administer bronchodilators Mucus plugging - airway clearance therapy Kinked or obstructed tube
44
Indications for MV
Apnoea Inability to protect airway Respiratory distress Inability to sustain adequate oxygenation Respiratory acidosis Post op respiratory failure Shock states