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Principles 1 > Anes Ventilators and Pulm Mgmt > Flashcards

Anes Ventilators and Pulm Mgmt Flashcards

1
Q

paralytics and a deepened anesthetic state cause what type of chest mvmts?

A

Uncoordinated/asynchronous chest movement

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2
Q

what type of ventilation is an unnatural process?

A

positive pressure ventilation

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3
Q

what 3 reasons are given as to why positive pressure ventilation is unnatural?

A

–Cyclic recruitment and de-recruitment of collapsed lung units
–Repetitive shear stress is shown to destroy cellular structures
–Inspiratory flow is directed to less resistant areas or areas qthat remain open resulting in overinflated alveoli

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4
Q

What 3 things happen to the lungs with anesthesia?

A

decrease in functional residual capacity
decrease in compliance
increased airway resistance

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5
Q

the loss of tone, reduced airway dimensions and smaller volumes result in what in the lungs?

A

airway closure and atelectasis

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6
Q

4 causes of ventilator-induced Lung Injury (VILI)

A
  • volutrauma
  • barotrauma
  • atelectrauma
  • biotrauma
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7
Q

Overdistention of alveoli

A

volutrauma

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8
Q

Excessive pulmonary pressures

A

Barotrauma

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9
Q

repeated opening and collapse of

atelectatic lung units

A

atelectrauma

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10
Q

nflammatory mediator release into
alveoli and surrounding bronchiole spaces (can be
caused by the 1st 3 traumas)

A

biotrauma

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11
Q

What is good for artificial positive pressure ventilation can be
detrimental to circulation and organ function because it:

A
  • increases intrathoracic pressures and pvr
  • cause distended lungs and cardiac septal shift
  • decreased renal function from decreased CO
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12
Q

the Increased intrathoracic pressures and pulmonary vascular resistance causes what to happen in lungs?

A

Venous return (preload) is impeded decreased cardiac output

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13
Q

distended lungs and cardiac septal shift causes what in the lungs

A
  • Alveolar distention may occur as well as air trapping

* Surfactant production may be impaired

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14
Q

Decreased cardiac output from pos pressure ventilation can lead to

A

decreased renal function, liver perfusion, low perfusion and ischemia to gastric mucosa

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15
Q

What causes the terminal bronchioles to collapse?

A

hyperinflated alveoli

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16
Q

what is the goal of protective mechanical ventilation?

A

to minimize injury to the lung

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17
Q

will large Vt and high fio2 prevent atelectasis?

A

NO

High FiO2 can accelerate atelectasis formation, does not help with gas exchange

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18
Q

what preserves lung mechanics

A

spontaneous ventilation

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19
Q

inspiration is terminated when

preset volume is reached.

A

Volume control:

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20
Q

inspiration is terminated when

preset pressure is reached.

A

Pressure control:

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21
Q

a change in volume for a given change in pressure

A

Compliance

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22
Q

when is compliance greater in the lung?

A

Compliance is higher at the beginning of inspiration because lungs are
empty, and the volume change is greater the given lower pressure

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23
Q

Low compliance results in

A

a smaller volume change for a given pressure change

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24
Q

High compliance results in

A

a larger volume change for a given pressure change

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25
Q

what determines how much time the respiratory cycle will last

A

respiratory rate

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26
Q

type of ventilator that will slow down flow as it nears the end of inspiration?

A

variable flow ventilator and is known as decelerating flow pattern

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27
Q

During inspiration a flow rate of 1 liter/ second

requires

A

2 cm H20 pressure

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28
Q

3 cm H20 pressure will distend lung to

A

500 cc

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29
Q

Occurs during times without gas flow, such as
during an inspiratory pause or at the end of
inhalation

A

Static Lung Compliance

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30
Q

Static Lung Compliance is measured by

A

plateau pressure which is mostly constant

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31
Q

what is the more accurate measure of compliance?

A

static compliance

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32
Q

Occurs during times of gas flow, during active

inspiration

A

Dynamic Lung Compliance

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33
Q

what does dynamic compliance measure?

A

lung compliance AND resistance

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34
Q

what contributes to a decrease in

dynamic compliance

A

airway resistance - it is measure by peak insp flow

35
Q

Weight of ascending bellows adds

A

2-3

cmH20 PEEP

36
Q

difference in descending bellows and ascending?

A

descending are not safe and ascend during

inspiration and descend during expiration so disconnect is not always caught

37
Q

Initial Ventilator Settings

A 
RR - 8-12
Vt - 6-8 ml/kg
avoid high PiP >35-40
PEEP >4 cmh2o
fio2 40-50%
I:E   1:2
38
Q

PEEP can decrease

A

venous return, CO, SBP but still USE IT

39
Q

Circuit compliance (distensibility) =

A

5ml/cmH20

40
Q

Gas sampling =

A

150 ml/min (2.5 ml/second)

41
Q

Gas compression=

A

3%

42
Q

what is the difference in set and delivered Vt?

A

basically, pt will not be getting Vt set because of loss from circuit compliance, gas sampling, and gas compression

43
Q

goal of Vt?

A

keep alveoli open, expanded, recruited, control ETCO2

44
Q

what do you want to keep Vt under?

A

10 ml/kg

45
Q

safest way to ventilate?

A

low Vt and PEEP

46
Q

most efficient way to ventilate?

A

Vt

47
Q

Hypoventilation (↓ PAO2 /↑ PACO2) is common with

A

MAC anesthesia or when using an

LMA with spontaneous ventilating patient

48
Q

Alveolar air equations

A

PAO2 = FiO2 x (760-47) – PACO2/0.8

49
Q

what determines how fast the Vt is delivered

A

inspiratory flow

50
Q

The higher the I:E ratio, the greater the

A

inspiratory time and the lower the inspiratory pressures

since the breath is delivered over a longer amount of time.

51
Q

has been utilized to allow

longer inspiratory times under lower pressures in order for inspired volume to reach & recruit collapsed alveoli.

A

Inverse ratio ventilation(IVR)(ex:2:1)

52
Q

Effect of I:E ratio on PiPs

A

the lower the ratio (1:4 vs 1:1.5), the higher the PiP because the Vt has to be delivered over a shorter period of time

53
Q

I:E ratio reflects the

A 
inspiratory time (time Vt is 
delivered) in relation to the expiratory time (end 
inspiration to start of next)
54
Q

Effect of I:E ratio on ETCO2 with constant

tidal volume and rate

A

The longer you stay in expiratory phase, the more CO2 you can breathe out.
Ex: 1:2 to 1:4 - will spend more time breathing OUT and releasing CO2 with 1:4

55
Q

Effect of I:E ratio on inspiratory flow and

pressure with constant Vt and rate

A

Pressure and flow will increase with a lower I:E ratio.
Ex: 1:2 vs 1:1 have a shorter time to get a tidal volume in at a ratio of 1:2 then at 1:1 because you are spending more time of the resp cycle in expiration phase

56
Q

Laminar flow changes to turbulent flow when

A
  • Critical velocity is reached
  • Direction and/or diameter is changed
  • Flow is obstructed or resistance increased
57
Q

What leads to turbulent flow in lungs

A

bronchospasm
airway edema
mucous and secretions

58
Q

Can adjusting the ventilator I:E ratio

lead to turbulent air flow?

A

Yes, the lower the ratio (1:4 vs 1:2) the higher the flow and pressure to get the tidal volume in during the inspiratory phase

59
Q

Effect of rate on inspiratory flow and

pressure with constant I:E ratio

A

the lower the RR, the longer the resp cycle. The longer the resp cycle, the longer amount of time you have to get tidal volume into patient. Increasing the RR would increase inspiratory flow and pressure

60
Q

Effect of increasing FGF on Vt and Vm

A

↑FGF = ↑Vt,↑ Vm and ↑ PiPs

61
Q

FGF decoupling

A

(flow compensator) is used on most of the newer

anesthesia ventilators to combat the increase of flow from an increase in FGF

62
Q

You are using a ventilator that only has rate and minute
ventilation. Turning the rate up and leaving the minute
ventilation unchanged will affect the tidal volume how?

A

the Vt will decrease because you are getting more breaths in per minute without changing the mV

63
Q

Effects of rate and Vm adjustment on Vt in

ventilators with only Vm and rate controls

A

ex: Vm = 8000, rate 10 = Vt 800 mls
- If you lower the RR and do not change mV the Vt ↑
- If you lower mV and do not change RR, Vt will dec
- if you ↑ RR and do not change mV, Vt will decrease

64
Q

Most common ventilation mode

•Advantages are that tidal volume is set and kept constant and delivered each breath

A

Volume controlled Ventilation (CMV or VCV)

65
Q

Volume controlled Ventilation (CMV or VCV) is best for patients and why?

A

Best for patients with no respiratory effort and little expected change in airway resistance and intra-thoracic pressure bc you PiP is variable which could lead to barotrauma

66
Q

How Inspiratory flow affects I:E ratio

A

increasing inspiratory flow decreases the I:E ratio because you are blowing the air in FASTER causing a decrease in the length of the inspiratory cycle

67
Q

Tidal volume delivered is based on preset

pressure target being reached

A

Pressure Controlled Ventilation (PCV)

68
Q

how are inspiratory times and tidal volumes effected with Pressure Controlled Ventilation (PCV)?

A
  • Inspiratory times are longer

- Tidal volume can vary breath to breath

69
Q

how are tidal volumes set with pressure controlled vent?

A

based on desired pressure
not volume so that peak airway pressure is
controlled.
NOT guaranteed

70
Q

when does expiration occur during pcv?

A

when the inspiratory time and

airway pressures are reached.

71
Q

Indications PCV?

A

•Useful when high PiPs are not appropriate:
–LMA, emphysema, neonates and children
•Useful when low compliance is present:
–Laparoscopy, pregnancy, morbid obesity, ARDS

72
Q

what type of lung damage can happen?

A

volutrauma r/t an increase in Vt

73
Q

Volume vs. Pressure Flow Patterns

A 
volume = constant flow rate, will have flat line and look like a box
pressure = decelerating flow pattern, will have a peak and then a slope downward
74
Q

If you are using pressure
control ventilation and compliance changes
from low to high how will volume change?

A

your volume is going to increase r/t lungs being able to more easily expand

75
Q

If you are using pressure
control ventilation and resistance changes
from low to high how will volume change?

A

lower resistance, higher volumes, increased resistance = lower volumes

76
Q

Ventilator’s attempt to guarantee a set volume in a pressure-controlled mode of ventilation

A

VG = Volume Guarantee

77
Q

how does pressure support ventilation work?

A

When patient’s effort reaches the set inspiratory flow
trigger (sensitivity) (≈ 2L/min) the pressure supported
breath is initiated and delivered throughout inspiration.

78
Q

describe flow, RR, and inspiratory phase of pressure support vent

A
  • When flow decreases expiration begins
  • Only inspiratory pressure is set.
  • Respiratory rate is determined by the patient.
79
Q

Pressure Support Ventilation (PSV) indications:

A

•Designed to augment Vt in spontaneously
breathing patients.
•To decrease WOB & increase patient comfort
•Weak inspiratory effort
–Deep level of anesthetic
–Residual muscle paralysis
•Obstructed airway breathing

80
Q

Senses negative pressure inside the chest cavity created by diaphragm and
knows the patient initiated a patient driven breath

A

Synchronized Intermittent Mandatory Ventilation (SIMV)

81
Q

If patient does not inspire within trigger synchronization window waiting
time, what happens?

A

ventilator then will deliver a breath
Ensures enough mandatory breaths if patient’s breathing efforts fall
outside time frame of breath

82
Q

Advantages of SIMV

A

more pt control of ventilations, backup for spontaneous breathing pt that may be too weak to stay normocarbic

83
Q

AC

A

will deliver set breaths no matter what the pt does so could result in some serious lung trauma

Principles 1 (12 decks)

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