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Advanced Respiratory Therapy Procedures > ARTP 07 Basic Vent Function > Flashcards

ARTP 07 Basic Vent Function Flashcards

(75 cards)

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1
Q

What is our normal physiological pressure of ventilation?

A

Negative pressure

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2
Q

Internal circuit

A

Pathway for air inside on it way to the external circuit

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3
Q

External circuit

A

Pathway for air through the inspiratory side to the patient then through the expiratory side back to the ventilator

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4
Q

Exhale valve

A

Functions to direct flow of the gas towars patient

Valve closes on inspiration

a functional exhale valve is required for the delivery of PEEP

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5
Q

2 types of negative pressure machines

A

Chest cuirass

Iron lung

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6
Q

PIP/MIP (peak inspiratory pressure) (Maximal inspiratory pressure)

A

Pressure it takes to vent lung. Also known as PAP (peak airway pressure)
Required to deliver a set volume.

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7
Q

MAP (Mean airway pressure)

A

Average airway pressure over the respiratory cycle

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8
Q

Sensitivity (trigger)

A

Pt effort needed to trigger ventilation.

Flow trigger sensitivity is more responsive to pt effort.

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9
Q

I:E ratio

A

1:2

I:E is manipulated with flow

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10
Q

Inverse I:E

A

Inspiratory time greater than expiratory time

Can be used for infants and adults who are critically ill.

Can be used to treat refractory hypoxia

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11
Q

What trigger is easiest for patients?

A

Flow trigger

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12
Q

Trigger

A

Starts inspiration

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13
Q

Cycle

A

Ends inspiration

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14
Q

Spontaneous

A

Inspiration is patient triggered and cycled

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15
Q

Mandatory

A

Inspiration is machine triggered or cycled

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16
Q

Alternate name for spontaneous

A

Pressure support

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17
Q

Alternate names for Mandatory

A

AC (assist/control)
Control
Mechanical
SIMV

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18
Q

When do exhalation valve open?

A

At the end of cycle

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19
Q

Control variable

A

What vent manipulates to deliver a breath (pressure or volume)

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20
Q

Volume control

A

Tidal volume and flow are preset

Volume is constant, pressure varies

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21
Q

Pressure control

A

Inspiratory pressure is preset

Pressure is constant and volume varies

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22
Q

CMV (continuous mandatory ventilation)

A

Control
Machines is set to deliver all breaths based on time

Patient CANNOT take assisted breaths

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23
Q

Assist/ control

A

Patient can take assisted breaths if breathing over a set rate. Patient can trigger or machine will trigger depending on rate.

Sensitivity is adjusted to allow patient breath at a set rate VT in volume control or set PIP in pressure control

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24
Q

IMV/ intermittent mandatory ventilation or SIMV

A

Combination of mandatory breaths from the vent, but the patient can also take spontaneous breaths between vent breaths. Spontaneous breaths are delivered at a volume the patient desires.

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25
Support modes
Vent provides the work for the patient Assist control SIMV + PSV A/C
26
Spontaneous
Patient is in control and does the work Pressure support, PSV and CPAP
27
Trigger variable
What starts the breath
28
Target variable
An upper boundary set which doesn’t terminate inspiration but is maintained at pressure, volume, or flow
29
Cycle variable
What ends inspiration
30
4 phases of breath
Change of expiration to inspiration Inspiration Change from inspiration to expiration Expiration
31
Pressure triggered
The patient generates inspiration from changing pressure. Sensitivity is set to -0.5 to -2 cmH2O
32
Flow cycled
Inspiration ends when a minimum flow is reached In “pressure support mode” the inspiratory pressure ends when inspiratory flow descreases to a certain level.
33
Where is flow cycled found
Only in pressure support mode
34
Time cycled
Inspiration ends due to a set time for inspiration If pip is reached, the machine holds inspiration until inspiratory time hs expired
35
When is time cycled used?
Used in adults with inverse ratio ventilation on occasion
36
Pressure limited
Reaches the pressure and holds that pressure until some cycling mechanism ends inspiration Pressure limit is a setting
37
Pressure limit relief (safety pressure limit) (high pressure alarm limit)
Vent will alarm and cycles inspiration off and releases gas when pressure limit is reached
38
Inflation hold/ plateau
At peak inspiration, holds pressure or volume. 0.5 to 2 sec
39
I:E limit
Prevents vent from delivering an I:E ratio greater than 1:1
40
PEEP (positive end expiratory pressure)
Positive pressure held at an elevated baseline above atmospheric pressure Helps increase PaO2 Aka facilitate oxygenation Keeps alveoli open
41
What modes use PEEP?
A/C or IMV/SIMV
42
Physiological effect of PEEP?
Causes decreased venous return to heart and possible decreased blood pressure (CAN BE USED TO TREAT PULM EDEMA) Increase FRC and decreased shunting Increase airway pressure Increase peep Increased pao2 to allow for decreased levels of FiO2 to be used
43
CPAP Continuous positive airway pressure
A purely spontaneous mode, cannot be used for patients that are apneic Used to aid in elevating PaO2 and does not remove PaCO2 Patient must be able to spontaneously ventilate.
44
Key factors in choosing flow pattern?
Best ventilate the patient Provide low PIP Lowest MAP I:E ratio of at least 1:2
45
Sine wave
Like normal breathing Flow is not constant
46
Square wave
Inspirstory flow is constant Could increase peak airway pressure and mean airway pressure
47
Tapered/decelerating/ rape waveform
Flow rate on inspiration is high then tapers off Helps reduce risk of barotrauma
48
How does increased/ decreased flow affect I:E time
Increased flow: decreased I time, increased E time Decreased flow: increased I time, decreased e time
49
How does volume effect I:E time
Increased volume: increased i time, decreased e time Decreased volume: decreased i time, increased e time
50
How does rate affect I:E time
Increased rate: decreased i time, decreased e time Decreased rate: increased i time, increased e time
51
Spontaneous breaths?
Patient triggered and patient cycled
52
Mandatory breaths?
Machine trigger and maching cycled Patient triggered and machine cycled
53
CMV or assist/control
Interchangeable terms Deliver mandatory breaths
54
CMV
Each breath delivered is a set volume or pressure CMV or control, the patient CANNOT take a spontaneous breath
55
IMV/ SIMV
The vent will deliver a mandatory breath and the patient can initiate a spontaneous breath.
56
CSV
Continuous spontaneous vent all breaths are initiated and cycled by the patient
57
Inverse I: E ratio is used when
Used when a patient is very critical and maximum levels of O2 and PEEP are not improving patients oxygenation.
58
IMV/ SIMV
Not a full support mode Used as a weaning mode *transtion to full weaning mode*
59
Will IMV have a set rate and if so can patient take spontaneous breaths?
Yes, and in between the set number of breaths the patient can take as many spontaneous breaths as needed
60
Main difference between simv and imv?
SIMV will not stack breath’s
61
What breathing mode is used for weaning and known as a spotter?
PSV
62
PSV (pressure support ventilation)
Purely spontaneous. Patient must be able to spontaneously breath Patient triggers the machines
63
What type of cycle is PSV
Flow cycled
64
What levels compensate for the airway resistance of an artificial airway and tubing?
5-7 cm H2O
65
How does PSV help?
``` Decreased WOB Can increase spontaneous tidal volume Can decrease RR Can increased VT Reduces respiratory muscle activity Can decrease O2 consumption (good for COPD) ```
66
What is your goal of PSV?
Maintain spontaneous VT of 4-8 ml/kg IBW Decrease RR < than 30 bpm Decrease WOB
67
If you want to increase spontaneous tidal volume with ps what do you do?
Increase PS until volumes near your desired level.
68
If your goal is to overcome RAW what do you do with PS?
Increase pressure support level until work of breathing decrease and vent pattern improves
69
Pressure support will not do all of the work for them, will help w increasing spontaneous tidal volume
Pressure support mimics our normal breaths
70
What mode if a patient is not breathing spontaneously or not strong enough to initiate an assisted breath?
Assist/control or CMV
71
What mode if patient is strong enough to assist vent in Assist/control?
SIMV
72
Patient whose tidal volume is large but has low PaO2?
Try PEEP or CPAP
73
Patient strong enough to assist vent but has low VT in spontaneous breaths
PSV
74
Who does flow triggering help?
All patients
75
When oxygenation is poor and pressure control does not work?
Inverse ratio ventilation

Advanced Respiratory Therapy Procedures (5 decks)

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