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PULMONOLOGY > Chapter 295 - Mechanical Ventilatory Support > Flashcards

Chapter 295 - Mechanical Ventilatory Support Flashcards

1
Q

What is the primary indication for initiation of MV

A

Respiratory Failure

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2
Q

Types of respiratory failure

A

hypoxemic

hypercarbic

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3
Q

Hypoxemic respiratory failure occurs when arterial O2 saturation falls below which level despite an increased FiO2

A

<90%

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4
Q

Hypoxemic respiratory failure results from which conditions?

A

VQ mismatch

Shunt

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5
Q

Hypercarbic respiratory failure occurs if arterial CO2 values are greater than which level?

A

> 50 mmhg

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6
Q

Hypercarbic respiratory failure results from which conditions?

A

decrease minute ventilation

increase physiologic dead space

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7
Q

When respiratory failure is CHRONIC, patients are obligatorily treated with mechanical ventilation.

A

FALSE

only when acute is MV lifesaving

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8
Q

Respiratory failure with hypoxemia is the most common reason for instituting MV. This accounts for how many percent of all ventilated cases?

A

65%

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9
Q

Most common cause of hypercarbic respiratory failure?

A

Coma (15%)

COPD in exacerbation (13%)
Neuromuscular disease (13%)
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10
Q

What are the primary objectives of MV?

A
  1. decrease work of breathing

2. reverse life threatening hypoxemia and acidosis

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11
Q

Complications of NIV?

A

pneumonia

tracheolaryngeal trauma

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12
Q

2 most frequently implemented ways of NIV

A
  1. bilevel positive airway pressure ventilation

2. pressure support ventilation

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13
Q

Major limitation of NIV

A

patient intolerance

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14
Q

Most important group of patients who benefit from a trial of NIV

A 
COPD in exacerbation
Respiratory acidosis (pH <7.35)
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15
Q

blood pH level associated with low failure rates (15-20%) and good outcomes with NIV

A

7.25 - 7.35

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16
Q

In more severely ill patients, with blood pH <7.25, the rate of NIV failure is inversely related to the severity of the respiratory acidosis; the lower the pH the higher the rate of failure

A

TRUE

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17
Q

Good clinical indicators of the therapeutic benefit of NIV

A
  1. reduction in respiratory frequency

2. decrease in the use of accessory muscles

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18
Q

What characterizes a conditioned gas?

A

warmed, oxygenated, humidified

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19
Q

Good choices of sedatives during intubation but can have a deleterious effect on hemodynamics in patients with depressed cardiac function or low systemic vascular resistance

A

Opiates and benzodiazepines

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20
Q

Drug used during intubation that can promote histamine release from tissue mast cells and may worsen bronchospasm

A

Morphine

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21
Q

Drug that may increase systemic arterial pressure and has been associated with hallucinatory responses

A

Ketamine

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22
Q

Contraindications for NIV

A 
Cardiac/ respiratory arrest
Severe encephalopathy
Severe GI bleed
Hemodynamic instability
Unstable angina or MI
Facial surgery or trauma
Upper airway obstruction
High risk aspiration
inability to clear secretions
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23
Q

Basic goals of MV

A

to optimize oxygenation while avoiding ventilator induced lung injury due to overstretch and collapse/re-recruitment

(protective ventilatory strategy)

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24
Q

Refers to the manner in which ventilator breaths are triggered, cycled, and limited

A

Mode

25
Q

defines what the ventilator senses to initiate an assisted breath

A

Trigger

26
Q

refers to the factors that determine the end of inspiration

A

Cycle

27
Q

operator specified values that are monitored by transducer internal to the ventilator circuit throughout the respiratory cycle

A

Limiting factors

28
Q

most widely used mode of ventilation

A

ACMV

29
Q

patient or timer triggered

delivers an operator specified tidal volume

A

ACMV

30
Q

Ventilatory rate is determined either by the patient or by the operator specified back up rate, whichever is of higher frequency

A

ACMV

31
Q

allows synchronization of the ventilator cycle with the patient’s inspiratory effort

A

ACMV

32
Q

Increased intrathoracic pressures resulting from dynamic hyperinflation occurring if there is inadequate time available for complete exhalation between inspiratory cycles

A

Auto-PEEP

33
Q

Variable set by ACMV

A 
TV
BUR
PEEP
FiO2
Pressure limit
34
Q

Patient triggered, flow cycled, pressure limited

A

Pressure support ventilation

35
Q

Operator sets the pressure level to augment every spontaneous respiratory effort

A

PSV

36
Q

Patients receive ventilator assistance only when the ventilator detects an inspiratory effort

A

PSV

37
Q

operator sets the number of mandatory breaths of fixed volume to be delivered by the ventilator; between those breaths, the patient can breathe spontaneously

A

Intermittent Mandatory ventilation

38
Q

If the patient fails to initiate a breath, the ventilator delivers a fixed TV breath and resets the internal timer of the next inspiratory cycle

A

SIMV

39
Q

time triggered, time cycled, pressure limited

A

Pressure control ventilation

40
Q

tidal volume and inspiratory flow rate are dependent and are not operator specified

A

PCV

41
Q

preferred mode of ventilation in whom it is desirable to regulate peak airway pressures, such as those with preexisting barotrauma, and for post-thoracic surgery patients in whom the shear forces across a fresh suture line should be limited.

A

PCV

42
Q

variant of PCV that incorporates the use of prolonged inspiratory time with the appropriate shortening of the expiratory time

A

Inverse ratio ventilation

43
Q

used in patients with severe hypoxemic respiratory failure. increases mean distending pressures without increasing peak airway pressures.

A

Inverse ratio ventilation

44
Q

provides fresh gas to the breathing circuit with each inspiration and sets to a constant operator specified pressure

A

Continuous positive airway pressure

45
Q

static pressure in the airway at the end of inspiration

A

Plateau pressure

46
Q

Preventive ventilatory strategy has decreased the mortality rate of patients with acute hypoxemic respiratory failure to how many percent?

A

30%

47
Q

Daily interruption of sedation in patients with improved ventilatory status results in a shorter time on the ventilator and a shorter ICU stay

A

True

48
Q

3 most common organisms causing VAP

A

pseudomonas aeruginosa
enteric gram neg rods
s aureus

49
Q

Hypotension resulting from elevated intrathoracic pressures with decreased venous return is almost always responsive to which management?

A

Intravascular volume repletion

50
Q

4 Conditions indicating amenability to weaning by the ventilatory weaning task force

WEAN SCREEN

A

(1) Resolving disease
(2) adequate gas exchange with low PEEP (<8 cmH2O) and Fio2 (<0.5)
(3) stable hemodynamics
(4) spontaneous breathing ability

51
Q

How is SBT implemented?

A

T-piece using 1–5 cmH2O CPAP with 5–7 cmH2O

PSV

52
Q

How many percent of patients require reintubation despite all precautions instituted

A

10-15%

53
Q

3 complex complications of long term tracheostomy

A

tracheal stenosis
granulation
erosion of the innominate artery

54
Q

Tracheostomy is planned if a patient needs MV for how many days?

A

> 10-14 days

55
Q

How many percent of ventilated patients ultimately become dependent on vent support?

A

2%

56
Q

When is SBT declared a failure?

A
  • RR >35 for 5 min
  • O2 sat <90%
  • HR >140 or 20% inc or dec from baseline
  • SBP <90 or >180
  • inc anxiety/ diaphoresis
57
Q

Mainstay for therapy for analgesia in MV patients

A

Opiates

58
Q

Use of neuromuscular blocking agents may result in prolonged weakness terms as

A

Post paralytic syndrome

PULMONOLOGY (10 decks)

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