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Neo Pathophys 2 > Conventional Vent > Flashcards

Conventional Vent Flashcards

1
Q

What is the goal when you first meet the baby at delivery?

A

Get the lung inflated

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2
Q

Oxygen is a ___________ gas.

It produces lots of _____ _______.

A

Poisonous

Free radicals

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3
Q

__% of CO goes to the lungs in fetus

When stressed can be ___%

A

7%

1%

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4
Q

The goal during transition is to have ___% of blood from right heart go to the lungs

A

100%

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5
Q

The lung inflates by ___ times in the DR that as in utero

A

4 x’s

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6
Q

There is an ___ -fold increase in pulmonary blood flow in the DR

A

8

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7
Q

In the DR, PVR immediately plummets by?

A

1/2

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8
Q

T/F: establishment of oxygenation and ventilation is independent of FiO2 used to establish the initial lung inflation.

A

True

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9
Q

O2 may delay baby’s first breath by ____ seconds.

A

24

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10
Q

NPR: use ___% O2 w/term
Use ___-___% w/preterm
Must rely on _____ ______ to determine O2 need.

A

21%/RA
21-30%
Pulse oximetry

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11
Q

NRP: O2 sats should be:
By 1 minute
by 5 minutes
by 10 minutes

A

60-65%

80-85%

85-95%

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12
Q

A study done of < 32 wkrs on RA vs 100% FiO2 showed which was better?

A

Neither, somewhere in the middle, follow institution guidelines

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13
Q

What pH is indication of Acute Respiratory failure?
PaO2?
What would you do?

A

pH 7.2 and falling
Inability to maintain > 50 w/O2
Give some PPV through CPAP or ETT & Surfactant admin

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14
Q

A PaO2 correlates w/SpO2’s around ___%

A

85%

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15
Q

Is Apnea a sign of Respiratory Distress?

A

No

Respiratory Failure

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16
Q

Respiratory Failure is defined by what?

A

Blood gases (pH too low, PaCO2 too high)

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17
Q

Respiratory Distress is a ________ ________.

A

Physical Finding:

Increased WOB, tachypnea, retractions, cyanosis

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18
Q

Try only provide ventilation for RDS/Resp Failure?

A

Respiratory Failure

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19
Q

Reasons for Apnea?

What will you see?

A

CNS injury
Apnea of Prematurity
**(2 most common)
High CO2, but oxygenate pretty well (b/c have inflated lung)

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20
Q

HMD/Alveolar Dz/Pneumonia babies do what?

So their problem is ____ not ___

A

Shunt blood b/c lung is collapsed

O2, not CO2

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21
Q

Most important concept to understand is:

A

The Massive Residual Volume of a babies lungs.

They have a large residual capacity.

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22
Q

What is the typical Vt set on vent?

A

5 cc/kg

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23
Q

What is the residual capacity of an infant?

A

25 cc/kg

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24
Q

If there’s an obstruction, baby can get air ___ but can’t get air ____.

Will result in a ___ level of _____.

A

in
out

high, CO2

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25
Q

Lawyers have decided a preemie <1500 gms is at risk of ROP if PaO2 is >___.

> ____ is a medical, legal emergency

A

> 80

> 100

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26
Q

BOOST and support trials concluded that targeted Sats

A

< 90

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27
Q

What happened in the ‘60’s when babies w/HMD were grunting (no surfactant then) and subsequently intubated?

A

We took away their FRC

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28
Q

Grunting is a babies way of maintaining?

A

FRC

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29
Q

What are the 6 hazards of mechanical ventilation?

A
  1. Airway trauma
  2. Infection
  3. Pneumothorax
  4. PIE
  5. Impaired venous return
    • IVH? (CPAP-inhibits venous return)
  6. Chronic Lung disease
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30
Q

The ETT is always smaller than?

So, if it is smaller, it has more________.

A

the trachea

Resistance

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31
Q

ETT’s _____ the lining of the trachea, even if just in/out for Surfactant

A

injure

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32
Q

In 1971, _____ was discovered, creating Neonatal ICU

A

CPAP

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33
Q

Name the 2 forms of oxygen toxicity

A
  1. O2 itself applied physically to the lung
    ~40% tolerated well
    >70% is toxic to the lung
  2. PaO2 (blood oxygen) is toxic to the organs inside (i.e. ROP)
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34
Q

The CORRECT PaO2 is _________

A

unknown

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35
Q

PaO2 measures?

A

The pressure in the dissolved plasma next to the RBC’s

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36
Q

O2 sat monitor is much more ________ measurement of O2 content than PaO2

A

exact

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37
Q

NIRS monitoring measures deep ______ saturation monitoring.

Why is this helpful?

A

Venous

To know the balance at oxygenation the end of the circulatory cycle (balance of checking account)

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38
Q

FRC is _____ compared to Vt

A

Huge

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39
Q

You have an FRC to allow for?

A

Oxygen exchange

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40
Q

CO2 diffuses ____ x’s faster than O2

A

22 x’s

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41
Q

O2 is _____ to diffuse.

A

Slow

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42
Q

Even during exhalation you use _____ to absorb oxygen.

A

FRC

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43
Q

FRC is a huge volume = ____cc/kg

A

25 cc/kg

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44
Q

Residual volume in adults is synonymous w/?

A

FRC

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45
Q

Oxygen =

A

FRC

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46
Q

Oxygenation is determined by ________, which is determined by _______, which is determined by ________.

A

FRC (residual volume)
MAP
PEEP

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47
Q

PEEP and _______ are synonyms

A

Oxygenation

48
Q

CPAP and PEEP are physiologically ?

A

FRC

49
Q

Blood is _____ color in the pulmonary artery and if the Alveoli is open, blood comes out _____ color.

If the Alveoli is collapsed, blood comes out _____

A

Blue
Pink

Blue

50
Q

HMD= loss of?

A

FRC, you can not oxygenate

51
Q

Too much FRC=

A

Overinflation

52
Q

W/over-inflation you have what 2 things?

A
  1. Decreased Vt
  2. Decreased Venous Return
    (can’t exhale, so increased CO2, can’t get blood back to chest so venous return goes down)
53
Q

Surfactant deficiency is primarily a loss of?

A

FRC

54
Q

With increased PEEP, you have a dramatic ________ in PaO2.

A

Increase

55
Q

If you get too much PEEP, you will lose ____ which will increase ______

A

Vt

PaCO2

56
Q

If a baby can maintain own FRC w/CPAP _____ them alone.

A

Leave

57
Q

If a baby has increased need for ____ and are on CPAP, give them __________.

A

O2

Surfactant

58
Q

There’s a relationship between _____ of Surfactant and lung _____.

A

Injury, so give Surfactant early if you need to give it.

59
Q

W/CPAP and Surfactant use, try to avoid:

__________ & ____ _________

A

Atelectasis

Over-Distension

60
Q

________ IS ventilation.

What determines this?

A

PaCO2

Alveolar Minute Ventilation (Inspired vol-phys. dead space x Rate/minute)

61
Q

Alveolar Minute Ventilation =

A

Inspired Volume - Dead Space x Rate/Minute.

62
Q

T/F: Alveolar MV is the same as MV reported on vent.

A

False.

63
Q

Alveolar Minute Ventilation is what determines ______

A

CO2

64
Q

Ventilation (PaCO2) depends on what 2 factors?

A

Tidal volume x Rate

65
Q

A low PaCO2 <35 is a/w ___, why?

A PaCO2 <20 is a/w____, why?

A

CLD - maybe r/t overventilation

PVL-maybe r/t barotrauma or CO2 causing clamp down of blood flow to brain

66
Q

There’s increase incidence of IVH if CO2’s over ____ in first few days of life.

A

70

67
Q

What are the 3 things you need to know about the ventilator you are using?

A
  1. How breath is initiated (ie. pt triggered, time-cycled, etc)
  2. How gas flow is controlled (what the target is-via pressure or volume?)
  3. How the breath is terminated (change in flow-pressure or volume)
68
Q

What does SIMV stand for?

A

Synchronized Intermittent Mandatory Ventilation

69
Q

What does SIMV mean?

A

You pick a # of breaths to assist every minute (baby can still breathe over)

70
Q

With PSV and A/C assist mode, how many pt breaths trigger the vent?

A

Every breath

71
Q

The Mode defines the _________ sequence.

A

Breathing

72
Q

Name the 3 types of Modes

A
  1. CMV-continuous mandatory ventilation (every breath is supported)
  2. IMV-Intermittent Mandatory ventilation (some breaths supported)
  3. CSV- Continuous Spontaneous Ventilation
73
Q

Do time-cycled ventilators care what the baby is doing?

A

No, just gives a breath

74
Q

Name the 3 modes of Patient Triggered ventilation

A
  1. SIMV
  2. PSV
  3. AC (SIPPV)
75
Q

What do you get w/SIMV?

A

Fixed number of breaths supported

Uneven Minute Ventilation (Vt), high WOB

76
Q

What do you get w/A/C?

A

Every breath is supported
Lack of control over rate (baby controls rate-or water in circuit can trigger)
Less intuitive, less familiar weaning strategy

77
Q

What do you get w/PSV?

A

Stand-alone mode or in combination w/SIMV
Similar to A/C (every breath supported), has back-up IMV rate
Synchronizes end of breath, not just start

78
Q

With PSV, baby controls ___ & ___.

What are 2 kinds of PSV?

A

Rate, IT

Pressure support alone or with Volume Guarantee

79
Q

Adults say SIMV is very comfortable/uncomfortable. Do many providers use just SIMV?

A

Uncomfortable

No-used in combo w/PSV (the breaths that are not SIMV breaths)/VG, etc

80
Q

Volume is dependent on what?

A

The compliance of the lung

81
Q

Compliance is the change in ______ over the change in _______

A

volume

pressure

82
Q

Pressure just tells you how ______ you’re pushing, it doesn’t tell you how much _____ you are giving

A

hard

gas

83
Q

What is the problem w/volume ventilation?

What can cause problems?

What can you do to avoid problems?

A

The volume has to be totally, evenly distributed
Plugs in the lungs

Set a pressure limit so that the volume doesn’t go over a pressure that’s safe

84
Q

PIP won’t hurt them unless…?

A

It generates too much Vt

85
Q

The lung is destroyed by _______ not pressure.

A

Stretch (volutrauma)

86
Q

What is the other type of trauma that is where the lung is collapsed (not enough PEEP) where it keeps opening and letting it collapse?

A

Atelecto-trauma

87
Q

Most studies show fewer ______ days when _________ is targeted.

A

vent

Volume

88
Q

An animal study showed that as few as ____ large breaths will give BPD

A

6

89
Q

Use just enough pressure to see?

A

Chest rise

90
Q

FRC is ____ whereas Vt is ____. Therefore, use ____ of PEEP and little _____.

A

Large, small

Lots, PIP

91
Q

Adjust pressure/volume to deliver ____ cc/kg

A

4-7 cc/kg

92
Q

Avoid these 2 things w/ventilation

A
  1. Hyperinflation

2. Underinflation

93
Q

Hypocarbia is bad for: (2 things)

A

Lungs

Brain

94
Q

Select ventilator Mode based on?

A

Whether baby is breathing or not breathing

95
Q

With PSV, baby controls their own what?

A

IT

96
Q

What is IT?

A

The time it takes to get the air in and the time it is held in (before coming out)

97
Q

The stiffer the lung the more/less time it will take to get the air everywhere it needs to go?

A

Less

remember the example of ventilating the rock

98
Q

All ventilators except which one use passive exhalation?

A

HFV

99
Q

What is the typical IT?

A

0.3-0.4 sec

100
Q

Time Constant is a marker of what?

A

how Stiff the lung is

101
Q

___ time constants is the amount of time it will take to get 99% of the gas out of your lung.

A

5

102
Q

What is the time constant for a healthy baby?

A

= about 0.12 seconds

103
Q

A baby w/HMD will have a very ______ time constant.

A

Short

104
Q

What is the equation for Time Constant?

A

Resistance (30 cm H2O/L/sec) x Compliance (L/cm H2O) = Time Constant

or Change in pressure over change in volume

105
Q

VG results in what?

9 things

A
  • Same/lower PIP
  • More stable Vt
  • Less hypocapnia
  • Faster recovery from forced exhalation episodes
  • Works better with A/C than SIMV (baby controls IT)
  • Faster recovery from suctioning
  • Pro-inflammatory cytokines decreased @ 5 mL/kg
  • Faster weaning from mech ventilation
  • Higher Vt needed w/advanced post-natal age
106
Q

1% FiO2 increase will increase PaO2 by ___mmHg.

If the lung is ________ and ____ is adequate

A

6 (without pulmonary shunt)

Inflated, FRC

107
Q

T/F: it’s easy to change PaO2 without a collapsed lung

A

True

108
Q

Does FiO2 affect CO2?

A

No

109
Q

Does FiO2 affect pH?

A

No

110
Q

CPAP/PEEP increase will increase ______ dramatically. It’s the most important volume to maintain.

A

PaO2

111
Q

CPAP/PEEP may make ______ higher and give you a metabolic _________ with increased/decreased venous return

A

CO2
Acidosis
Decreased

112
Q

What is the most important parameter for PaCO2 that may recruit and improve PaO2 some as well?

A

Vt/PIP

113
Q

Rate increase will ________ PaCO2.

If the baby is controlled by ventilator-direct correlation. If spontaneous breathing may have ___ effect.

A

Decrease

No

114
Q

IT may increase _____ by having more FRC ________, no _____ effect. Beware ____ trauma

A

PaO2
Longer
PaCO2
Volutrauma

115
Q

True/False: It’s not unusual w/CPAP to have a little respiratory and metabolic acidosis

A

True

116
Q

A 10 increase in CO2 leads to ____ decrease in pH

A

0.1

Neo Pathophys 2 (20 decks)

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