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MODES OF VENT > Effects of PPV > Flashcards

Effects of PPV Flashcards

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1
Q

PPV has cardiac considerations include

A

The amount of PPV we use

The patients lung condition

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2
Q

What does PPV do to MAP

A

Increases

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3
Q

What does PPV do to CMO

A

Decreases

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4
Q

Why does PPV decrease CMO?

A

The impedance of Venous Return

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5
Q

How does PEEP affect MAP?

A

Increases

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6
Q

How does PPV affect Pulmonary Vascular Resistance?

A

Increases

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7
Q

High volumes or PEEP does what to alveoli and pulmonary vessels?

A

Over distend alveoli

Squeeze pulmonary vessels

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8
Q

What is PVR most increased by?

A

Mean Airway Pressure (MAP)

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9
Q

T/F Pulmonary vascular resistance is increased by PIP?

A

False

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10
Q

How does PVR affect Right Ventricular Afterload

A

Increases

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11
Q

Normal people can over come PVR how?

A

Increasing Right Ventricular Contractions

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12
Q

People with abnormal hearts can not compensate from PVR and then what happens?

A

Right Ventricular Stroke Volume drops

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13
Q

Dilation of right ventricle can cause what to happen?

A

Force the intraventracular septum to shift left

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14
Q

What PEEP levels can cause the Intraventricular septum to shift left?

A

> 15 cmh20

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15
Q

What else can cause the Intraventricular septum to shift left?

A

decreased blood volume

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16
Q

If the intraventricular septum is shifted left, what is that going to do to the Left Ventricle Stroke Volume

A

Decrease it

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17
Q

PPV -> ___________-> compress pulmonary vessels -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> high v/q mismatch -> hypoxemia -> decreased o2 content -> reduced o2 delivery

A

Increase intrathoracic pressure

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18
Q

-> Increase intrathoracic pressure -> compress pulmonary vessels -> Reduce stroke volume -> ____________-> high v/q mismatch -> hypoxemia -> decreased o2 content -> reduced o2 delivery

A

reduce cardiac and pulmonary blood flow

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19
Q

-> Increase intrathoracic pressure -> compress pulmonary vessels -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> high v/q mismatch -> hypoxemia -> _________ -> __________

A

decreased o2 content

reduced o2 delivery

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20
Q

-> Increase intrathoracic pressure -> _________ -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> high v/q mismatch -> hypoxemia -> decreased o2 content -> reduced o2 delivery

A

compress pulmonary vessels

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21
Q

-> Increase intrathoracic pressure -> compress pulmonary vessels -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> _______ -> _______ -> decreased o2 content -> reduced o2 delivery

A

high v/q mismatch

hypoxemia

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22
Q

T/F PPV can cause a decrease in intrapulmonary shunting?

A

False.

Can cause an INCREASE in intrapulmonary shunting

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23
Q

T/F ventilation is gravity independent

A

FALSE

Ventilation is gravity dependent

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24
Q

Ventilation is gravity dependent and areas of lung are ______, where as blood flow is _______

A

decreased, increased.

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25
Intrapulmonary shunting can increase how much with ppv?
10%
26
PPV does what to Endocardial (coronary) blood flow
Decreases
27
PPV reduces Venous return and _______
Cardiac Minute Output
28
PPV reduces _____ _____ and Cardiac Minute Output
venous return
29
PPV reduces venous return and CMO and this will cause what to decrease?
Coronary Perfusion
30
What else can contribute to myocardial dysfuntion?
Ischemia
31
Compensation in Normal People: Rarely have a decrease in CMO. The decrease in stroke volume is compensated for by _______ and increase in systemic vascular resistance
tachycardia
32
Compensation in Normal People: Rarely have a decrease in CMO. The decrease in stroke volume is compensated for by
tachycardia and increase in systemic vascular resistance
33
Compensation in normal people Since most people do not have a decrease in Cardiac Minute Output. The decrease in stroke volume is compensated for by tachycardia and SVR. Also shunts blood away from where?
from the kidneys and other lower extremities
34
Why would a patient be hypotensive?
Impeded venous return
35
hypotension is rare due to
Compensation
36
BP Increase's in?
Heart Rate Systemic Vasoconstriction Shunt blood away from kidneys and other ext.
37
Effectiveness of compensation depends upon | integrity of
neuroreflexes.
38
Pts who are hypertensive increase venous | return to which ventricle
Left ventricle
39
Pts who are hypertensive increase venous | return to the left ventricle. This is because
pulmonary vessel compression is minimal in | HTN.
40
Vascular effects can be blocked by ``` I) pulmonary hypotension II) spinal/general anesthesia III) spinal chord transection IV) polyneuritis V) increased venous return ```
II, III, IV
41
High Airway Resistance In pts with high Raw much of the pressure is lost to the
poorly conductive airways and | less actually reaches the alveolar level.
42
Which Patient is less likely to experience hemodynamic changes because less pressure is transmitted to the pleural space? ``` A) ARF type II B) ARF type I C) ARDS D) COPD E) Patients with compliant lungs and stiff chest wall ```
ARDS Pts with stiff lungs (ARDS) , are less likely to experience hemodynamic changes because less pressure is transmitted to pleural space.
43
Which Patient is more likely to experience hemodynamic changes because less pressure is transmitted to the pleural space? ``` A) ARF type II B) ARF type I C) ARDS D) COPD E) Patients with compliant lungs and stiff chest wall ```
People with compliant lungs and stiff chest | walls are most are risk.
44
Effects of lung/ compliance and Raw: Pts with stiff lungs (ARDS) , are less likely to experience ___________ changes because less pressure is transmitted to pleural space. People with compliant lungs and stiff chest walls are most are risk.
hemodynamic
45
Effects of lung/ compliance and Raw: Pts with stiff lungs (ARDS) , are less likely to experience hemodynamic changes because _______ ______ is transmitted to _____ ______. People with compliant lungs and stiff chest walls are most are risk.
less pressure; pleural space
46
Systemic hypotension rarely occurs in normal individuals receiving positive-pressure ventilation due to
compensatory mechanisms.
47
Beneficial or Harmful effects of Left Ventricular | dysfunction
Beneficial
48
Duration and Magnitude of PPV Lower _____ to reduce cardiovascular changes. PIP, MAP, inspiratory flow, I:E ratio, inflation hold and PEEP play a role.
MAP
49
Duration and Magnitude of PPV Lower MAP to reduce cardiovascular changes. What else play a role. ``` I) PIP II) MAP III) inspiratory flow IV) I:E ratio V) RR VI) inflation hold VII) FIO2 VIII) PEEP ```
I, II, III, IV, VI, VIII
50
Three Points About High Flow
More pressure lost to pt circuit More pressure will be needed to overcome Raw Uneven ventilation occurs with high flows
51
Altering vent to reduce PPV complications What would you reduce?
MAP
52
Altering vent to reduce PPV complications MAP increases ____ which leads to (increased/decreased) o2
FRC | Increases
53
Altering vent to reduce PPV complications High Insp flow tend to increase ?
PIP
54
Altering vent to reduce PPV complications High insp flows tend to increase PIP, but shorten ?
Inspiration
55
Altering vent to reduce PPV complications high insp flows tend to increase PIP, but shorten inspiration which can lower
MAP
56
What occurs with high flow?
Uneven Ventilation
57
What is the goal with flow?
Flow not too high to cause problems Flow not too low to cause ^ WOB.
58
When would you use an INSP hold?
Diagnostically only
59
What I:E Ratio do you typically want
1 : 2 to 1 :4
60
What can happen if you have an I:E ratio of 1:1?
Air trapping | Increase in MAP
61
PEEP = Stiff lungs may not always decrease
CMO
62
What will PEEP always do to MAP
Increase it
63
T/F High Peak PIP does always reflect Paw | MAP
FALSE | High Peak PIP does NOT always reflect Paw MAP
64
Vent calculations of MAP may not always | be accurate if pt has
auto-PEEP
65
Vent calculations of MAP may not always | be accurate if pt has auto-PEEP. This is why inflation hold is only used for
plat pressure
66
What mode can reduce Paw by allowing | spontaneous breathing.
SIMV
67
PPV can help pts with
LV dysfunction
68
PEEP may Increase PaO2 and improve ____ _____ dysfunction is due to ______
cardiac perfusion ; hypoxemia
69
Decreased venous return may
Improve Stroke Volume

MODES OF VENT (4 decks)

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