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Mechanical Ventilation > Exam 2 > Flashcards

Exam 2 Flashcards

(115 cards)

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1
Q

ventilation def

A

the movement of gas into and out of the lungs

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2
Q

what does adequate spontaneous ventilation require

A

sufficient Vt, RR, and minute volume to support O2 and CO2 removal, while maintaining acid-base balance

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3
Q

Single best clinical index of ventilation

A

PaCO2

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4
Q

Hypoventilation, hyperventilation, normal values

A

Normal 35-45 mmHg
Hypoventilation > 45 mmHg
Hyperventilation < 35 mmHg

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5
Q

anatomic deadspace def (and normal)

A

vol of gas in conducting airways down to terminal bronchioles
Normal 1mL/ lb IBW (~150mL)

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6
Q

alveolar deadspace (and normal)

A

alveoli that are ventilated w/o perfusion
Normal 0

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7
Q

what diseases increase alveolar deadspace

A

deadspace diseases; emphysema and PE

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8
Q

physiologic deadspace def (and normal)

A

total fxnal DS volume that consists of the alveolar and anatomic DS
VDphys = VDanat + VDalv
Normal phys DS = anat DS
Phys DS > anat DS with DS disease (ex emphysema and PE)

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9
Q

mechanical DS def

A

volume of rebreathed gas d/t mechanical device (ex ventilator tubing)

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10
Q

alveolar ventilation def (and normal)

A

vol of gas reaching alveoli that are ventilated AND perfused per min
Normal 4-5Lpm

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11
Q

most common reason for initiating mechanical ventilatory support

A

acute respiratory failure

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12
Q

what is ventilatory capacity affected by

A

respiratory drive, lung function, ventilatory workload, and ventilatory muscle strength

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13
Q

ventilatory requirements are determined by

A

oxygenation status, CO2 production, lung function, circulatory balance, acid base production

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14
Q

causes of ARF

A
  • PNA
  • ARDS
  • Trauma
  • Sepsis
  • Post op respiratory failure
  • COPD exacerbation
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15
Q

early manifestations of ARF

A
  • Tachycardia
  • Tachypnea
  • Diaphoresis
  • Anxiety
  • Respiratory distress
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16
Q

signs of ARF

A
  • Decreased resp drive
  • Accessory muscle use
  • Intercostal retractions
  • Chest wall & diaphragmatic asynchrony
  • Decreased chest wall excursion
  • Apnea
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17
Q

goals for mechanical ventilatory support

A
  • Provide adequate alveolar ventilation
  • Ensure adequate tissue oxygenation
  • Restore & maintain acid-basis balance
  • Decrease WOB
  • Normalize alveolar ventilation & PaCO2
  • Correct respiratory & metabolic acidosis
  • Reverse hypoxemia
  • Relieve respiratory distress
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18
Q

indications for mechanical ventilation

A

apnea, acute vent failure, impending vent failure, refractory hypoxemia,

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19
Q

what do you do if a peds pt is apneic

A

check for foreign body aspiration

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20
Q

causes of apnea

A

cardiac arrest, MI, trauma, shock, OD, spinal cord injuries, neuro disease, general anesthesia, paralytics

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21
Q

acute vent failure def

A

sudden increase in PaCO2 w a decrease in pH

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22
Q

what pH indicates mech vent needed

A

pH < 7.25

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23
Q

chronic vent fail def

A

increase in PaCO2 but pH normal d/t metabolic compensation

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24
Q

impending vent failure def

A

vent failure likely to occur in immediate future

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25
what does IVF often lead to
elective intubation/ventilation
26
what do you try before elective intubation
HHF/HFNC for 30-120 mins
27
wdyd for a COPD pt w IVF and pH > 7.25
BiPAP trial
28
how to dx refractory hypoxemia
FiO2 increase > 10% & PaO2 increase < 5 mmHg
29
P/F ratio def
PaO2/FiO2 - measure the effectiveness of O2 transfer across the lung
30
P/F ratio classifications
- Mild ARDS: P/F 200-300 mmHg (while on PEEP 5) - Mod ARDS: P/F 100-200 mmHg (while on PEEP 5) - Severe ARDS: P/F < 100 mmHg (while on PEEP 5)
31
why do ARDS pts have severe oxygenation problems
increased intrapulmonary right to left shunt
32
full ventilatory support def
provides 100% of pt's vent needs
33
full vent support is available through
VC and PC
34
types of full vent support
AC/VC, AC/PC, SIMV/VC, SIMV/PC
35
how does a ventilator (on full support) minimize amt of pt effort
by delivering adequate Vt, RR, and minute volume
36
can spont breathing pts trigger vent in CMV
YES; if pt goes apneic, vent will deliver set breath
37
partial vent support def
Requires pt to continue to spont breathe to maintain adequate alveolar ventilation but provides enough support required to maintain good PaCO2
38
what is partial vent support available through
SIMV
39
what rate requires pt to breathe on SIMV
RR < 8-10bpm
40
VC-CMV
all mandatory breaths, pt/time triggered, volume/time cycled
41
what does the clinician set in VC-CMV
desired Vt, minimum RR, insp peak flow, insp flow waveform, trigger sensitivity
42
advantages of VC-CMV
i. Constant Vt (even when compliance/Raw changes) ii. Guaranteed minimum ventilation delivered (d/t set RR and Vt) iii. Provides full vent support
43
disadvantages of VC-CMV
i. Unsafe PIPs may occur (d/t reduced compliance or increased Raw) ii. Unsafe Pplat may occur (d/t inappropriate Vt or reduced compliance) iii.Improper trigger sensitivity or inadequate flow rates may increase WOB
44
PC-CMV
all mandatory breaths, pt/time triggered, time cycled
45
what does the clinician set in PC-CMV
insp pressure, RR, I-time (or insp % time), insp rise time/ramp, trigger sensitivity
46
advantages of PC-CMV
i. Constant insp pressure ii. Desired Vt can be achieved by adjusting PIP or I-time
47
disadvantages of PC-CMV
i. Vt varies d/t changes in pt effort, system compliance, or Raw ii. Increased PEEP w/o increased PIP = decrease ∆P and Vt iii. Increased PIP and Pplat may cause barotrauma or VILI
48
VC-SIMV
Breaths can be mandatory, time/pt triggered, volume/time cycled PS normally added, insp pressure support pt triggered, pressure limited, flow cycled
49
what does the clinician set in VC-SIMV
Vt, min RR, peak flow, trigger sensitivity for mandatory breaths (PS and tube compensation for spont breaths)
50
advantages of VC-SIMV
1. reduced mean airway pressures (may maintain CO & BP) 2. Maintenance of ventilatory muscle activity, strength and coordination 3. Reduced need for sedation or paralytics
51
disadvantages of VC-SIMV
1. Increased WOB associated with ETT/trach tubes during spont breathing 2. Spont breathing with high ventilatory workloads may cause ventilatory muscle fatigue and dysfxn
52
PC-SIMV
Breaths mandatory/spont, pt/time triggered, pressure limited, time cycled
53
what does the clinician set in PC-SIMV
pressure control level, min RR, I-time, trigger sensitivity for mandatory breaths (PS and tube compensation for spont breaths)
54
advantages of PC-SIMV
1. Constant PIP 2. Desired Vt can be achieved by adjusting pressure control level (∆P=PIP-PEEP), or I-time
55
disadvantages of PC-SIMV
1. High mean airway pressures may reduce venous return and CO 2. Too rapid rise times may cause pressure spike in insp 3. Vt varies d/t changes in effort, compliance, resistance
56
PS-CSV aka
PS-CPAP
57
PS-CPAP
PS provided with each breath - Variable Vt, RR, flow, I-time
58
what does the clinician set in PS-CPAP
trigger sensitivity, pressure support, I-time, and flow termination
59
CPAP def
continuous positive airway pressure; spont breathing at constant elevated pressure during insp and exp
60
advantages of PS-CPAP
1. May improve pt-ventilatory synchrony and pt comfort 2. As PS increases, spont Vt increases and WOB decreases 3. May increase lung SA for gas exchange, improve oxygenation, prevent alveolar collapse/atelectasis 4. Often used for SBTs
61
disadvantages of PS-CPAP
1. CPAP increases mean airway pressure, mean intrathoracic pressure, and FRC
62
initial Vt
6-8mL/kg IBW; must be adjusted to maintain Pplat < 28-30 cmH2O
63
initial RR
12-16bpm
64
normal min vent
5-10Lpm
65
IBW equation
Male 50 + 2.3(ht - 60) Female 45.5 + 2.3 (ht-60)
66
initial PC
12-15 cmH2O above PEEP
67
initial PS
12-15 cmH2O above PEEP
68
what pressure should PIP remain
< 40 cmH2O
69
RR should remain below
25 bpm
70
Pplat should remain below
28-30 cmH2O
71
pressure trigger initial
-0.5 to -1.5
72
flow trigger initial
1-2 Lpm below baseline
73
what does PEEP/CPAP do
restores FRC, improves and maintains lung volumes, and improves oxygenation
74
temp for inspired gas
35 +/- 2C
75
positive pt-vent interaction
results in adequate oxygenation/ventilation, decreases WOB and promotes pt comfort
76
poor pt-vent interaction
asynchrony, increase WOB, pt discomfort, poor oxygenation/ventilation
77
what trigger is more comfortable for pts
flow trigger
78
trigger work
portion of WOB performed by pt to trigger vent
79
what can increase trigger work
inappropriate trigger sensitivity, autoPEEP
80
missed triggering
pt insp effort does not trigger vent
81
missed triggering causes
autoPEEP
82
trigger delay
pt tries to initiate breath but vent delays in giving it
83
double triggering
pt receives 2 consecutive breaths from vent before exp
84
double triggering is d/t
pts breathing longer than vent I-time
85
double trigger tx
increase I-time
86
auto triggering
vent initiates insp w/o corresponding pt effort d/t inappropriate vent trigger sensitivity settings
87
what causes autotriggering
triggers are too sensitive; cuff leak; system leak; water in system
88
reverse triggering
time triggered vent breath stimulates diaphragm -> diaphragm contracts -> triggers next vent breath
89
reverse trigger tx
reduce sedation
90
PaO2 normal and clin goal
normal 95 clin goal 60-99
91
SaO2 norm and clin goal
normal 97 clin goal 90-99
92
Hb norm and clin goal
norm men 15 norm women 12-15 clin goal >8
93
CaO2 norm and clin goal
norm 19.8 clin goal >16
94
CO norm and clin goal
norm 5 clin goal varies d/t pt size
95
SV norm and clin goal
norm 70 clin goal 60-80
96
HR norm and clin goal
norm 80-100 clin goal 80-100
97
BP norm and clin goal
norm 120/80 clin goal within norm range
98
MAP norm
90
99
LIP
overcoming distending pressure to open alveoli; level at which compliance improves
100
PEEP & LIP
PEEP set 2 cmH2O above LIP
101
UIP
lung overdistension begins
102
30 for 30
PEEP 30 for 30 secs
103
40 for 40
PEEP 40 for 40 secs
104
3 chambers of chest tube collection system
collection chamber, water seal chamber, suction chamber
105
collection chamber
Drainage from chest flows into collection chamber; made of transparent material w calibration markings to allow for observation of drainage fluid
106
water seal chamber
filled with sterile water 2 cm in depth
107
how is the water seal chamber a one way valve
allows gas to exit from pleural space via chest tube on exhalation while preventing air from entering pleural cavity on inhalation
108
what does bubbling mean in the water seal chamber
there is an air leak
109
does increasing the suction source increase chest tube suction
no, only increases airflow and noise
110
where should the chest tube be positioned
below the pt's chest; normally on floor
111
RSBI
rapid shallow breathing index; > 30bpm with Vt <300mL are associated with need for mech vent
112
RSBI equation
RSBI = f/Vt (L)
113
RSBI classification
< 105 = adequate spont breathing, high chance of successful liberation > 105 = inadequate spont breathing, failure of vent wean
114
dynamic compliance equation
Cdyn = Vt / (PIP - PEEP)
115
static compliance equation
Cstat = Vt / (Pplat - PEEP)

Mechanical Ventilation (1 decks)

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