Final Flashcards

Question

Radial and Ulnar Arteries

Answer 1

Radial and ulnar arteries will meet in the palm of the hand at the superifical and deep palmar arteries

Answer 2

2 small radial veins on either side of radial artery Major nerves are seperated from artery by tendons at this optimal site

Answer 3

Continuation of musculocutaneous nerve Will pass over brachioradialis tendon

Answer 4

Seperated from radial artery by the flexor carpi radialis tendon and deep to the pollocis longus tendon

Answer 5

From back of the arm and is seperated from the radial artery by the brachioradial tendon and travel along the lateral side of the radius and wrist

Answer 6

If the analysis of the sample will take more than 10 min put it in the ice slurry

Answer 7

Venous samples will vary due to local tissue metabolism Capillary samples are prone to venous admixture and air contamination

Answer 8

Slowly withdraw the needle

Answer 9

**Effect on Parameter:** Decrease PaCO2, Increased pH Increased low PaO2 Decreased high PaO2

Answer 10

**Effect on Parameter:** Increased PaCO2, Decreased pH, Decreased PaO@ **How to Recongize:** Excessive time since collection and inconsistent with pt status **How to Advoid:** Analye within 15 min, and place in ice slurry

Answer 11

**Effects:** Decreased PaCO2, Increased pH Increased low PaO2 Decreased high PaO2 **Recognization:** Visible heparin in syringe **Avoidance:** Use samples with pre pared heparin amounts

Answer 12

**Effect:** Increased PaCO2, Decreased pH, Greatly lower PaO2 **Recognize:** Syringe failure to fill with pulsation **Advoidance:** Advoid brachial nd femoral sites, do not aspirate sample, use short bevel

Answer 13

Partial pressure of oxygen in arterial blood **Severe Hypoxemia:** PaO2 \< 40 mmHg **Moderate Hypoxemia:** PaO2 40-60 mmHg **Mild Hypoxemia:** PaO2 \>60 mmHg

Answer 14

Concentration of O2 in 100 ml of aerterial blood **Normal:** 18-20 ml

Answer 15

Percentage of oxygen bound to hemoglobin in blood returning to the right side of the heart and reflect the amount of oxygen left over after the tissues remove what they needs Used to help recognize when the body is extracting more oxygen than normally An increase in extraction is the bodies way to meet tissue oxygen needs when the amount of oxygen reaching the tissues is less than needed.

Answer 16

A true mixed venous sample (SvO2) is obtained from the tip of the pulmonary artery catheter and includes all the venous blood returing from Superior vena cava, inferior vena cava, and coronary sinus By the time the blood reaches the pulmonary artery, all venous blood has "mixed" to reflect the average amount of oxygen remaining after all tissues in the body have removed oxygen from the hemoglobin. The mixed venous sample also captures the blood before it is re-oxygenated in the pulmonary capillary.

Answer 17

ScvO2 = central venous sample. An ScvO2 measurement is a surrogate for the SvO2. Because pulmonary artery catheter use has declined dramatically, ScvO2 measurements obtained from internal jugular or subclavian catheters are often used It may be used to identify changes in a patient's tissue oxygen extraction. We usually assume (possibly incorrectly at times) that a blood gas sample obtained from the internal jugular or subclavian (which reflects only head and upper extremities) will have the same meaning as an SvO2.

Answer 18

Mixed venous oxygen saturation (SvO2) can help to determine whether the cardiac output and oxygen delivery is high enough to meet a patient's needs. It can be very useful if measured before and after changes are made to cardiac medications or mechanical ventilation, particularly in unstable patients.

Answer 19

Normal SvO2 60-80%. Normal ScvO2 (from an internal jugular or subclavian vein) is \> 70%.

Answer 20

Allow the pt to talk and move air

Answer 21

**Plastic Connector:** Hook bag, ventilate **Radio Opacie Line:** Check position **Cuff:** Seal airway and allow ventilaiton **Pilot Balloon:** Maintain cuff seal **Murphy:** Allow breathing when other ports are occluded

Answer 22

PaCO2 35-40 Decreased PaCO2 will cause vasoconstriction and decrease cerebral blood flow (decrease ICP) PaO2 80-120

Answer 23

PIP Decreases Use Equation for resistance and compliance when in volume control

Answer 24

Everything will increase with the exception of Ve (I:E will increase)

Answer 25

Normal Vd/Vt is 0.25-0.40, but will be increase to 0.4-0.6 when PPV is used Distribution of PPV will go to the apices and less to the bases when compared to a spontaneous breath

Answer 26

Pip Increases

Answer 27

Want 3-5 cm above carina as a buffer zone for when the tube moves with the neck

Answer 28

A measure of distensibility of the lung Normal is 60-100 mL/cmH2O \<25-30 cmH2O in ARDS

Answer 29

Ti dyn Decreases Flow Increases

Answer 30

PIP Decreases Pplat Decreases Pmean Decreases

Answer 31

Use the compliance and resistance formulas

Answer 32

There is an increase in resistance which can be responsible for auto PEEP

Answer 33

Control volume and flow so as lung mechanics change pressure will change Because we are controlled volume and flow we are controlled minute ventilation Set: Vt, RR, Flow, PEEP, Ti pause, FiO2

Answer 34

(Hb x 1.34) x SvO2 + (PvO2 x 0.003)

Answer 35

\<10% Normal Lungs 10-19% Seldom Needs Ventilatory Support 20-29% May need CPAP \>30% Needs Ventilatory Support

Answer 36

6-8 ml/kg ## Footnote May be as high as 10ml/kg for neuromuscular and post op pts. Lung protective 4-6 ml/kg.

Answer 37

12-16 bpm ## Footnote Higher rates run the risk of air-trapping

Answer 38

0.8-1.2 s I:E of 1:2 or lower Try not to inverse unless you really need to affect MAP

Answer 39

5 cmH2O Typical start is 5 cmH2O Aim for optimal PEEP Increases typically made in increments of 2-3 cmH2O Watch for CV compromise

Answer 40

~ 100 mL/kg to start! Also used: ♂- 4 x BSA ♀-3.5 X BSA Febrile pt’s require higher MV Adjusted based on PaCO2

Answer 41

Plat \< 25 cm H20 Vt should be 6-10 ml/kg Pplat25-30 Vt should be ≤ 8 ml/kg, Ppat≥ 30 Vt should be ≤ 6 ml/kg

Answer 42

Increased ICP, untreated pneumo, hypotension

Answer 43

Weaning by SIMV with pressure support is better (reducing oxygen dependency) than SIMV alone. Meta-analysis of volume-targeted ventilation demonstrated significant reductions in the duration of ventilation and pneumothorax, but the trials were small and of different designs. Volume guarantee may provide more consistent blood gas control.

Answer 44

PRVC ## Footnote If Leak \> 40% may change to A/C PCV

Answer 45

larger ETT, extubationto NIPPVS, or A/C PC ventilation

Answer 46

4 mL/kg What about deadspace? - eg. Flow transducers, ETCO2

Answer 47

40 to 50 bpm

Answer 48

0.30 sec Adjust to reach equilibrium

Answer 49

6 cmH2O Increases typically made in increments of 1-2 cmH2O. PEEP may be 8 before alternative modes trialled.

Answer 50

MV, VTe, VTi: +- 20% RR total 90 bpm HiP 35cmH2O, readjust to PIP +10 (G5 in APV will have the 10 buffer so you get an alarm when you are within 10 of high pressure alarm ) PEEP +- 2 cmH2O Flow Trigg: 0.5 Lpm– 2 Lpm, assess for auto trigg Apnea time; 5 – 10 sec Apnea FiO2 (Match set on vent)

Answer 51

28-40 weeks GA ## Footnote pH \>7.25 PaCO2 45-55 PaO2 50-70 HCO3 18-20 SpO2 85-92

Answer 52

\< 28 weeks GA ## Footnote pH \>7.25 PaCO2 45-55 PaO2 45-65 HCO3 15-18 SpO2 85-92

Answer 53

* Most modern ventilators have the capabilities to ventilate all patient groups * May require special equipment (eg. flow transducer) * Consider the recommended weight ranges specified by the manufacturer! * The patient ventilator circuit also varies with the patient type! Consider: * Deadspace * Compressible volume * Humidity requirements

Answer 54

Flow Volume Trigger sensitivity Response time Ranges of the settings and…the modes available!

Answer 55

* FiO2and PPV start the cascade of lung injury (VILI) that leads to lung remodeling and chronic lung disease * Lung disease is NOT homogeneous = PPV can cause over distension, and shear forces * CPAP/PEEP is GOOD! * Prevents surfactant deficient alveoli from collapsing * Promotes alveoli recruitment, increases FRC

Answer 56

Least traumatic flow occurs in the middle of the P/V curve

Answer 57

during bagging, recruitment, and high pressure ventilation

Answer 58

* Provide adequate ventilation * Provide adequate oxygenation * Recruitment and maintenance of lung volume * Improve FRC and lung compliance * Appropriate WOB * Support muscles of ventilation * Use the correct balance of patient work vs. ventilator work * Promote patient/ventilator synchrony

Answer 59

Adjust alveolar minute ventilation to achieve the target PaCO2 VA= RR x (VT- VD) Adjust/ensure VTwithin target goal Adjust RR to achieve desired PaCO2 Mention that the Vt is less accurate in equation as Vdnot taken into account Note: Ensure they assess if VT are appropriate before blindly choosing to change RR.

Answer 60

Ideally we want normal PaCO2 but sometimes it is unachievable without damaging the lungs PaCO2 levels are allowed to rise as long as pH \<7.25 Typically allow the rise to occur gradually Sedation is required Most often used in ARDS patients, but also COPD/Asthma Contraindicated in head injuries, intracranial lesions, and cardiac ischemia/heart failure

Answer 61

Intrinsic PEEP will increase MAP because of recruitemnt and increased FRV and improved C which will contribute to overall improved oxygenation and increased Map

Answer 62

Adjust the following to obtain target SpO2 (and/or PaO2) * FIO2 * PEEP * Increases MAP, recruits/stabilizes alveoli increasing SA for gas exchange, improves compliance, increases FRC * MAP * Typically via an increased inspiratory time, possibly even an inverse ratio * NOTE: Inverse ratios are NOT used in neonates * Note that as FIO2is increasing, PEEP should be increased * Generally increasing TInot done until FIO2 \>0.60 and appropriate PEEP set

Answer 63

3-5 cmH2O Maintains lung volume

Answer 64

5-15 cmH2O is used to treat atelectasis and refractory hypoxemia \> 15 cmH2O is used for severe ARDS

Answer 65

Goal is "Open Lung Ventilation" ## Footnote The theory states: to prevent de-recruitment, PEEP should be set above the LIP or above the lower deflection point Need to do a static pressure-volume curve Ensure that VTis adjusted so PIPs do not exceed the UIP This setting is thought to give the best alveolar recruitment Setting PEEP above LIP/LDEF really is to prevent collapse/de-recruitment (ie. It stabilizes those alveoli that open during the inspiration) Set PEEP 2 cmH2O above LIP

Answer 66

PEEP at which maximal respiratory benefits occur (lung mechanics, oxygenation) with minimal impact on the cardiovascular status Finding optimal PEEP esophageal balloon or you could do a lung volume recruitment maneuver to get a flow volume loop and then look at the inflactionpoint

Answer 67

Passive inflation of the lung in increasing increments of 50 – 100 ml At each end point static pressure obtained (end insp pause) and plot a pressure volume curve. Upper and lower inflection point can generally be determined LIP thought to be where recruitment starts UIP - Overdistention Difficult and time consuming

Answer 68

The application of PEEP increases intrapleural and intrathoracic pressures The extent of the transmission is dependent on: * Amount of PEEP * Lung compliance * Low C (eg. ARDS): PEEP transmission significantly reduced * High C (eg. COPD): PEEP transmission is highest * Can be regionally affected due to disease process * eg. pneumonia, atelectasis * Thoracic compliance * Hemodynamic compromise is most likely to occur when thoracic compliance is low (eg. Abdominal distension, thoracic deformities-eg. Kyphoscoliosis)

Answer 69

The stiffer the lungs the less easy the PEEP is transferred to affect hemodynamics more floppy lungs are more susceptible to changes in hemodynamics (COPD)

Answer 70

CXR showing diffuse bilateral infiltrates = ALI/ARDS Atelectasis Increased OI (eg.\> 12; may vary with institution) Patients requiring a high PEEP May also be done in patients who de-sat after disconnect/suctioning Lung recruitment maneuvers are Typically only done in adults!

Answer 71

Patients should be adequately sedated Many different procedures but generally involve high CPAP pressures (eg.30-45 cmH2O) for short periods (30 sec to 2 minutes) The CPAP level is often based on a plateau pressure of a specified VT(ml/kg) (eg.12 mL/kg) Ensure that the PEEP returned to is adequate PEEP adequate as - above the LIP or the lower deflection point

Answer 72

* Pulmonary air leaks: * Recent, active pneumothorax, PIE, etc * Bronchopleural fistula * Hemodynamic instability (eg.low BP) * Head Injury * Obstructive lung disease * Pregnancy

Answer 73

oWatch vital signs during maneuver oWatch for hypoxemia CHR P&P-D/c maneuver if SpO2 falls \< 80%, MAP \< 60 or 20% change from baseline, HR \< 60 or 20% change from BL, new arrhythmia

Answer 74

Typical start-up strategy (as patient may be paralyzed/ sedated from intubation) When patient is apneic When we want the vent to do all the WOB eg.Patient hemodynamically unstable, acute state of disorder (eg.ARDS, severe pneumonia)

Answer 75

When patients are spontaneously breathing Patients with primarily hypoxemic respiratory failure Weaning

Answer 76

Sensitivity should be set at the most sensitive level that avoids auto-triggering Patient triggering across populations: Pressure triggering acceptable for pedsand adults Neonates require flow or volume triggering Minimize auto PEEP The patient has to overcome the auto PEEP and more to create a negative pressure in the chest relative to the circuit, resulting in a triggered breath This causes increased work to trigger the ventilator (regardless if P or flow triggering is used) COPD applying PEEP can offset the autoPEEPbut in asthma applying PEEP is additive to auto-PEEP

Answer 77

May be intubated and then extubated to CPAP if stable \< 28 weeks should receive surfactant immediately post-birth

Answer 78

Set PEEP for appropriate recruitment (CXR) Permissive hypercapnia VT~ 4 mL/kg Goal pH ≥ 7.25 PaCO245-55 mmHg Peak pressures should be \< 25 cmH2O Consider HFO for more severe cases/problems with oxygenation

Answer 79

PPHN=infants whose pulm. Vasculature remains constricted due to hypoxia and acidosis secondary to lung diesease, MAS, congenital pulm. Hypoplasia, polycythemia, CHD, sepsis, CHS disorders or metabolic abn(hypocalcemia or hypoglycemia)

Answer 80

* Older strategy: hyperventilate to PaCO230-35 and pH ~ 7.50 * New trend is target low/normal PaCO2(35-40) with pH 7.40-7.45 * Hyperoxygenateto PaO2\> 100 mmHg and higher SpO2 * Nitric oxide therapy Also, fluids/inotropes for good systemic pressures PPHN Goals: 7.40-7.45 and CO2 35-40

Answer 81

* Conventional mechanical ventilation * HFO * HFJV * ECMO Sildenafil sometimes used though CPS doesn’t list PPHN as an indication for the drug

Answer 82

Usually require a PDA for survival Eg.Transposition, Tetralogy of Fallot, Hypoplastic left heart Prostin– given via IV continuously to maintain PDA

Answer 83

Rule of 40’s: pH 7.40, PaCO240’s, PaO240’s SpO2 70-80% These mimic in-utero conditions and maintain a PDA

Answer 84

* Surfactant replacement therapy (+/-) * Lung protective strategy * Appropriate VT’s * Mild hyperventilation (low/normal CO2) andhyperoxygenateto treat concurrent PPHN * Peak pressures should be \< 25 cmH2O * Watch for hyperinflation * For more severe cases consider NO, HFO, HFJV, ECMO * Avoid acidosis and hypoxemia! * (This will increase PVR and potentially cause the development of PPHN)

Answer 85

* Use the lowest FIO2 possible * Later stages (confirmed BPD) maintain adequate oxygenation to prevent development of corpulmonale * Surfactant therapy * Done during the RDS stage…before true BPD * Minimize mechanical ventilation * Permissive hypercapnia * VT4-6 mL/kg * Goal pH ≥ 7.25 * Peak pressures \< 25 cmH2O * Once stable: * Target lower SpO285-88% up to 94% * Volume-targeted modes tend to work best for BPD.

Answer 86

* Reduce risk of barotrauma by using minimal ventilatory support * Low VT’s (~4 mL/kg) with permissive hypercapnia (pH \>7.25) and low pressures ( peak \< 25 cmH2O) * Position neonate with worst lung down * Improves perfusion to promote healing * Decreases ventilation to affected lung * Severe cases: * HFO or HFJV * Selective intubation of good lung side * Allows affected lung to collapse and heal

Answer 87

* Intubate immediately (avoid BVM); gastric tube * Use 100% O2from beginning * Connect to vent ASAP

Answer 88

* “Gentle ventilation”: AVOID vigorous chest rise * Preserve spontaneous efforts (ie. Minimal sedation) * Permissive hypercapnia * Avoid high pressures (pneumothorax a strong marker for mortality) * HFO and NO considered; * ECMO in severe cases (often decided antenatally)

Answer 89

PPHN very likely to coincide! pH \>7.25 Pre-ductal SpO2³85%, though ideal is 90-95% Use preductal saturations to guide oxygen requirements Preductal indicates oxygen delivery to the brain and therefore critical; postductalis non-cerebral and therefore less critical NOTE: These babies have delayed transition from fetal circulation and it may take several hours to attain optimal oxygenation

Answer 90

The most important principle in the mangement of CDH Preservation of spontaneous respirations and avoid neuromuscular blockades uses minimal sedation Permissive Hypercapnia- No hyperventilation, no induced alkalosis Avoid high ventilator pressures – pneumothorax can result from high pressures and is a very strong marker for mortality.

Answer 91

Do not use post ductal O2 values to adjust ventilator settings Use preductal oxygenation to guide oxygen requirements

Answer 92

Indicate oxygen delivery to the brain via the carotid arteries and is therefore critical. Ideal is 90-95% Acceptable is \>85% is the baby is otherwise stable (normal lactate levels)

Answer 93

Indicates non-cerebral oxygen delivery and less critical

Answer 94

Same strategies as adults

Answer 95

* Non-invasive ventilation the preferred method for ventilatory support * Long-term prognosis decreases when patient is placed on conventional mechanical ventilation * Pt with end-stage disease should not be intubated * Concerns: * Obstructive disorder \autoPEEP, hyperinflation… * Allow for longer expiratory times! * Predisposed to development of respiratory infections

Answer 96

* V/Q mismatching * Increased intrapulmonary shunting, increased VD * Decreased pulmonary perfusion * VILI (ventilator-induced lung injury) * Barotrauma,volutrauma, shear stress, atelectatrauma, biotrauma * Air-trapping (autoPEEP) * Increases risk of VILI * Contributes to patient-ventilator dyssynchrony(which leads to increased WOB, increased need for sedation and longer weaning times) * Oxygen toxicity

Answer 97

Renal, Liver, GI, Metabolism, Muscle function

Answer 98

May decrease CPP 2°to decreased MAP ICP increases 2°to an increased CVP

Answer 99

Decreased CO 2° to decreased venous return Magnitude of effect depends on the transmission of P Altered R and L ventricular function

Answer 100

Want OPEN LUNG VENTILATION Want to recruit and prevent de-recruitment (\set above LIP) Ensure UIP not exceeded during inspiration

Answer 101

As most of the harmful effects are a direct result of the positive pressure applied, the goal is to use the lowest minimal pressures (or VT) required

Answer 102

* Ideally want pressure equilibration on inspiration * Allow for complete exhalation to prevent autoPEEP

Answer 103

* Attempt to avoid ventilator dependence * Attempt to minimize VILI and BPD

Answer 104

* BPD * Associated with high concentrations of oxygen, PPV, endotracheal intubation, duration of therapy, fluid overload, degree of pulmonary prematurity… * ROP * A complication of prematurity * Associated with duration of exposure to high PaO2 * Minimize by: * Use lowest FIO2required * Make changes in small increments

Answer 105

* Intracranial hemorrhage * Associated with mechanical ventilation but not necessarily caused by it (may be due to prematurity) * Periventricular leukomalacia * Softening of the white matter around the ventricles of the brain; associated with hypocarbiain preterm infants * Minimize by: * Maintain PaCO2at goal level * Don’t over-ventilate when bagging! Try to use a vent ASAP after resuscitation.

Answer 106

* Vent not sensing pt. effort * Vent not sensing due to leak (ETT) * Minimize by: * Ideally choose a newer ventilator with patient sensing * Tailor the settings to the patient * Remember: AutoPEEPwill also cause patient-ventilator dyssynchrony! * (This is mostly an adult problem).

Answer 107

* Chronic lung disease (BPD) * Associated with prolonged PPV and oxygen toxicity * Air-leak syndromes * Pneumothorax/pneumomediastinum… * PIE (Pulmonary interstitial emphysema) * Much less common with today’s goal ventilatory parameters * Minimize by: * Use lowest pressures/volumes required * Wean ventilator settings when appropriate

Answer 108

pH \<7.20 PaCO2 \>60 mmHg SaO2 \<85% with FiO2 40-70% and CPAP 5-10 This means we should intubate

Answer 109

Generally a pressure limited mode will be used with a sinsoidal flow

Answer 110

If a longer Ti is requires before surfactant administration is should be lowered to 0.3 seconds after the surfactant is administered

Answer 111

SIMV or assist control modes can help to reduce WOB and stabilize BP if properly set Modes are generally volume controlled in order to reduce the risk of volutrauma (important with surfactant administration)

Answer 112

RR: 30-60 VC: 5-7 Vt:35 Compliance: 25-50 Resistance: 1-2

Answer 113

RR: 12-20 VC: 65-75 Vt: 4-8 Compliance: 50-170 Resistance: 0.6-2.4

Answer 114

Set to 15-25 Limit should be set to 30

Answer 115

3-6 cmH2O Set to prevent further alveolar collapse Increases will be made in increments of 1-2 cmH2O If PEEP reaches 8 then alternative modes should be considered

Answer 116

Start at 50

Answer 117

0.3-0.4 Start at 0.3 Adjust to reach equibrium

Answer 118

Start at 5 and aim for optimal PEEP Increases made in 2-3 increments

Answer 119

Male: 50+ 2.3 ( {Height in inches}-60) Female: 45.5 + 2.3 ( {Height in inches}-60)

Answer 120

Below the clavicles Above carina ~T3 and mid trachea

Answer 121

Pre oxygenate for 20 seconds before intubation

Answer 122

Suction the mouth before intubation to prevent aspiration

Answer 123

Try to give free flowing oxygen to the neonate durign the intubation attempt without interfering with the intubation

Answer 124

If BMV was required for longer than 2 min before the procedure

Answer 125

**Normal:** 0.9-1.1 **Critical:** \>6

Answer 126

Ramp/Rise Time ## Footnote Will control how quickly the limit is reached Can affect pt comfort Will tend to smooth out flow and lower initial peak flow

Answer 127

**Automatic tube compensation will helps by adding pressure support when weaning** WOB is directly related to size of ETT and MV Clinicians will enter tube type and internal diameter which will **nullifie the resistance imposed on the airway** Will be similar to PS in that an inspiratory pressure is used to compensate for imposed WOB Different from PS in that TC varies the pressure depening on tube size and inspiratory flow

Answer 128

TC Tube Compensation

Answer 129

ARC Airway Resistance Compensation

Answer 130

TRC Tube Resistance Compensation

Answer 131

ATC Automatic Tube Compensation

Answer 132

P_trachea= Paw-KTube x Flow²

Answer 133

Increase patient comfort over Pressure Support Accurately predict readiness for extubation Reduce risk of air trapping cause by expiratory resistance-Some allow inspiratory and expiratory compensation

Answer 134

Spontaneous Mode that is pressure limited and volume targeted Flow cycled

Answer 135

**MMV you set a MV so if the pt is not reaching the MV on their own the the vent will kick in to help** Guarantees a minmum MV even though a pts spontaneous ventilation may change If the pt maintain MV above set MV then this mode functions like CSV-PS If the pt MV falls below the set MV only then will mandtory breaths be dleivered

Answer 136

A MV is set indirectly via RR and Vt If the patient breaths above MV than all breaths are pressure support breaths If the patients MV falls below the set MV then the vent will delvier manadatory breaths at a set Vt to make the total MV

Answer 137

Used to assit spontaneous ventilation the breath delivered is similar to PS but the pressure support level delivered is variable and porportional to spontaneous effort The harder the pt works the more support the vent delivers and vice versa)= POSITIVE FEEDBACK

Answer 138

E Sensitivity set at 27% (27% of inspiratory peak flow) Pressure support patient trigger pressure limited flow cycles (flow cycle=e sensitivity) You will never get equilibrium on a pressure support breath

Answer 139

decrease portional will increase tidal volume and Ti unless the patient is air hungry and try to breath in more at a higher peak volume then it will cut off faster and they will get a lower breath

Answer 140

Volume will stay the same and Tidy will get shorter What will happen to tidal volume if you decrease the compliance in pressure control Decrease TC and Ti dyn and volume will go down

Answer 141

FiO2 \<0.40 and PEEP \<8 OR FiO2 \<0.5 and PEEP \<5 PEEP and FiO2 less than the previous day with spontaneous breathing

Answer 142

Systolic BP \>90 mmHg w/o vaso pressor No neuromuscular blockade

Answer 143

Both A and C Persistant cyanosis and bradycardia may mean that the ETT is not in the correct placement Bilateral breath sounds can confirm placement Decreasing HR can confirm they neonate is getting good respiratory support but is not a confirmation for placement Even though the CO2 is not that high we are getting a reading which means that it is in the trachea

Answer 144

0.5 seconds inspiratory pause Should be checked q 4h and after each change in PEEP or Vt

Answer 145

Decrease Vt by 1 ml/kg Minumum 4 ml/kg

Answer 146

Increase Vt by 1 ml/kg until Pplat is \>25 cmH2O or Vt 6 ml/kg

Answer 147

May increase Vt by 1 ml/kg incrememts to 7-8 ml/kg As long as Pplat remains \<30 cmH2O

Answer 148

Assess WOB and Oxygenation **Normal:** 0.75-0.85 **Critical:** \<0.15

Answer 149

pH\<7.30 Increase RR (max 35)

Answer 150

Increase RR to 35 and if still \<7.15 Vt can increase by 1 ml/kg May give NaHCO3

Answer 151

Decrease RR

Answer 152

T-Piece, Trach collar, or CPAP \<5 with PS \<5

Answer 153

SpO2 \> 90% and/or PaO2 \>60 mmHg Vt\> 4 ml/kg RR \<35 pH\>7.3 No respirtory distress If tolerated for 30 min consider extubation

Answer 154

HR \>120% baseline Accessory muscle use Abdominal paradoxus Diaphoresus Dsypnea

Answer 155

Head injury, unstable spinal injury, inotropes and vasopressors, or planned surgery Head and spinal injuries are relative contraindication and they can still be extubated with dr orders

Answer 156

* Resolution of disease * Adequate oxygenation * PaO2 \>60 mmHg * P/F \> 200 * SpO2 \>90% * PEEP \<5 * FiO2 \< 0.4 * No uncompensatory respiratory acidosis * HR \<140 * GCS \>13

Answer 157

Place pt on PSV of 7 and PEEP of 5 unless there is automatic tube compensation which you put PSV to 0 in first 5 minute monitor tobin score (\>105), sweating, anxiety, mental status, SpO2 \>90% If any negative changes occur increase PSV and inform physician

Answer 158

Also known as rapid shallow breathing index = (RR)/ (Vt) An RSBI \< 105 breaths/min/L has been widely accepted by healthcare professionals as a criteria for weaning to extubation. Whereas patients with RSBI \> 105 will have a high chance of failure and require re-intubation.

Answer 159

for pt who are ventilated for \<72 hours continue SBT fot 30 min For pt who are ventilated \>72 hours continue SBT 60-120 min Monitoring should be done first 5 min and the Q15 after

Answer 160

.The PIP to increase

Answer 161

Try to delay clamping the cord for at least 60 seconds If not possible cord milking is a reasonable alternative

Answer 162

Oxygen for resusucitation should be controlled via a blender An initial concentration of 30% oxygen is appriopraite of babies \<28 GA For babies that are 28-10 week use an FiO2 of 21-30

Answer 163

In spontaneous breathing babies stabilize babies with CPAP at 6 cmH2O via mask or nasal prongs

Answer 164

Plastic bags or occlusive wrapping under radient warmer should be used during stabilization in babies **\<28 weeks**

Answer 165

Saturation goals should be 90-94%

Answer 166

RDS \< 30 weeks gestation when intubation is not needed

Answer 167

The interface should short binasal prongs or mask with a starting pressure of 6-8cmH20 CPAP pressure should then be individualized based on oxygenation and ventilation

Answer 168

CPAP with early rescue surfactant should be considered optimal management for babies with RDS

Answer 169

Synchronized NIPPV if delivered through a ventilator rather than a bilevel CPAP device can reduce extubation failure, but may not confer long-term advantages such as reduction in BPD

Answer 170

HF may be used as an alternative to CPAP for some babies during weaning phase

Answer 171

Target tidal volume should be used to shorten time on mechanical ventilation

Answer 172

When weaning from MV it is reasonable to tolerate a modest degree of hypercarbia provided pH \>7.22 Caffeine should be used to facilitate weaning from MV A short tapering course of low dose dexamethasone should be considered to facilitate extubation in babies who remain on MV after 1-2 weeks

Answer 173

Maintain optimum lung volume and FRC in order to avoid de-recruitment and overdistension in L&D and acute phase avoid CPAP \>6 Infants \>28 weeks will be intubated by a senior practitioner "Early surfactant" does not mean "immediate surfactant"

Answer 174

Clear airway and CPAP at +5 If the baby is not spontaneously breathing or has a HR under 100 begin PPV If there is mild WOB with SpO2 then maintain CPAP level and move to NICU If there is more severe WOB or SpO2 is not in range than increase CPAP by 1 and increase FiO2 by 0.10-0.20 to achieve SpO2 If the above did not help consider intubation

Answer 175

Apnea Gasping HR less than 100 Oxygen saturadtion below target range