ICU - Marino

Question 1

Volume Control, preselect

Answer 1

TV

Question 2

Volume Control, pressure

Answer 2

peak pressure in proximal airways > peak pressure in alevoli

Question 3

Volume Control Advantages

Answer 3

• Constant TV which allows for pressure adjustments to offset increased resistance or decreased compliance

Question 4

Volume Control Disadvantages

Answer 4

• pressure at end of inspiration are higher (?risk of lung injury)
• duration of inspiration is short, inspiratory flow rate can be inadequate which can lead to pt discomfort

Question 5

Pressure Control, preselect

Answer 5

pressure, do so with decelaerating inspiratory flow that allows high flow at onset of lung inflation

Question 6

Pressure control, pressures

Answer 6

end inspiratory airway pressure = peak alveolar presure

Question 7

Pressure Control Advantages

Answer 7

control peak alveolar pressure (30cmH20)

Patient comfort due to high initial flow rates

Question 8

Pressure Control Disadvantages

Answer 8

decrease in alveolar volume when resistance increases or compliance decreases (concern in ARF)

Question 9

PRVC

Answer 9

constant tidal volume but limits end inspiratory airway pressure
selecting lowest pressure needed to deliver tidal volume

Question 10

Assist Control ventilation, mode

Answer 10

can be PC or VC

Question 11

Assist Control triggers

Answer 11

negative pressure or flow rate

Question 12

Negative Pressure as Trigger

Answer 12

generate 2-3cmh20 however this is double the pressure during quiet breathing
1/3 of efforts fail to trigger ventilator

Question 13

Flow Rate as Inspriation Trigger

Answer 13

rates of 1-10L/min required

possible issue is auto-triggers from system leaks

Question 14

Assist Control Concerns

Answer 14

Respiratory cycle and decreasing exhalation

rapid breathing

Question 15

Respiratory Cycle, IE ratio should be

Answer 15

1:2

prevent dynamic hyperinflation or intrinsic PEEP

Question 16

IMV

Answer 16

allow spontaneous breathing between ventilator breathes

can be VC or PC

Question 17

IMV major indication

Answer 17

rapid breathing with incomplete exhalation

Question 18

why is spontaneous breathing good?

Answer 18

promotes alveolar emptying and reduces the risk of trapping/intrinsic PEEP

Question 19

when not to use IMV

Answer 19

respiratory muscle weakness

left heart failure

Question 20

IMV Disadvantages

Answer 20

increased WOB
decrease CO (esp in pts with LVdysfxn)

Question 21

IMV, increased WOB

Answer 21

due to resistance in ventilator circuit

pressure-support can help overcome

Question 22

pressure support

Answer 22

allows pt to terminate the lung inflation

Question 23

PEEP at 5-10

Answer 23

helps prevent collapse of distal airways

Question 24

PEEP at 20-30

Answer 24

can reopen distal airspaces = alveolar recruitment

Question 25

what can happen with alveolar recruitment if not significant volume of recruitable lung?

Answer 25

alveolar distention, increases risk of ventilator-induced lung injury

Question 26

how to measure if there is recruitable lung

Answer 26

lung compliance | pa/fio2 ratio

Question 27

increased PCO2

Answer 27

resp acidosis

Question 28

decreased PCO2

Answer 28

resp alkalosis

Question 29

increased HCO3

Answer 29

metabolic alkalosis

Question 30

decreased HCO3

Answer 30

metabolic acidosis

Question 31

Metabolic Acidosis, secondary response

Answer 31

increase minute ventilation (TV x RR) --> decrease in PCO2

Question 32

how long do secondary respiratory responses take

Answer 32

can being in 30min-2h, can take 12-24 hrs to be complete

Question 33

Metabolic Acidosis and using PaCO2 to infer secondary disorder

Answer 33

paco2 > 23, resp acidosis | paco2 less than 23, resp alk

Question 34

Step "1" of Acid/Base: looking at PaCo2 and PH

Answer 34

if both abnormal, comparing directional change | if only one is abnormal, condition is mixed (directional change of paco2 or pH identifies primary disorder)

Question 35

Primary Resp disorders, how to tell if acute

Answer 35

normal or near-normal HCO3

Question 36

chronic resp acidosis and HCO3

Answer 36

if lower, incomplete renal response | if higher, secondary metabolic alkalosis

Question 37

chronic resp alkalosis and HCO3

Answer 37

if higher, incomplete renal response | If lower, secondary metabolic acidosis

Question 38

AG

Answer 38

NA - Cl + HCO3

Question 39

AG range

Answer 39

3-11 (7 plus/minus 4)

Question 40

AG with albumin

Answer 40

AG + 2.5 x (4.5-albumin)

Question 41

Evevated AG occurs when

Answer 41

accumulation of fixed or nonvolatile acids

Question 42

Normal AG occurs when

Answer 42

primary loss of bicarb

Question 43

Delta Ratio

Answer 43

AG-12 / 24 - HCO3

Question 44

Delta Ratio, how to interpret

Answer 44

1 = HG metabolic acidosis only less than 1 = second acidosis more than 1 = metabolic alkalosis

Question 45

Causes of High Anion Gap Acidosis

Answer 45

Methanol/Metformin, Uremia, DKA/Starvation/Alcohol Ketosis, Paraldehyde, Isonizaid or Iron, Lactic Acidosis, ethylene glycol, rhabdo, salicilaytes

Question 46

Causes of Normal Gap Acidosis

Answer 46

Hyperalimentation, Acetalozamide, RTA, Diarrhea, Ureterosigmoid fistula, pancreatic fistula

Question 47

ARDS defintion

Answer 47

acute onset, bilateral infiltrates on xray, pao2/fio2 less than 300mmhg no evidence of left heart failure presence of predisposing condition

Question 48

ARDS: old criteria vs berlin criteria

Answer 48

pao2/fio2 changed ALI eliminated no wedge pressure measurement

Question 49

volutrauma

Answer 49

excess inflation of distal airspaces | ventilator-induced injury

Question 50

barotrauma

Answer 50

associated with escape of air from lungs

Question 51

biotrauma

Answer 51

during conventional high volume mechanical ventilation, proinflamm cytokines can appear in lungs and systemic circulation despite no structural differences in lungs

Question 52

atelectrauma

Answer 52

collapse of small airways at end expiration