ILD, PNA, Vent Management Flashcards
(36 cards)
What is Plateau Pressure?
Plateau pressure is the pressure applied to the small airways and alveoli after inhalation is complete but before exhalation begins — essentially, the pressure needed to keep the lungs open at the end of inspiration.
What is Peak Pressure?
The maximum pressure reached in the airways during mechanical ventilation at the end of inspiration.
What is Tidal Volume?
Tidal volume is the amount of air delivered to the lungs with each breath by the ventilator. It’s one of the most critical settings in mechanical ventilation because it directly affects gas exchange and lung mechanics.
Recomended Tidal Volume
- What are some causes of ⬆️ Plateau Pressures?
- How to lower the Plateau Pressures?
- Decrease Tidal Volume (Most Effective)
- Optimize PEEP
- Treat underlying cause
- Prone Positioning
Difference between Peak and Plateau Pressures?
🧠 Plateau pressure tells you how hard the lungs are being stretched — and keeping it under 30 cm H₂O protects against lung injury.
Because lowering the tidal volume more directly and safely reduces minute ventilation (VE) while maintaining patient comfort, oxygenation, and lung protection —
especially important in conditions like ARDS.
In Respiratory Alkalosis on the vent, 🥇 Reduce tidal volume (if safe), especially in ARDS. Only reduce RR if TV is already at the minimum safe level.
What is the tidal volume target for ARDS patients on a ventilator?
4–6 mL/kg of ideal body weight
Why use low tidal volumes in ARDS?
To prevent barotrauma and volutrauma from alveolar overdistension
What plateau pressure should be maintained in ARDS?
≤ 30 cm H₂O
What is the initial ventilator mode for ARDS?
Volume Assist-Control (AC-VC)
What is the minimum acceptable pH in permissive hypercapnia for ARDS?
7.15
If plateau pressure is >30 cm H₂O, what should be done?
Reduce tidal volume by 1 mL/kg (down to minimum of 4 mL/kg)
What FiO₂ should you aim for once oxygenation improves in ARDS?
Titrate FiO₂ to < 60% if possible while maintaining SpO₂ > 88%
What PEEP should be used in ARDS?
Use the PEEP/FiO₂ ARDSnet table
When should prone positioning be considered in ARDS?
When PaO₂/FiO₂ < 150 despite optimized vent settings
When should neuromuscular blockade be used in ARDS?
If patient is ventilator asynchronous or severely hypoxic despite max support
What PaO₂/FiO₂ ratio defines severe ARDS?
< 100 mmHg
What are the oxygenation goals for ARDS?
PaO₂ 55–80 mmHg or SpO₂ 88–95%
Why do we tolerate high PaCO₂ in ARDS (‘permissive hypercapnia’)?
To avoid lung injury from high tidal volumes
If peak pressure is elevated but plateau pressure is normal, it’s likely an airway resistance problem.
If both are high, it’s likely a compliance problem (e.g., ARDS).
What is interstitial lung disease (ILD)?
ILD refers to a group of disorders that cause inflammation and fibrosis of the lung interstitium, leading to restrictive lung disease and impaired gas exchange.
What are common symptoms of ILD?
Progressive dyspnea, dry cough, crackles on exam, and clubbing in chronic cases.
What are common causes of ILD?
Idiopathic pulmonary fibrosis (IPF), connective tissue disease (RA, scleroderma), drug-induced (amiodarone, methotrexate), occupational (asbestos, silica), and sarcoidosis.
