Improving Oxygenation

Question 1

Types of sigh technique

Answer 1

Check camera roll

Question 2

Causes of anaemic hypoxia

Answer 2

Blood can’t carry oxygen:
Abnormal Hgb
CO poisoning
Low RBC

Question 3

How do you treat anemic hypoxia

Answer 3

Blood products
Hyperbaric therapy

Question 4

What causes circulatory hypoxia

Answer 4

Poor blood flow
Can be regional or widespread

Question 5

How do you treat circulatory hypoxia

Answer 5

Pharmacologic intervention

Med to increase ventricular contraction or decrease vascular resistance

Question 6

What causes histotoxic hypoxia

Answer 6

Oxygen is in the system, but unable to carry the O2

Ex: cyanide poisoning

Question 7

How do you treat histotoxic hypoxia

Answer 7

Administer a cyanide kit

Question 8

What causes cytopathic hypoxia

Answer 8

Diminished production of ATP despite normal or better PO2 near mitochondria

Ex: sepsis link

Question 9

Treatment for cytopathic hypoxia

Answer 9

Oxygen therapy

Question 10

Formula for desired FiO2

Answer 10

Desired PaO2 x known FiO2/ Known PaO2

Question 11

What do we shoot for if the patient isn’t oxygen great and has highest FiO2

Answer 11

60 mmHg
90%

Question 12

Complication of oxygen toxicity

Answer 12

Mild tracheobronchitis

Absorption atelectasis

Alveolar damage indistinguishable from ARDS

X-Ray:

Bilateral, peripheral, asymmetrical consolidation with bronchogram

Question 13

What increases MAP

Answer 13

Increase:

PIP
PEEP
Ti

Change to decelerating flow

Question 14

How do you increase PIP in a volume mode

Answer 14

Increase:
PEEP
Ti

Question 15

By what increments should you increase PC to increase PIP

Answer 15

2 cmH2O

Question 16

Indications for CPAP and PEEP

Answer 16

Bilateral infiltrates (CXR)

<60 mmHg and >50%

P/F <300 (ARDS)

Refractory hypoxemia (<10 increase per 20% increase)

Question 17

Is there PEEP on noninvasive ventilation

Answer 17

No. There is EPAP

Question 18

Application for CPAP

Answer 18

CPAP Mask

CPAP Nasal

ETT or tracheostomy

Flow and threshold resistors

Spontaneous w/ freestanding system and MV

Question 19

How is PEEP increase with infants

Answer 19

2-3cmH2O

Question 20

Low PEEP Strategy: 30%

Answer 20

5

Question 21

Low PEEP Strategy: 40%

Answer 21

5-8

Question 22

Low PEEP Strategy: 50%

Answer 22

8-10

Question 23

Low PEEP Strategy: 60%

Answer 23

10

Question 24

Low PEEP Strategy: 70%

Answer 24

10-14

Question 25

Low PEEP Strategy: 80%

Answer 25

14

Question 26

Low PEEP Strategy: 90%

Answer 26

16-18

Question 27

Low PEEP Strategy: 100%

Answer 27

18-24

Question 28

High PEEP Strategy: 30%

Answer 28

5-14

Question 29

High PEEP Strategy: 40%

Answer 29

14-16

Question 30

High PEEP Strategy: 50%

Answer 30

16-18

Question 31

High PEEP Strategy: 60%

Answer 31

20

Question 32

High PEEP Strategy: 70%

Answer 32

20

Question 33

High PEEP Strategy: 80%

Answer 33

22

Question 34

High PEEP Strategy: 90%

Answer 34

22

Question 35

High PEEP Strategy: 100%

Answer 35

22-24

Question 36

How do you find optimal PEEP on PC

Answer 36

Keep delta P constant (15-25cmH2O) Asses increase in VT

Question 37

Contraindications for PEEP

Answer 37

Hypovolemia Untreated PTX Intracranial Pressure Hyperinflation Pulmonary effects of PEEP Transmission of AW pressure to pleural

Question 38

What do you decrease PEEP in increments of

Answer 38

2cmH2O

Question 39

When do you wean PEEP

Answer 39

FiO2 less than 40% Hemodynamic stable Non septic Improved lung condition

Question 40

What less talked about uses for PEEP

Answer 40

CHF Postoperative atelectasis and hypoxemia Sleep apnea Cystic fibrosis Aw suction

Question 41

Types of lung recruitment maneuvers

Answer 41

Sustained inflation PC-CMV w/ high PEEP PC-CMV w/ increasing PEEP Recruitment and decremental PEEP Sigh technique

Question 42

How do you preform PCV lung recruitment maneuver

Answer 42

PIP 35-50cmH2O Ti 1-2 PEEP 20-30cmH2O Applied for 1-3 minutes

Question 43

Physical benefits of prone position

Answer 43

Changes position of heart Changes regional diaphragm motion Pleural pressure more uniformly distributed, which improves recruitment

Question 45

Technique for prone position

Answer 45

Sedation Labor intensive Extubation Loss of vascular & catheter Head turn Cushion and compression of Abs Arm positioning

Question 46

What do kinetic beds do

Answer 46

Turn patients Side to side 45-60 degrees

Question 47

Rationale for turning prone patients frequently

Answer 47

Prevent pulmonary complications (atelectasis and hypoxemia)

Question 48

Body positioning complications

Answer 48

Pt. Agitation Worsening dyspnea Hypoxia Cardiac arrhythmia Increased ICP Difficulty examining patient

Question 49

Patient position for a unilateral lung disease

Answer 49

Independent lung ventilation Good lung down

Question 50

Steps to wean FiO2 with a P/F of: >300 (100%)

Answer 50

20 20 10 (>95) 10 (>90) ABG (consider 5)

Question 51

Steps to wean FiO2 with a P/F of: 200-300 (100%)

Answer 51

20 20 10 (>95) 10 ABG

Question 52

Steps to wean FiO2 with a P/F of: 150-199 (99-100%)

Answer 52

20 20 (>90) ABG

Question 53

Steps to wean FiO2 with a P/F of: 100-149 (96-100%)

Answer 53

20 (>90) ABG

Question 54

Steps to wean FiO2 with a P/F of: <100 (<96-100)

Answer 54

Consider PEEP

Question 55

Complication for lung recruitment maneuver

Answer 55

Hypotension Hypoxemia Barotrauma

Question 56

Hazards of recruitment maneuver

Answer 56

Decrease venous return to thorax Drop CO Hypotension Uneven blood pressure and/or flow to lungs Variability amongst Pt. Variability of chest wall compliance

Question 57

Who gets proned

Answer 57

P/F <150 w/ > or equal 60% and greater of equal to 5 PEEP Severe ARDS Refractory hypoxemia P/F equal or < 100 and PaO2 = or < 60 100% not responding to other means

Question 59

How long should you wait in between each wean

Answer 59

10-30 minutes