Initiation of Mech. Vent.

Question 1

Indication for Initiation of Mechanical Ventilation:

Reason why we need to put a patient on mechanical ventilation

Answer 1

• Acute Ventilatory failure.
• Acute Oxygenation Failure
• Impending Respiratory Failure
• Prophylactic Ventilatory Support
• Apnea.

Question 2

What does it mean Acute Respiratory Failure?

Answer 2

Mean unable to remove PaCO2 normally.

• PH <7.25*
• PaCO2 > 50 mm Hg*
• COPD patients
• Head trauma patient
• Drug over dose patients
• Chest trauma patients ( all these condiction are common on ER and it will take the patient to ARF)

Question 3

When you assess an Acute Ventilatory failure Patient, what you expect to see?

Answer 3

Rapid Shallow Breathing Index

• RSBI = RR/V_T *
• Normal value is < 100*
• Abnormal value: RR40/0.25ml = 160 (>100) (*The faster is the breathing, the lower the volume will get)

Question 4

Tecnically when we consider Hypoxemia?

Answer 4

When PaO₂ decreases < 60 mm Hg

Question 5

P/F ratio is used to:

Answer 5

Calculate the worsenesses of Hypoxemia, the lower the ratio is the worse the Hypoxemia will be.

Example: 100 PaO2 at 0.21 %

100/0.21 = 476 (>200 is normal)

Question 6

What is P/F ratio?

Answer 6

PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure to fractional inspired oxygen. It is a widely used clinical indicator of hypoxaemia.

Question 7

What impending Respiratory Falirure?

Answer 7

• A gradual ↑ of PaCO₂
• ↑ WOB to mantain normal gas exchange.
• Progressive Acidosis and Hypoventilation, PH <7.35, PaCO₂ >50 mm Hg
• Progressive Hypoxemia <60 mmHg

Question 8

Assessment Parameters Suggesting IRF?

(IRF= Impending Respiratory Failure)

Answer 8

• V_T : <3-5 mL/Kg IBW
• RR : >25/min
• V_E : >10 L/min
• VC : <15 mL/Kg IBW
• MIP : >-25 cm H₂O
• PaCO₂ trend: ↑ to >50 mm hg
• PaO₂ trend: ↓ to <60 mm Hg
• VS : ↑RR, ↑HR, ↑BP, ↓ SpO₂

Question 9

V_T of <3-5 mL/Kg IBW, this numers suggest what?

Answer 9

Impending Respiratory failure

Question 10

RR has to be more than what number in orden to be Impending Respiratory Failure?

Answer 10

>25 breaths per minute, if the patient continues to breath like that por a long period of time eventually will get into RF.

Question 11

V_E >10 L/m and VC of <15 mL/Kg IBW, What indicate on patient assessment parameters?

Answer 11

Impemding Respiratory Failure

(Patient must be connected to a ventilator)

Question 12

How PaCO₂ and PaO₂ trend has to be for a patient to go on Respiratory Failure?

Answer 12

• PaCO2 ↑ >50 mmHg
• PaO2 ↓ <60 mmHg

Question 13

In a patient that is getting into RF, RR will:

a. Decrease

b. Increase

c. No change will occurs

Answer 13

b. Increase

Question 14

In a patient that is getting into respiratory failure HR will be:

1. Normal
2. Decreased
3. Increased

Answer 14

3. Increased

Question 15

How BP will be on a patient that is getting into RF?

Answer 15

Increased

Question 16

SaO₂ on a patient that in getting into respiratory failure will be:

Answer 16

Decreased

Question 17

What happened to a patient that can not take the minimun Vital Capacity (<15ml/Kg IBW)?

Answer 17

Tecnicaly this patient can’t take deep breaths, He won’t be able to cough, going into RF eventually.

Question 18

Indication for Prophylactic (prevention) Ventilatory Support

Answer 18

• Reduce Risk of Pulmonary Complication
• Reduce Hypoxemia of mejor body organs
• Reduce Cardiopulmonary Stress

Question 19

• Prolong Shock
• Head Injury
• Smoke Inhalation
• Hypoxic Brain
• Hypoxia of the heart muscles

What would you do if a patient shows up one or some of these signs?

Answer 19

Ventilate the Patient to prevent RF.

Question 20

What is the absolute Mechanical Ventilation Contraindication and why?

Answer 20

Tension Pneumothorax, because of the positive pressure of the ventilator create Barotrauma.

Question 21

Contraindications for Mechanical Ventilation.

Answer 21

• Tension Pneumothorax
• Patient informed consent
• Medical Futility
• Reduction of the patient pain and suffering.

Question 22

What do we need to select for the initial Ventilatory Setting?

Answer 22

1. Mode (S/T, AC, Assist)
2. V_T or PIP/T_I
3. RR
4. FiO₂
5. PEEP
6. I:E ratio
7. Flow Pattern (Square, accelarating, desalarating)

Question 23

Before select the mode, what the Therapist need to have in consideration regarding to the patient?

Answer 23

If the patient need Full Ventilatory Support (FVS) or Partial Ventilatory Support (PVS)

Question 24

What modes are include on FVS?

Answer 24

1. A/C (VC or PC)
2. SIMV (VC or PC)

Question 25

Once the patient is on Ventilator, how long the therapist should wait to do and ABG test?

Answer 25

30 minutes

Question 26

The initial FiO2 setting should be betwen?

Answer 26

**50% - 100%**

Question 27

On the ventilator setting, what would you ajust to correct low PaO₂?

Answer 27

**↑ PEEP or ↑ FiO₂** ## Footnote ***Note: 40% & 10 cm H₂O is better than 60% & 5 cm H₂O. This mean that is better to raise the PEEP than the FiO₂***

Question 28

**Volutrauma is:**

Answer 28

Overstretching of the lung caused by to much volume

Question 29

Hazards & complications of mechanical ventilation:

Answer 29

* **Barotrauma** * **Volutrauma** * **↓ Cardiac out put** * **Multiple lung failure** * **Operator error** * **Ventilator associated pneumonia**

Question 30

If a patient comes to ER with PH \<7.25 and PaCO2 \>50mm Hg, what would you say about this patient?

Answer 30

This patient in on Respiratory failure, must be ventilated

Question 31

**If a patient is breathing 40 time per minute, with a tidal volume of 0.25L, what is his or her Rapid shallow breathing index (RSBI) and what would you do, and why?**

Answer 31

40/0.25= **160 → RSBI** ## Footnote ***This patient have to be mechanically ventilated before gets into RF. Why, because it will not last too much breathing 40/min** (It will get tired)*

Question 32

What will happent to **T_I, T_E,** and **I:E** ratio when we **↑ Flow**?

Answer 32

* T_I will ↓ * T_E will ↑ * I:E ratio will ↓

Question 33

If we decrease **Flow**, is what direction **T_I, T_E**, and **I:E** ratio will move?

Answer 33

* T_I will ↑ * T_E will ↓ * I:E ratio will ↑

Question 34

When we increase **V_T: T_I, T_E,** and **I:E** ratio will move up or down?

Answer 34

* T_I will ↑ * T_E will ↓ * I:E ratio will ↑

Question 35

↓ **V_T **will cause **T_I**, **T_E**, and **I:E** ratio to move in what direction?

Answer 35

* T_I will ↓ * T_E will ↑ * I:E ratio will ↓