Invasive and non-invasive mechanical ventilation

Question 1

what are the indications for mechanical ventilation?

Answer 1

airway protection 
ARDS 
shock 
acute neuromuscular dz 
respiratory or cardiac arrest 
acutely elevated intracranial pressure 
tachypnea / bradypnea 
respiratory acidosis

Question 2

what does positive pressure ventilation do?

Answer 2

generates a mechanically induced change in transpulmonary pressure within the airways

Question 3

what is the downside of positive pressure ventilation?

Answer 3

supine positioning changes the distribution of inspired gases - delivered primarily to anterior portions of lung

Question 4

what are the 3 Ts that define volume and pressure targeted breaths?

Answer 4

target
trigger
termination

Question 5

spontaneous breaths are targeted solely by what parameter?

Answer 5

pressure

Question 6

what is the airway pressure in volume targeted breaths?

Answer 6

variable

Question 7

the tidal volume in pressure targeted breaths is determined by what factor?

Answer 7

inspiratory pressure

inspiratory time

Question 8

who determines the flow in pressure targeted breaths?

Answer 8

patient

Question 9

what mode is used when the operator wants to minimize patient work of breathing?

Answer 9

assist

Question 10

what are the two major disadvantages of assisted mode ventilation?

Answer 10

high minute ventilation and respiratory alkalosis

dynamic hyperinflation

Question 11

what are the two types of assist modes?

Answer 11

pressure

volume

Question 12

what is used to determine if a patient is ready to be taken off ventilation?

Answer 12

spontaneous

Question 13

what are ways to improve oxygenation?

Answer 13

increase FiO2

adjust airway pressure

Question 14

what are two methods to adjust airway pressure?

Answer 14

PEEP

increased inspiratory time

Question 15

what are the drawbacks to increased airway pressure (PEEP)?

Answer 15

1. increased dead space from overdistending functional alveoli
2. decreasing venous return, CO, and oxygen delivery from increased intrathoracic pressure
3. VALI from overstretching alveoli
4. barotrauma leading to alveolar rupture, air leak

Question 16

what ventilation parameter determines pCO2?

Answer 16

minute ventilation

Question 17

equation: minute ventilation

Answer 17

TV x RR

Question 18

what is the tidal volume for anyone without ARDS?

Answer 18

6-8 cc / kg predicted body weight

Question 19

why is it important to keep tidal volumes low during ventilation?

Answer 19

tidal volumes can injure the lung (overdistension)

Question 20

what are the indications for noninvasive mechanical ventilation?

Answer 20

acute exacerbation COPD 
acute cardiogenic pulmonary edema 
neuromuscular failure 
pneumonia - immunocompromised 
time? 
asthma? 
other respiratory failure?

Question 21

what are contraindications to noninvasive mechanical ventilation?

Answer 21

comatose 
secretions 
bleeding 
vomiting 
ARDS 
hemodynamic instability 
inability to wear mask

Question 22

high flow nasal cannula oxygen is mainly used for what indication?

Answer 22

hypoxic respiratory failure

Question 23

what is ECMO? what does it provide?

Answer 23

use of cardiopulmonary bypass circuit for prolonged but temporary life support

provides mechanism for gas exchange and/or cardiac support allowing for recovery