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mech vent Flashcards

1
Q

What are side effects of increased PEEP?

A
  • barotrauma
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2
Q

Increase intrathoracic pressure from mech vent will?

A

decrease venous return = decreased preload and decreased CO

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3
Q

If you have an O2 prob you can change?

A
  • PEEP

- FiO2

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4
Q

if you have a vent prob you can change

A
  • RR

- TV (if on Bipap- you can increase IPAP to increase TV) and get rid of CO2)

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5
Q

what is IPAP used for?

EPAP

A

IPAP- positive inspiratory pressure.
- ventilation PaCO2. If PaCO2 is high, increase IPAP to increase TV
EPAP- expiratory positive pressure.
- oxygenation and gas exchange PaO2. improves lung compliance. If PaO2 is decreased then increase EPAP or FiO2

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6
Q

how do you know if you should use BiPAP or CPAP?

A

look at ABG. Is it O2 or CO2 issue? if CO2 is normal use CPAP

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7
Q

perfusion

A

deliver blood to cap bed

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8
Q

diffusion

A

across membrane

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9
Q

what is right shift curve?

A
  • decreased pH
  • increased temp
  • increased CO2

difficult pick up and the lungs but releases for tissues more easily

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10
Q

what do you look at when you want to wean someone from the vent?

A
  • PaO2 and Oxy/Hgb curve
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11
Q

inhale is what? and on the vent its what?

A
  • Active. - pressure intrathoracic

- on vent inhale is + intrathoracic pressure

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12
Q

what is a normal MAP? what does MAP indicate

how do you measure

A

> 65 normal
indicates best global EOP

(Diastolic x2) + systolic/ 3 =

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13
Q

Indicators for invasive mech vent:

QUIZ

A
  1. RR > 35
  2. PaCO2 > 55 with pH < 7.2
  3. PaO2 (with supplement O2) < 55
  4. severe dyspnea with use accessory muscles/trouble speaking/fatigue
  5. Resp arrest
  6. low TV/shallow resps
  7. cardiovascular complications (shock, HF, Hypotension)
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14
Q

what is the best indicator for ventilation?

A

PaCO2

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15
Q

COPD can have decrease in ? and increase in?

A

decrease in PaO2 and increase in PaCO2

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16
Q

what do we watch for on the vent?

A

Trends:

what did they start with? are the getting worse

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17
Q

Common meds for intubation

A
  • ketamine
  • Rocuronium (NMBA)
  • Phenylepherine (vasoconstrict)
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18
Q

What to monitor pre-intubation

A
  • position, Equip, moniotr (ECG, stats, BP…), Meds
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19
Q

What to do during intubation

A
  • Cricoid pressure (maybe)

- monitor

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20
Q

what to do post-intubation

QUIZ**

A
  • Bag PT
  • confirm position (auscultate, chest rise, tube at teeth, CO2 detector, secure tube
  • attach to vent
  • confirm with X-ray
  • put in OG
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21
Q

What is volume cycle vent?

advantage

disadvantage

A

Delivers preset or predetermined volume

advan: vol gas is controlled, constant O2 delivery

Disadvan: potential for excess airway pressures, barotrauma

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22
Q

What is pressure cycle vent?

A

deliver gas to the PT until predetermined system pressure is reached

  • TV will vary** depending on lung compliance
  • used for: when vol vent is not effective. For decreased lung compliance** and increased risk of barotrauma
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23
Q

when vol is a set parameter?

when pressure is a parameter?

A
  • pressure will vary

- vol will vary

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24
Q

goals of vent

A
  1. decrease WOB
  2. support/improve vent
  3. improve oxygenation
  4. balance pH
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25
Q

what variable initiates change from exhalation to inhalation?

A

Trigger

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26
Q

the classification of + pressure is based on this variable

A

cycle

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27
Q

what is flow cycle vent

A
  • set flow rate has been achieved
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28
Q

what is timed cycle vent

A
  • set or predetermined time has elapsed
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29
Q

VT setting

A

6-10cc/kg normal

4-7cc/kg protective lung poor compliance

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30
Q

normal PEEP

A

5-15

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31
Q

Peak flow

A

Rate of gas delivery to a PT (40-100L/min)

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32
Q

I:E ratio

A

1:1-1:4

normal is 1:3

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33
Q

sensitivity

A

amount of - pressure the PT has to generate to initiate own breath (ex. - 2 cmH2O)

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34
Q

airway pressure

A

Set in pressure cycled modes (PSV PCV)(pressure support and pressure controlled) ;

peak inspiratory pressure (PIP) monitored in volume cycled modes (AC SIMV)

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35
Q

questions to ask when you see a vent

A
  1. Vent settings
  2. what is the PT doing?
  3. What are my alarms set at?
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36
Q

controlled breath

A
  • PT does no work, vent does all
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37
Q

Assisted breath

A
  • PT starts to breath, vent takes over
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38
Q

Supported breath

A
  • Pt can do some or most of the work, vent assists or finishes the work (pressure support)
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39
Q

assisted AC mode

When do you use it?
What is set
What can the PT do?
What to monitor

A
  • To initiate vent. when full vent needed
  • RR, TV (PEEP, FiO2, alarms)
  • Pt can breath above set RR but receives pre-set TV
  • monitor RR (above set), MV (TVxRR), PIP/PLAT pressures
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40
Q

Assisted PC mode
When do you use it?

What is set
What can the PT do?
What to monitor

A

pressure controlled normal 15-25
- for decreased lung compliance

  • set RR, pressure (upper limit pressure) (PEEP, FiO2, alarms)
  • Pt can breath above RR but receives set pressure
  • monitor: RR (above), MV, TV
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41
Q

Spontaneous pressure support
When do you use it?

What is set
What can the PT do?
What to monitor

A
  • weaning mode ICU
  • set pressure (boost), NO RR, NO TV (PEEP, FiO2, alarms)
  • Pt has to be able to breath spontaneously
  • monitor: RR, TV, MV
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42
Q

Hybrid SIMV + PS
When do you use it?

What is set
What can the PT do?
What to monitor

A
  • weaning PACU
  • Set RR, TV (PEEP, FiO2, Alarms)
    (PS- added on spontaneous breaths)
  • PT can breath above RR but received OWN TV
  • monitor: RR (above), MV, PIP/PLAT pressures
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43
Q

All vent settings common assess

A
  • ABGs
  • WOB
  • alarms
44
Q

Ppeak

A

pressure airway peak -

calc PEEP + set pressure = Ppeak

45
Q

PIP

A
  • the highest airway pressure generated by the delivery of the set Vt
  • elevated inspiratory pressure. indicates changes in lung compliance or something obstructing airflow delivery (secretions)- the whole system
  • pressure with each breath in entire system (lungs, tubes, ETT…)

Normal is < or = 50

46
Q

side effects of PEEP?

A

barotrauma and increased intrathoracic pressure

47
Q

Plat pressure

A

pressure at the end of inhalation, like holding your breath

  • lung compliance
  • norm < or = 30
48
Q

settings are?

A

on the bottom screen

49
Q

what is PT doing?

A

on the left side screen

50
Q

SIMV + PC

A

synchronized intermit mandatory vent

  • assist with spontaneous breathing
  • the PT can initiate breaths in between mandatory breaths
  • PTs own TV, varies by PT lung compliance
  • lung compliance reflects pressure
  • inspired pressure varies
  • PC normal 15-25
51
Q

when do you extubate from SIMV?

A

wean PS down to 5 for 12-24hrs and then can extubate (5 is min)

52
Q

TV is set at …… for lung trauma

A

4-7cc/kg, when trying to protects against lung trauma

53
Q

sensitivity determines

A

how much effort the PT has to make to trigger a breath or gas delivery from the vent

54
Q

Peak or PIP is…

A
  • determines the flow rate for gas to the PT

- may be 40-100L/min

55
Q

For PT on AC mode, which changes to vent setting would decrease PaCO2?

A

increase RR or TV

56
Q

on PC vent, which changes would you make to decrease PaCO2?

A

increase set pressure

57
Q

increasing PEEP on a vent…

A
  • increases baseline intrathoracic pressure

- can decrease venous return and preload

58
Q

in AC mode, what is not monitored

A

set pressure

59
Q

in PS mode, what is not monitored?

A

Set Tv

60
Q

in PC mode what is not monitored?

A

Set Tv

61
Q

Which parameter occurs in SIMV but not in AC?

A

spontaneous MV

62
Q

in PCV and PSV, _______ influences_______ so minute vol must be closely monitored

A

compliance, TV

63
Q

what does it mean if PIP increases?

A

lung compliance is decreasing

64
Q

Pt is getting 10cm H2O PSV, exhaled TV has been decreasing from 450–> 375, what does that mean for lung complinace?

A

decreasing

65
Q

Pt getting 10 cm H2O PSV, in 3 hrs their RR increased from 14–> 26, what does this indicate?

A

not enough PS

66
Q

on SIMV mode, in the last 3 hrs Vt has decreased and their spontaneous RR has increased. what might this indicate?

A

Pt is fatiguing

67
Q

Pt is vented with PCV with PS of 20cm H2O, iTime 1 sec, RR 16. you care concerned that lung compliance is deteriorating. What parameters will provide best indication that this is occurring

A

Exhaled TV

68
Q

Responses to mech vent

A

-barotrauma
- hemodynamic alterations
- fluid retention (ADH secretion)
- O2 related issues: atelectasis, toxicity
- upper airway damage
-

69
Q

Nurse management of mech vent

A
  • assess PT/moniotr/alarms
  • troubleshoot alarms
  • know complications of mech vent
70
Q

vent alarm always start at the?

A

PT. if in doubt of airway patent/inadequate vent. the bag the PT with O2 connected
- work from PT to vent

71
Q

apart from secretions what else causes high pressure alarm?

A
  • kink vent tube
  • biting on ETT
  • bronchospasm
72
Q

low pressure alarm causes

A
  • loose connections
  • low cuff pressure/cuff leak
  • crack in tubing
73
Q

cause of low exhaled TV alarm

A
  • PT tiring in weaning mode
  • cuff leak, low cuff pressure
  • bronchospasm
74
Q

Low VT alarm and Pt cough and becomes restless, you?

A

listen to breath sounds and suction

75
Q

increasing PEEP will?

watch for? 3

A
  • increase intrathoracic pressure and falsely increase CVP
  • drop in BP
  • preload
  • barotrauma
76
Q

what would you want to give if you increase PEEP and have a low CVP?

A

NS bolus to increase preload

77
Q

Pt is on PCV and has resp acidosis with mild hypox, what changes do you want to make

A

increase set pressure and increase PEEP

increased PEEP = increased intrathoracic pressure = decreased venous return

78
Q

PT on PCV and has resp acidosis, what do you change

A

increase pressure support

79
Q

Pt on ACV set RR 20/24, Vt 350, FiO2 0.35, PEEP 5.
Pr has resp alkalosis

what is most approp intervent?

A

decrease Vt

80
Q

what causes barotrauma?

A

rising PIP
keep < 50!!
more important to watch the trend

81
Q

how does a fluid imbalance happen when vented?

A

positive pressure decreases venous return (increased intrathoracic pressure). This triggers the RAAS and increased ADH secretion.

  • watch urine O/P, CVP, and other indicators of preload
82
Q

Pt has resp acidosis with mild hypoxic. On PC. what is the prob and what do you change?

A

Prob. Ventilation

increase the pressure support will indirectly increase the Vt

83
Q

Decreasing PEEP, you need to watch for potential for?

A

changes in lung compliance

84
Q

positive pressure vent can lead to what lung complications?

A
  • volutrauma

- pneumothorax

85
Q

mech vent impacts GI system by?

A
  • increase risk gastric ulceration and gastric distension
86
Q

absorption atelectasis?

A

when FiO2 is close to 1.0 (100%)

87
Q

high levels of O2 can lead to? 5

A
  1. release of free radicles
  2. increase lung inflam
  3. atelectasis
  4. pulm fibrosis
  5. localized lung edema
88
Q

how do you minimize high levels of O2

A

use or increase PEEP

89
Q

Pt has metabolic acidosis with hypoxemia

FiO2 is 0.8 on PC 15, PEEP 5, Vt 250-325, RR12

A

potential complication for oxygen toxicity

increase PEEP so that you can decrease FiO2

90
Q

Airway management

A
  • suction
  • warm humidified air to thin secretions (tenacious secretions)
  • mucolytics (aerosolized mucomyst)
  • reposition to mobilize secretions
  • bronchodilators to decrease airway resistance
91
Q

suctioning

A
  • If PIP increasing
  • pre-oxygenate for 30-60 sec 100%- for PT who desat easy or have high O2 needs
  • insert cath no longer than carina
  • less than 15 sec max
  • cont not int
92
Q

increase in PIP could be from?

A

decreased compliance

93
Q

what are the concerns with an increasing PIP for a PT on ACV

A
  • barotrauma

- worsening pneumonia

94
Q

beside changing vent settings, how can you decrease PIP?

A
    • provide sedation
  • chemically paralyze
  • provide verbal reassurance
  • ensure adequate analgesia
95
Q

when switched to PC what would you monitor for lung compliance?

A

Tv

96
Q

what do you want to change with partial comp metabolic acidosis

A
  • decrease FiO2 and decrease PC
97
Q

weaning methods

A
  1. spontaneous breathing trials** ICU
  2. progressive decrease in the level of pressure support in PSV** ICU (NOT decreasing PC- pressure)
  3. progressive decrease in vent-initiated breaths in SIMV mode ** PACU
  4. decreasing SIMV RR
98
Q

SBT

A

lasts: 30-120 min
- gradual decrease PSV to 5 bfr extube

Short term- from OR: can use T-tube, CPAP, or low PS. Low rate SIMV 30 min then extubate

99
Q

the RSBI calc readiness to wean

A

rapid shallow breathing index

RR and TV

100
Q

RSBI is 40-50 (RR/Tv)

A

<105

indicates she is ready to be weaned

101
Q

essential criteria for indicating PT readiness to wean

A
  • PEEP 5-7
  • FiO2 < or = .5
  • low to no vasopressors
  • condition resolved or almost resolved
  • ability to initiate insp effort
102
Q

a - inspiratory force of _____ and a VC of _____ ml/kg are parameters that are indicative of readiness to wean

A

< -10, >10

103
Q

how do you know if a PT is not tolerating the SBT

A
  1. sweating, agitation, anxiety
  2. SpO2 < 88
  3. PaCO2 increased by 10mmHg
  4. HR >140
  5. RR> 35 for > 5min with increased WOB
  6. SBP <90 or >180
104
Q

for long-term vents, approp weaning?

A
  • regular decreases in PS
  • PS followed by AC rest periods
  • complete when able to breathe spontaneous for 24 hrs
105
Q

common causes of failure to wean:

A
  • source of resp failure not corrected
  • fluid vol overload
  • cardiac dysfunction
  • neuromuscular weakness
  • delirium
  • metabolic disturbances
  • anxiety
106
Q

not ready to be extubated

A
  • pH< 7.25

- PaCO2 51

107
Q

mech vent CVP goal

A

Now 8-12

7320 (8 decks)

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