Mechanical Ventilation

Question 1

Benefits of MV

Answer 1

facilitate lung expansion
improve gas exchange
decrease effort of ventilation

Question 2

What is MV based on?

Answer 2

Pressure
volume
time and/or flow

Question 3

Indications for MV

Answer 3

AFR
ARDS
hypoxemia
hypercapnia
airway protection
apnea/arrest
post op

Question 4

What are 2 types of MV?

Answer 4

invasive and non invasive

Question 5

What does invasive MV involve and why is it used?

Answer 5

ET-tube or trach
for prolonged respiratory support

Question 6

What is non invasive MV and why is it used?

Answer 6

CPAP ( continuous positive airway pressure)
BiPAP (bilevel positive airway pressure)

for patients that can still breathe on their own but need resp support

Question 7

Explain what FiO2 is?

Answer 7

Fraction of inspired oxygen
the concentration (%) of oxygen delivered to the patient

Question 8

Why do you want the lowest possible FiO2?

Answer 8

avoid O2 toxicity

Question 9

Explain tidal volume (Vt)?

Answer 9

Volume (amount) of air delivered to the lungs in one breathe

Question 10

What is the typical range for Vt?

Answer 10

6-8 mL/kg

Question 11

Why is choosing the correct Vt important?

Answer 11

to prevent lung trauma/injury

Question 12

What can happen if Vt is too high?

Answer 12

Barotrauma or volutrauma

Question 13

What can happen if Vt is too low?

Answer 13

atelectasis collapse of alveoli)

Question 14

What is PEEP?

Answer 14

Positive End-Expiratory Pressure
pressure applied by the ventilator at the end of expiration to keep alveoli open

Question 15

Typical range for PEEP

Answer 15

5-10

Question 16

Purpose of PEEP

Answer 16

help improve oxygenation by preventing collapse of alveoli
maintains functional residual capacity

Question 17

What is pressure support? When is it used?

Answer 17

Additional pressure applied during spontaneous breaths to reduce the work of breathing

when patients need extra help especially for weaning

Question 18

What is the meaning of PaO2?

Answer 18

reflects how well oxygen is transferred from the lungs to the blood

Question 19

PaO2 range

Answer 19

80-100

Question 20

PaCO2 range

Answer 20

35-45

Question 21

What are the volume controlled modes

Answer 21

Assist-control
synchronized intermittent mandatory ventilation

Question 22

What are the pressure controlled modes?

Answer 22

pressure control and pressure support

Question 23

Explain Assist-control MV mode?

Answer 23

delivers a SET tidal volume with each breath
patient can still initiate a breath

Question 24

indications for assist-control?

Answer 24

pt can’t breathe or start breaths
pt cant protect their airway
ARF
post op

Question 25

Reason for Assist-control?

Answer 25

ensure patient receives full tidal volume

Question 26

Explain synchronized intermittent mandatory ventilation

Answer 26

delivers set number of breaths with PRESET Vt but allows spontaneous breathing initiated breaths are not assisted

Question 27

Indications for SIMV

Answer 27

weaning pt cant breathe on their own but needs assistance to maintain adequate ventilation

Question 28

Explain pressure-control ventilation

Answer 28

delivers breaths based on a set of inspiratory pressure Vt will vary based on lung compliance

Question 29

indications for PCV

Answer 29

ARDS pt with high risk of barotrauma pt with severe lung injury or high PEEP requirements

Question 30

Explain pressure support mode?

Answer 30

only applies pressure during spontaneous breaths

Question 31

indications for PSV

Answer 31

used to ASSESS patients readiness to wean pt who may have muscle fatigue from breathing

Question 32

Why is PSV used?

Answer 32

reduces work of breathing

Question 33

Explain inverse ratio ventilation

Answer 33

inspiratory time is LONGER than expiratory time higher risk of air trapping

Question 34

indications for inverse ratio ventilation

Answer 34

Severe ARDS patients with poor oxygenation refractory hypoxemia

Question 35

Why is IRV used?

Answer 35

to allow more time for gas exchange keep alveoli open to improve V/Q

Question 36

Explain Airway pressure release ventilation

Answer 36

A mode where pt breaths spontaneously while ventilator alternates between two levels of continuous positive airway pressure

Question 37

Indications for ARPV

Answer 37

ARDS refractory hypoxemia pt at risk for ventilator induced lung injury

Question 38

Reason for ARPV?

Answer 38

allows alveolar gas to be expelled by the lungs own natural recoil allows maximum alveolar recruitment and oxygenation while allowing spontaneous breathing

Question 39

Explain independent lung ventilation

Answer 39

each lung is ventilated separately using two ventilators double lumen requires sedation and paralytics

Question 40

indications for ILV

Answer 40

unilateral lung disease ARDS in one lung large lung abscess single lung transplant

Question 41

Reason for ILV

Answer 41

allows for tailored ventilation of each lung

Question 42

Explain high frequency ventilation

Answer 42

uses very high respiratory rate 60-900 with low tidal volumes pt must be sedated/NMB breath sounds are hard to hear

Question 43

indications for HFV

Answer 43

ARDS severe lung injury in peds/neonate

Question 44

Reasons for HFV

Answer 44

rapid rate for effective gas exchange small Vt helps avoid overdistention of the alveoli

Question 45

Nursing care for mechanical ventilation

Answer 45

continuous monitoring hourly resp assessment patient safety suctioning necessary medications positioning

Question 46

Signs of weaning intolerance

Answer 46

RR greater than 30 or less than 8 BP or HR changes less than 90% SaO2 dysrhythmias restlessness

Question 47

What does low pressure alarms indicate and what do you do?

Answer 47

low exhaled volume check for disconnection, cuff leak, or tube displacement

Question 48

What do high pressure alarms indicate?

Answer 48

excess secretions pt biting tube, kinks coughing PE bronchospasm pneumothorax

Question 49

What do apnea alarms indicate and what do you do?

Answer 49

vent does not detect spontaneous breathing check the vent, tube and patient