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Cardiopulm 2 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

goals of mechanical ventilation

A

1: maintain alveolar ventilation
2: correct hypoxemia
3: decrease work of breathing

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2
Q

what controls the breath?

A

1: pressure: flow is not constrained to a preset value, allows for better pt-ventilator synchronization
2: volume: more stable minute ventilation
3: flow

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3
Q

parts of breath

A

start=trigger
sustains=control variable
stops=cycle
in-between=baseline

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4
Q

triggers

A

based on the frequency set. It becomes time for the pt to receive a breath

pressure
flow
volume

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5
Q

pressure trigger

A

the patient creates enough negative pressure to initiate a breath

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6
Q

flow trigger

A

the ventilator constantly measures the flow of the inspiratory and expiratory sides of the ventilator.
when he expiratory side shows a decrease in flow, the ventilator initiates a breath

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7
Q

limit

A

a preset level that must be reached before the breath will end.
reaching this level does no necessarily end the breath

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8
Q

cycle

A 
ends inspiration and begins expiration
pressure
volume
flow
time
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9
Q

baseline=expiration

A

pressure-most practical
if atmospheric pressure is 0, the baseline is measured from 0
positive end expiratory pressure (PEEP) is a baseline pressure above 0

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10
Q

PEEP

A

positive end expiratory pressure
baseline pressure above 0

improves oxygenation by opening or holding open the lung alveoli preventing collapse

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11
Q

ventilation mode

A

combination of breathing pattern, control type and control strategy

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12
Q

breath types (patterns)

A

mandatory
spontaneous
assisted
supported

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13
Q

mandatory breath type

A

=ventilator sets the start time and control variable (pressure or volume)

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14
Q

spontaneous breath type

A

=pt sets start time and tidal volume

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15
Q

assisted breath type

A

mandatory breath that is patient initiated

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16
Q

supported breath type

A

spontaneous breath that has a pressure greater than baseline

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17
Q

tidal volume

A

=volume of air that moves in and out of the lungs for each breath

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18
Q

minute volume

A

=volume of air breathed in 1 minute

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19
Q

FiO2

A

=fraction of inspired oxygen expressed as the percentage of oxygen being breathed

20
Q

I:E ratio

A

=the ratio of inspiratory time to expiratory time

21
Q

sensitivity

A

=a measure of the amount of effort to trigger a breath

22
Q

peak inspiratory pressure (PIP)

A

=the highest pressure produced during inspiration

23
Q

plateau pressure

A

=pressure reflected on the ventilator during an inspiratory pause… after inspiration is complete, but before expiration has begun

24
Q

auto PEEP

A

spontaneous development of PEEP, usually due to insufficient expiratory time

25
Q

rise time, flow acceleration %, or pressure slope

A

=terms that indicate the speed which gas flows to deliver a breath

adjustment of the rise time can improve pt comfort
promote ventilator/pt synchrony
decrease work of breathing

26
Q

common ventilation modes

A

1: A/C (CMV)
2: IMV (intermittent mandatory ventilation)
3: SIMV (synchronized IMV)
4: spontaneous

27
Q

A/C ventilation

A
  • AKA CMV (continuous mandatory ventilation)
  • all mandatory breaths set to be delivered at a minimum rate, sensitivity level and control variable (pressure or volume)
  • the pt can initiate assisted breathes and breathe at a faster rate, but the preset pressure or volume will be delivered

-provides pt with max ventilator support

28
Q

SIMV ventilation

A

=synchronized intermittent mandatory ventilation

  • all mandatory breaths set to be delivered at a min rate, sensitivity level, and control variable (pressure or volume)
  • the pt can breathe spontaneously between mandatory breaths at their own tidal volume and rate
  • positive pressure can be delivered during spontaneous breathes by adding pressure support or tubing compensation
  • allows for respiratory muscle use preventing atrophy
  • the negative pressure generated by spontaneous breaths allows for improved blood return to the heart
29
Q

spontaneous ventilation

A
  • all breaths are determined by the pt
  • positive pressure can be added to support breaths
  • the pt must have an intact respiratory drive
  • evaluates pt’s ability to breathe independently while ventilating parameters are measured and alarms available
  • various support breaths can be added
30
Q

PEEP vs. CPAP

A

PEEP: positive end expiratory pressure
-an adjunct to mechanical ventilation

CPAP: continuous positive airway pressure

  • measurement of baseline pressure during spontaneous ventilation
  • can be administered non-invasively with a face mask
  • both are a measurement of baseline pressure
  • both improve oxygenation through the same mechanism
31
Q

additional modes of ventilation

A

1: bilevel
2: pressure regulated volume control (PRVC)

32
Q

bilevel

A
  • pressure controlled breaths with a set rate, that determines I:E ratio, and a baseline pressure
  • inspiratory pressure=high PEEP
  • baseline pressure (PEEP)= low PEEP
  • the pt can initiate spontaneous breaths
  • pt can assist breaths

-improves patient/ventilator synchrony and reduces the need for sedatives or paralytics during PCV

33
Q

APRV

A

airway pressure release ventilation

34
Q

PRVC

A

pressure regulated volume control

pressure control with a targeted tidal volume

35
Q

types of supported breaths

A

-can only be applied to spontaneous breaths

pressure support
tubing compensation

36
Q

pressure support

A
  • preset pressure delivered with each spontaneous breath

- estimated to overcome artificial airway resistance

37
Q

tubing compensation (TC)

A
  • type and size of airway is entered into the ventilator
  • using flow and airway calculations the pt is given enough pressure support to only overcome tube resistance
  • simulates spontaneous respirations w/out an airway present
38
Q

alarms

A

properly set and functioning alarms are essential for the safe operation of any mechanical ventilator

it is important for the licensed care professional to be aware of proper corrective actions to take with each type of alarm

39
Q

basic alarms

A

sound when patient becomes disconnected or develops a significant leak
sound when the pressure in the circuit exceeds a specified level

40
Q

high pressure alarms

A

sounds when the pressure in the circuit has exceeded the set level

  • evaluatie the need for suction
  • tube biting
  • reposition pt’s head
  • evaluate need for sedation
  • consult your respiratory care practitioner
41
Q

low inspiratory pressure alarm

A

inspiratory pressure falls below set level

  • look at your patient: chest rise, color, SpO2
  • check for disconnect or major leak
  • if ventilation is inadequate, bag the patient and call your respiratory care practitioner
42
Q

low exhaled tidal volume alarm

A

sounds the the pt’s tidal volume falls below set level

treat the same as low inspiratory pressure alarm

43
Q

low inhaled minute volume alarm

A

sounds when the pt’s minute volume falls below set level

treat the same as low inspiratory pressure alarm

44
Q

apnea alarm

A

sounds when a specified amount of time has passed without the ventilator sensing a spontaneous or mandatory breath

  • may need to stimulate the pt. if respirations are still inadequate, bag patient and contact respiratory care practitioner
  • most ventilators have clinician set apnea parameters that should ventilate the pt when apnea is sensed
45
Q

silencing alarms

A

should only be done judiciously, if at all.

once an alarm is silenced, the clinician must continuously monitor the adequacy of ventilation by evaluating chest excursions, SpO2, heart rate and general appearance of the pt.
failure to ensure adequate ventilation and oxygenation can result in anoxic brain injury and death. never silence an alarm and leave the pt’s room

Cardiopulm 2 (13 decks)

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