Mechanical Ventilation Flashcards Preview

Principles III > Mechanical Ventilation > Flashcards

Flashcards in Mechanical Ventilation Deck (38):
1

Inverse Ratio Ventilation

PCV plus prolong inspiratory time. Decreased insipratory flow rate is used to prolong the time for lung inflation (helps prevent aveolar collapse

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Indications for inverse ratio

Refractory hypoxemia, or hypercapnia

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Inverse ratio settings you can adjust

RR, Pressure support, I:E ratio, PEEP, FiO2

4

Adverse affects of Inverse ratio

Can cause Auto PEEP

5

Pressure Support (PSV)

Pt triggers each breath, but a set amount of pressure assists each breath

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Indications for PSV

Weaning mode, patient only needs airway protection

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PSV settings you can adjust

Pressure support, PEEP, FiO2

8

Adverse effects of PSV

may not receive adequate tidal volumes

9

High Frequency Ventilation (HFV)

Extremely small tidal volume ventilation with gas exchange occuring via diffusion. Lung is effectively kept open throughout ventilation. AKA open lung

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High Frequency Ventilation (HFV) indications

Acute resp failure with need to provide lung protection. which prevents (volutrauma)

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adverse effects of High Frequency Ventilation (HFV)

Very difficult mode of ventilation best used by those with alot of experience

12

Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP

Mode used for a spontaneously breathing Pt in which you are trying not to intubate

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Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP indications

Acute resp failure, COPD, CHF, hypercapnic resp failure

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Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP adverse effects

May insuflate the stomach and the patient needs to be awake

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Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP Settings

Insp. pressure and exp. pressure, FiO2

16

Extrinsic PEEP

Prevents alveoli collapsing at the end of expiration and recruits already collapsed alveoli

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Extrinsic PEEP indications

Improve gas exchange and increase lung compliance

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Extrinsic PEEP adverse effects

Reduces cardiac filling and cardiac output, can over distend alveoli causing deadspace

19

Intrinsic PEEP. AKA Auto PEEP

caused by prolonged inspirtory times and the vent doesn't give enough time for full expiration by the Pt

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Ways to treat Auto PEEP

decrease the inspiratory time, increase the expiratory time and increase the PEEP to match the Pts

21

Plateau Pressure

The pressure needed at the end of inspiration to keep the alveoli open

22

What is the minimal flow resistance in a typical ETT

3-7 cm of H2O/liter/sec

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Ways to overcome persistent hypoxia

-increase Pt sedation
-paralytics
-placing pt in a prone position
-nitric oxide
-inhaled prostacyclin

24

What is the greatest predictor of the pt being weaned off the vent

the RR/TV ratio

25

Criterior for coming off the vent

FiO2 < 0.5 and PEEP (< or =) 7.5 cm H2O

26

Assist Control (AC)

The Pt initiates the breath but a set tidal volume is delivered if the Pt doesn't initiate the breath then a set rate of breathes is delivered

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Assist Control (AC) Indications

Acute Resp failure, ARDS, Pneumonia

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Assist Control (AC) Settings

RR, TV, PEEP, FiO2

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Assist Control (AC) Adverse effects

Resp alkalosis due to hyperinflation or auto PEEP

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Intermittent Mandatory Ventilation (IMV)

Vent delivers periodic breaths however spontaneous breaths are allowed between ventilator delivered breaths

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Intermittent Mandatory Ventilation (IMV) Indications

reduce risk of alkalosis and hyper inflation, COPD, Asthma,

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Intermittent Mandatory Ventilation (IMV) Settings

RR, TV, PEEP, FiO2

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Intermittent Mandatory Ventilation (IMV) adverse effects

Large work of breathing and high pressures maybe needed to deliver the preset tidal volume

34

Syncronized vs Asyncronized

SIMV are syncronized breaths with spontaneous breathing. IMV can cause breath stacking and a breath being delivered while the Pt tries to exhale.

35

Pressure Control Ventilation (PCV)

Breathes are delivered at a certain pressure and rate with a variable TV.

36

Pressure Control Ventilation (PCV) Indications

Reduce risk of barotrauma, Pneumothorax, ARDS

37

Pressure Control Ventilation (PCV) Settings

RR, Pressure support

38

Pressure Control Ventilation (PCV) adverse effects

Variable inflation volumes R/T changes in lung mechanics