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Small Baby Care Specialist > Mechanical Ventilation (CMV, HFOV, HFJV) > Flashcards

Mechanical Ventilation (CMV, HFOV, HFJV) Flashcards

1
Q

What are the 4 types of ventilator-induced lung injury?

A

Barotrauma
Volutrauma
Biotrauma
Atelectotrauma

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2
Q

Barotrauma

A

Using pressures that are too high

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3
Q

Volutrauma

A

Expanding the lungs too much (tidal volume)

- The most common cause of lung injury

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4
Q

Biotrauma

A

Lung injury associated with infection

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5
Q

Atelectotrauma

A

Allowing the lung to develop atelectasis which prevents the alveoli from staying open

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6
Q

When was the first conventional neonatal ventilator designed and what made it unique?

A

1970s

  • Allowed continuous flow through respiratory cycle
  • Delivered continuous PEEP, was time-cycled and pressure limited, and could provide intermittent mandatory ventilation (IMV)
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7
Q

When was CPAP proposed?

A

1971 (for the treatment of RDS)

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8
Q

What is the primary goal of mechanical ventilation?

A

Safe, effective gas exchange

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9
Q

What are 4 important therapies to reduce lung injury and BPD in neonates receiving mechanical ventilation?

A

Surfactant, caffeine, avoiding a pneumo, reducing nosocomial infections

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10
Q

What are the characteristics of “intermittent mandatory ventilation” (IMV)?

A

A mode of conventional ventilation in which all mechanical breaths are delivered at regular intervals, regardless of respiratory effort

  • May lead to inefficient ventilation, pneumothorax, IVH
  • Spontaneous breaths supported by PEEP only, which may increase WOB
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11
Q

What are the characteristics of “synchronized intermittent mandatory ventilation” (SIMV)?

A

This mode of conventional ventilation is patient-triggered

  • Each inspiratory effort that exceeds a trigger threshold during a certain time frame results in a mandatory mechanical breath
  • If patient fails to breathe, a breath is provided
  • Spontaneous breaths are unsupported
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12
Q

What are the characteristics of “assist/control” (AC) ventilation?

A

In this mode of conventional ventilation, each spontaneous breath that exceeds a trigger threshold leads to the delivery of a mechanical breath (assist) synchronous to patient’s inspiratory effort
- If the patient fails to breathe or doesn’t trigger the sensitivity threshold, a breath (control) is provided at the preset interval

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13
Q

What are the characteristics of “pressure support ventilation” (PSV)?

A

A mode of conventional ventilation that applies a burst of inspiratory pressure to spontaneous breaths

  • Used in conjunction with SIMV if patient doesn’t have reliable respiratory drive
  • Patient-triggered (initiated and terminated)
  • Can be adjusted to provide full or partial support
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14
Q

What is the “trigger” feature of mechanical ventilation?

A

The mechanism used to initiate a breath, which may be time, airway pressure, or flow

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15
Q

What is the “limit” feature of mechanical ventilation?

A

The targeted variable (pressure or volume)

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16
Q

What is the “time-cycling” feature of mechanical ventilation?

A

A mechanism in which inspiration ends after a preset inspiratory time (i-time)
- Every breath is identical

17
Q

What is the “flow-cycling” feature of mechanical ventilation?

A

A mechanism in which inspiration ends when decelerating inspiratory flow is a small percentage of PIP (doesn’t have to reach zero-flow state)

  • Enables patient to control i-time and rate while allowing for inspiratory and expiratory synchrony
  • Safeguards against gas trapping
18
Q

Describe pressure and volume in pressure-targeted ventilation

A

Pressure is limited, volume is variable (depends on lung mechanics)

  • Mechanical breaths are initiated and terminated by time
  • Inspiratory flow is constant
  • Can be delivered using SIMV, IMV, or AC
19
Q

Conventional ventilation can be pressure-targeted or volume-targeted. What are the two types of pressure-targeted ventilation?

A 
Pressure Control (PC): variable inspiratory flow (proportional to patient effort)
- Breath is "front-end loaded" as peak pressures and tidal volumes are delivered early in inspiration
Pressure Support (PS): pressure is limited, inspiratory flow is variable
- Applied only to spontaneous breaths and may be used during weaning phase
20
Q

Describe pressure and volume in volume-targeted ventilation

A

Volume is limited, pressure is variable

  • As lung compliance improves, pressure is weaned to provide target volume
  • Inspiratory flow is held constant until inspiration ends
21
Q

What are 3 short-term benefits of SIMV over IMV?

A
  1. Oxygen stability
  2. Patient comfort
  3. Shorter duration of support
22
Q

What is unique about high frequency ventilation?

A

Provides smaller tidal volumes at rapid rates
- A high PEEP recruits alveoli and maintains lung volume at a constant level with small changes in tidal volume to help accomplish ventilation

23
Q

What are the primary goals of ventilation (CMV and HFV)?

A
  1. Maintain adequate lung volume
  2. Avoid atelectasis
  3. Preserve surfactant function
  4. Maximize ventilation-perfusion match and avoid cardiac output impairment
24
Q

Which type of HFV delivers small tidal volumes at rates between 240-660 breaths per minute?

A

HFJV

25
Q

Is exhalation active of passive in HFJV?

A

Passive (HFJV is used in tandem with CMV to provide PEEP)

- Dependent on chest wall and lung recoil

26
Q

What are some characteristics of HFJV?

A

Time-cycled, pressure-limited, with constant gas flow interrupter (jet pulsations)

  • Oxygen is proportional to mean airway pressure (MAP)
  • Ventilation is proportional to amplitude (difference between PIP and PEEP)
27
Q

Which type of ventilation applies a piston to a diaphragm, pushing gas into the lung during inspiration?

A

HFOV

28
Q

What is the typical inspiratory/expiratory ratio seen in HFOV?

A

1:2

29
Q

Which type of ventilation is the only one in which expiration is an active process?

A

HFOV

30
Q

What is NAVA?

A

Neurally-adjusted ventilatory assist: uses electric activity in the diaphragm to trigger inspiratory support

Small Baby Care Specialist (6 decks)

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