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NSCC 7320 - Critical Care Theory 3 > Mechanical Ventilation (MV) & ARF > Flashcards

Mechanical Ventilation (MV) & ARF Flashcards

(111 cards)

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1
Q

what is ventilation

A

movement of gases in and out of lungs

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2
Q

what is gas exchange

A

O2/CO2 across membrane

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3
Q

what is respiration

A

exchange of O2/CO2 out of cell (internal)

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4
Q

What is compliance

A

distensibility of the lung tissue

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5
Q

2 examples of when lung compliance may be decreased

A

PNA

pulmonary edema

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6
Q

what ventilation method is preferred in cases of decreased lung compliance

A

pressure support

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7
Q

what is meant by resistance in terms of ventilation and ARF

A

diameter of airways

i.e. increased airway resistance in asthma

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8
Q

what is respiratory failure

A

condition in which the respiratory system fails in one or both of its major fns - gas exchange or ventilation

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9
Q

how is respiratory failure diagnosed regarding blood gases

A

blood gases
PaO2 <60
PaCO2 >45
pH < 7.35

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10
Q

what are other diagnostic criteria for ARF aside from blood gases

A

clinical presentation, deviation from pts baseline if they have COPD, history, imaging, VQ scan

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11
Q

what is the difference between respiratory insufficiency and respiratory failure

A

insufficiency gradually needing some O2 support

failure - full O2 support with MV and O2

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12
Q

what are the 3 types of respiratory failure

A

Type 1: acute hypoxemic respiratory failure
type 2: acute hypercapnic respiratory failure
combined

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13
Q

what is the primary problem in type 1

A

gas exchange

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14
Q

what is the primary problem in type 2

A

ventilation

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15
Q

what are the two main causes of type 1 resp failure

A

diffusion

V/Q mismatch

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16
Q

what are the 4 components affecting diffusion in type 1 resp failure

A

SA of alveoli
thickness of AC membrane
diffusion coefficient CO2: O2
Driving pressure - difference between alveolar partial pressure and capilliary partial pressure

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17
Q

what are the two components of V/Q mismatch

A

intrapulmonary shunt

alveolar deadspace

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18
Q

what can cause alveolar deadspace

A

PE, decreased CO, shock

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19
Q

does respiratory acidosis or alkalosis occur in early stages of resp failure? why?

A

decreased PaO2 causes peripheral chemoreceptors to trigger resp center to increase rest rate/depth (ventilation) causes more CO2 exhaled resulting in resp alkalosis

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20
Q

what type of gas would you expect with prolonged type I resp failure

A

resp acidosis as pt fatigues and hypogentilation occurs, decreased O2 delivery to cells causes impaired tissue perfusion and lactic acidosis and MODS

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21
Q

what PaO2 triggers peripheral chemoreceptors to increase RR and depth

A

<60

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22
Q

what is the diffusion coefficeint and what does it mean

A

20:1 CO2 diffuses 20X faster than O2

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23
Q

What happens with CO2 in blood and alveoli in type 2 resp failure

A

equalize so CO2 can’t cross AC membrane

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24
Q

what is alveolar hypotension? what type of resp failure does it occur in?

A

amount of O2 to alveoli is insufficient to meet O2 demand

type 2

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25
what can cause type II resp failure? (10)
``` neuromuscular disease (GBS, myasthinis gravis) spinal cord injury musculoskeletal abnormalities supression of CNS resp fxn - drug poisoning post cardiac arrest brain injury upper airway obstruction general anestehsia bedrest pneumo chest trauma obesity ```
26
what 3 things does resp failure type II result from
decreased muslc fn - malnutrition, underlying disease, fatigue increased airway resistance - stridor, upper airway disease, asthma decreased lung compliance
27
what are common management strategies for type 1 resp failure (4)
PEEP minimize deadspace by optimizing CO increase driving pressure (FiO2) repositioning
28
What are common management for Type 2 Resp failure
improve ventilation - WOB, RR, tidal volumes optimize O2 demand, CO and O2 transport bicarb intubation and MV
29
what are 4 ways in which pneumonia can be acquired
aspiration inhalation bloodborn translocation - changing pH of gastric content encourages growth of microbes which can travel to the lungs
30
what are the two main types of pnuemonia
CAP | HCAP
31
what is a subset pneumonia of HCAP
VAP
32
CAP dx vs HCAP
CAP dx <48hrs from admission | HCAP dx >48 hrs within hospital or w/in last 90 days
33
what are typical gram positive bacteria responsible for CAP
streptoccus pneumonia, MRSA
34
what are typical gram negative bacteria responsible for CAP
mycoplasma, legionella, chlamydia, psudomonmas
35
Aside from bacteria what else can cause pneumonia
viruses - coronavirues, adenovirus, influenza, RSV | fungi - aspergillosis, spiralis
36
is HAP typically gram positive or gram negative
negative
37
what is VAP typically caused by (3)
MRSA, pseudomonas, Enterobacter
38
4 things about ETT that increase chance of VAP
prevents cough - bodies natural defense prevents upper airway filtering and humidification inhibits ciliary transport by epithelium direct conduit into lungs for airborne pathogens
39
how is VAP dx
positive cultures new consolidation on CXR worsening infiltrates S&S
40
8 ways VAP can be prevented
semi recumbent position HOB 30-45 degrees hand hygiene sedation vacation ETT with polyurethane cuff, subglottic or EVAC suction non-invasive postive pressure ventilation/extubate ASAP conduct SBT trial daily early mobilization and exercise oral care
41
how do you treat atypical pneumonias
antivirals - tamiflu | antifuncal - clotrimazaole, fluconazole, micafungin
42
how do atypical pneumonias present
inflammation in alveolar septums and interstitial of lung | appear as patchy infiltrates on CXR more diffuse
43
fungal pneumonias are most often found in what type of pts
immunocompromised
44
2 types of ventilation and main difference between the two
spontaneous - negative pressure for inspiration | mechanical - positive pressure for inspiration
45
what causes the start of inspiration in spontaneous breathing
increased PaCO2 stimulates resp center in medulla
46
is inspiration in spontaneous breathing passive or active? exhalation?
inhalation - active | exhalation - passive
47
Is which mode of ventilation is intrathoracic pressure increased, what can this cause
MV | inhibits venous return and lowers preload
48
T or F exhalation is passive in both MV and spontaneous breathing
T
49
Benefits of mech vent
``` alveoli recruitment reversal of atelectasis increased FRC decreases WOB improves gas exchange ```
50
what is the best indicator for needing MV
PaCO2 >55 or pH < 7.20
51
above what RR might we consider MV
35
52
at what PO2 might we consider MV
<55
53
What are the 3 types of ventilator breaths
controlled assisted - delivered if they attempt to trigger breath spontaneous - triggered by pt effort and provides some support
54
in spontaneous ventilator breaths who determines the TV
pt
55
when is pressure cycle ventilation indicated
for decreased compliance and pts at inc risk for barotrauma
56
what is Vt
tidal volume
57
how is Vt calculated
4-7mL/kg to protect lungs | calculated based on pts ideal body weight to reduce baotraumas
58
what is Mv and how is it caluclated
minute volume amount of air delivered to pt in one min TV x RR
59
what is goal MV
5-10 L/min
60
how do you calculate PiP or Ppeak
PEEP + pressure
61
what is measured to determing lung compliance; how is this done
plateau pressure | measured @ end of inspiration by inspiratory hold goal <30 increased values indicate poor lung compliance
62
what is FRC and how do we improve it
functional residual capacity opening more alveoli and preveenting collapse PEEP and CPAP
63
what is the most common mode of ventilation
volume control/assist control
64
what is set in Assisted Volume Control
RR and TV, trigger | PEEP, FiO2
65
what can the pt do in VC
breathe above set RR receive set TV
66
what values should you monitor in VC (3)
RR PIP plateau pressures
67
what happens if compliance deteriorates in VC how would you know and what should you do
will see inc PiP | change to PC
68
can VC cause resp alkalosis?
yes if pt is breathing at inc RR for non-resp reasons such as pain, anxiety
69
what type of patients is PC used for
pts with decreased lung compliance and severe oxygenation problems
70
what do you set in PC
pressure, RR, Ti, trigger | PEEP, FiO2, alarms
71
what can a pt do in PC
can breathe above set RR but receive set P
72
what values should you monitor in PC
RR MV TV EtCO2 - will vary based on MV
73
what setting do you see I:E
PC
74
in what setting do we see laminar flow
PC
75
what are the benefits of laminar flow
less turbulent better at opening smaller airways
76
what can affect I:E
RR
77
why is PC better for sever oxygenation issues
because you can alter I:E, improves V/Q mismatch
78
what does inc PiP over time indicate
decreased lung compliance
79
what can an isolated event of inc PiP incidate
``` ETT obstruction secretions pneumo kink in system bronchospasms ```
80
what is the most common mode for weaning a pt from the vent
pressure support
81
what is set for PS mode
level of inspiratory pressure flow and trigger parameters FiO2/PEEP/CPAP alaras and apena mode
82
what must the pt be able to do for PS mode
spontaneously breath | own RR and TV
83
what values should be monitored for PS
RR TV and MV EtCOT2 - will change based on MV
84
What does SIMV stand for and when is it used
sychrnoized intermittent mandaotry ventilation SIMV | short term post anasethsia CSICU
85
what is set in SIMV
RR and TV triggers | Peep, Fio2 and alarms
86
what can the pt do in SIMV
breathe above rate and receive own TV
87
what should be monitored in SIMV
RR TV and MV - minute volume is set to gaurantee a minimum PIP - fluctuate based on compliance
88
why is SIMV synchronized
ventilator has the ability to sense pts inspiratory effrot and can reschedule mandatory breaths to avoid breath stacking
89
when do apnea alarms occur
occurs if no breath is taken for 10-20s
90
what would cause a high pressure alarm
``` biting on ETT water in tubing secretions kinked tube pneumo bronchospasm ```
91
what would cause a low pressrure
leak in system leak in cuff disconnection
92
what can cause a low exhaled volume
leak in system or cuff pt tiring pressure limit being reached - decreased lung compliance
93
what can cause high RR
anxiety, agitation, hypoxia, hypercapnia, pain, readiness to wean?
94
when can O2 toxicity occur
FiO2 > 50% for over 24 hours
95
what happens in O2 toxicity and what can it cause
O2 free radiacls toxic metabolites of O2 metabolism can damage AC membrane can cause atelectasis, localized edema, reduced compliance
96
what is absorption atelectasis
too much O2 can wash out nitrogen in the alveoli | nitrogen helps keep alveoli open so can cause them to collaspse
97
what are the 7Ps of RSI
``` preparation preoxygenate for 3-5 mins pre-treatment paralysis positioning sniff position placement post intubation managment ```
98
what type of trauma can occur with insufficient PEEP
atelectrauma - shearing injury d/t alveoli repeatedly opening and closing
99
weaning criteria
able to initiate spontaneous breathing cause has resolved hemodynamically stable low or no pressers able to protect airway
100
does a patient have to be awake and alert to wean from ventilator
no
101
what results in failure to wean
``` HR >140 bpm SBP <90 or >180 RR >35 for >5 mins, inc WOB diaphroesis changes in mental status spO2 <90 or PaO2 decrease by 10 or <50 ```
102
what are 3 weaning methods
SBT - spontaneous breathing trials Progressive decrease in PS in PSV progressive decrease in ventilator initated breaths in SIMV mode
103
when would a MV pt be switched from from ETT to trach
1-3 weeks
104
why are trachs preferred to ETT (3)
less analgesia and sedation required facilitates communication facilites weaning
105
hwy are post pyloric feedings preferred in MV
lowers risk of aspiration fewere GI complications higher caloric/protein intake
106
what vitamin do we need to ensure is supplemented in MV and why
thimaine glucose/dextrose load increases demand for thiame thiamine deficiency can occur in <28 days and can cause lactic acidosis, cardiac dysfxn, hypertrophy and arrhythmias
107
what is gluconeogenesis
creating glucose from non-carb sources mainly in liver
108
what is glycogenolysis
breakdown of glycogen to provide energy for muslce contraction
109
why does hyperglycemia occur in critically ill
hypermetabolic state results in increased glycogenolysis and glucoenoesis results in increased glucose levels
110
what can hyperglycemia do to the body
weakened immune system decreased GI motility increased cardiovascular tone abnormal inflammatory response
111
what are benefits of feeding
``` decreased catabolic response reduces risk of infection improved healing improved GI fn improved glucose absorption prevents bacterial translocation decreases lenght of stay ```

NSCC 7320 - Critical Care Theory 3 (5 decks)

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