Mod 5 Invasive Vent Modes and Settings

Question 1

Mechanical breaths modes only?

Answer 1

Controlled -> mandatory breaths only

CMV -> Mandatory + Assisted breaths

Question 2

Combination breath modes?

Answer 2

IMV -> Mandatory + spontaneous

SIMV -> Mandatory + assisted + spontaneous breaths

Question 3

Spontaneous breath modes only?

Answer 3

CSV

Question 4

Continuous Mandatory Ventilation (CMV)

Delivers what kind of breath?

Answer 4

CMV is also known as A/C (assist/control ventilation)

SO…Mandatory and assisted breaths.

-guarantees a min rate.

Question 5

Indications for CMV?

Answer 5

Patient requires full vent. support (FVS)

-high WOB

-crisis management

Question 6

Ventilators: What mode requires a sensitivity set?

Answer 6

Any mod that has patient triggering as an option

Question 7

Ventilators:
Advantages of CMV?

Answer 7

Pt can set rate

Guarantees:
-min number of mandatory breaths/min

-volume or pressure delivered (pt or time triggered)

-syncs w/pt effort

Question 8

Ventilators:
Cons to CMV?

Answer 8

May cause/worsen auto-peep

Resp. alkalosis (if pt’s rate is high)

increased WOB if sensitive not set right

poor tolerance in non-sedated

possible resp. muscle atrophy

Question 9

Ventilators:
what is synchronized Intermittent Mandatory Ventilation (SIMV)?

Answer 9

-Pt has a set rate and number of mechanical breaths.

Question 10

IMV vs CMV?

Answer 10

IMV Patient can take breaths in between set breaths?

Question 11

I:E ratio calculation

Question 12

What vent setting is present lets you know you’re in volume control?

Answer 12

Flow

Question 13

What setting is present that lets you know you’re in IMV vs CMV?

Answer 13

Pressure support.

Question 14

Volume vs Pressure: Compliance equation

Answer 14

Compliance = Delta Volume / Delta Pressure

Question 15

Compliance = Delta Volume / Delta Pressure

What does the compliance equation tell us?

Answer 15

Depending on which delta you set (control), the other variable depends on the compliance is.

Question 16

If you set a patient in volume control [VC]; which values are constant and which values are targets?

Answer 16

Volume is constant.

Depending on the volume; the pressure that’s required to reach that volume is gonna vary

Question 17

In pressure control; which variable do we set (constant) and which is the target?

Answer 17

Pressure is constant

Volume is variable (depending on compliance)

Question 18

In volume control; which variable do you set and what does the vent do?

Answer 18

The vent adjusts pressure to ensure proper pressure is achieved

More P -> more flow -> More Vt (and in the inverse)

Question 19

In pressure control; what variables do you set?

Answer 19

Respiratory rate [Frequent], FiO2, PEEP

AND

inspiratory pressure and time

Question 20

Define: Dual Mode Ventilation: Pressure regulated volume control (PRVC)

Answer 20

Operates like pressure control but ensuring a set volume is achieved; takes feedback and makes adjustments based on that

Question 21

True or False:

Pressure regulated volume [PRVC] adjustments are made in real time according to spontaneous breaths

Answer 21

False

Adjustments are made slowly overtime

Question 22

In PRVC; what are the advantages of setting a target volume rather than a fixed volume?

Answer 22

TLDR: Gradual adjustments until it reaches and can operate at target volume based on pt compliance

Advantage: when patients compliance improves; the vent will adjust and reduce pressures so the pt can breath (can ween the inspiratory pressure)

-Can operate a pressure control but ensures that you are getting enough volume.

Question 23

Auto PEEP: How can you recognize it?

Answer 23

Expiratory flow does not return to 0 after pause or when the next breath is given

Question 24

Auto PEEP: purpose in use

Answer 24

Increase FRC, dilate the airways by manipulating the I : E ratio (increasing expiratory time)

Question 25

Auto PEEP: How to measure auto PEEP?

Answer 25

Expiratory hold; measuring expiratory pressures

Question 26

What is intrinsic PEEP

Answer 26

amount set above the PEEP?

Question 27

How do you prevent over distension of airways?

Answer 27

Keep Pplat under 30

Question 28

How do you calculate TCT?

Answer 28

60/rate

Answer 29

R -> PIP -> V C -> Pat -> o V

Question 30

What mode is pt/time triggered, pressure limited, and time cycled?

Answer 30

Pressure control

Question 31

What mode is pt/time triggered, flow limited, and volume cycled?

Answer 31

Volume control

Question 32

What mode is pt triggered, pressure limited, and flow cycled (insp flow declined to a certain level)

Answer 32

Pressure support

Question 33

What mode is pt/time triggered, pressure adaptive variable limited, and time adaptive cycled?

Answer 33

PC-CMV Adapative

Question 34

Explain pressure control in terms of trigger, limited, and cycle

Answer 34

Pt/time triggered pressure limited time cycled

Question 35

Explain volume control (w/o inspiratory pause) in terms of trigger, limited, and cycle

Answer 35

pt/time triggered flow limited volume cycled

Question 36

Explain volume control (w/inspiratory pause) in terms of trigger, limited, and cycle

Answer 36

pt/time triggered volume/flow limited time cycled

Question 37

What is pressure support in terms of trigger, limited by what, and cycled by what?

Answer 37

pt triggered pressure limited flow cycled

Question 38

What is VC-CMV control variable (w/inspiratory hold)?

Answer 38

volume/flow

Question 39

What is PC-CMV control variable?

Answer 39

Pressure

Question 40

What is PC-CMV Adaptive control variable?

Answer 40

Pressure

Question 41

A flow-cycled breath is considered to be cycled by what?

Answer 41

Patient cycled

Question 42

What are assisted breaths?

Answer 42

Triggered by Pt, but the vent controls the rest of the breath

Question 43

What is the difference between a mandatory breath and a assisted breath?

Answer 43

Assisted breath is pt triggered

Question 44

How do you calculate compliance?

Answer 44

C = Volume/ (Pplat - PEEP)

Question 45

How do you calculate resistance?

Answer 45

R = (PIP-Pplat) / flow

Question 46

How do you calculate time constant?

Answer 46

TC = R x C

Question 47

Why are some complications of increasing of PEEP risky?

Answer 47

**Barotrauma aka overdistension of lungs** As PEEP is increased, the volume of air delivered to the lungs during each breath (VT) may need to be decreased to maintain safe levels of lung inflation.

Question 48

What affect does an increase of PEEP have on RR?

Answer 48

**Increasing PEEP can decrease patient's respiratory rate. ** *Because* Higher pressure in lungs by PEEP makes it easier to exhale, which can lead to a slower respiratory rate.

Question 49

How does increasing PEEP affect the I:E ratio?

Answer 49

**Increasing PEEP can increase Ti** Because: Higher pressure in lungs by PEEP make it harder for air flow in/out of lungs; requiring a longer Ti time to achieve adequate ventilation

Question 50

Why ma you need to FiO2 when PEEP increases?

Answer 50

PEEP decreases amount of fraction of O2 delivered to pt, conversly the O2 reaching the alveoli. **[hypoxemia]** Solution: increase FiO2

Question 51

How can you increase Vt?

Answer 51

**1. Increase the respiratory rate**: -By increasing the number of breaths per minute, more air is delivered to the lungs over the course of a minute. **2. Increase the inspiratory flow rate**: -This can help deliver more air to the lungs in a shorter period of time, thereby increasing the tidal volume.

Question 52

When there is an increase in lung compliance, what does this mean for airway pressure/flow?

Answer 52

Lung are easier to inflate: meaning less pressure is required to achieve adequate ventilation.