Modes of Ventilation

Question 1

Difference between BiPaP and CPAP

Answer 1

Question 2

Indications for CPAP

Answer 2

patients without resp failure

*sleep apnea

Question 3

Indications for Bipap

Answer 3

Patients with impending or existing respiratory failure

*bridge to mv

Question 4

What does IPAP improve?

Answer 4

• improve tidal volume
  
  • thus decreasing CO2

Question 5

What does EPAP improve?

Answer 5

• improve FRC
• Helps recruit more alveoli thus increasing O2,may reduce work of breathing associated with autopeep

Question 6

Indications for N/V

Answer 6

• Restrictive disease
  
  • Pregnancy
  • Neuromuscular disease
  • Obesity
• Obstructive Disease
  
  • COPD

Question 7

N/V not indicated

Answer 7

• Asthma
• Pneumonia

Question 8

N/V SETUP/ SETTINGS

CHART

Answer 8

Question 9

I:E ratio

COPD

Answer 9

1:2 TO 1:3

Question 10

I:E RATIO

OHS, NM & CWD

Answer 10

1:1

Question 11

INSPIRATORY VOLUME

COPD

OHS, NM, & CWD

Answer 11

COPD: 0.8 - 1.2s

OHS, NM, & CWD: 1.2 - 1.5S

Question 12

Four phases of the ventilatory cycle

Answer 12

• Inspiration
• Inspiration to expiration
• Expiration
• Expiration to inspiration

Question 13

Trigger

Answer 13

FLOW VS PRESSURE

Question 14

LIMIT

Answer 14

Determines the size of the breath

* normally associated with volume-controlled ventilation

Question 15

CYCLE

Answer 15

Determines what actually ends the breath

Question 16

PSV

Answer 16

FLOW IS CYCLE

Question 17

VCV and PCV

Answer 17

TIME IS CYCLE

Question 18

PCV

Answer 18

• less barotrauma
• esp. with pediatrics

Question 19

Volume cycled; volume-controlled

Answer 19

• preset volume
• DOES NOT ELIMINATE THE WORK OF BREATHING

Question 20

Assist- Control Ventilation

Answer 20

• if not breathing go to CMV
• if breathing too rapidly go to SIMV

Question 21

What is this?

Answer 21

assisted breath

Question 22

What does SIMV allow a patient to do?

Answer 22

Dr. Massie often put LMA with PS

if they are not breathing after the induction meds she puts her patient on SIMV OR PC

one they go above that pressure she changes them

• BETTER THAN CMV

Question 23

How is the patient’s compliance tested?

Answer 23

most sensitive is when we bag the patient

Question 24

if lung compliance is lower what happens to pressure?

Answer 24

compliance is lower = higher pressure

Question 25

Change in Pressure/change in volume =

Answer 25

compliance

Question 26

What is compliance?

Answer 26

**measure of distensibility**

Question 27

how is compliance expressed?

Answer 27

change in volume for given change in pressure Vt (Paw-Peep)

Question 28

What is **normal compliance**? What is **compliance in ARDS**?

Answer 28

## Footnote **70 - 100 ml/cm H20** **\<40-50 ml/cm H2O**

Question 29

## Footnote **What is FeO2?**

Answer 29

what the patient is expiring and it should equilibrate with your FiO2 \* we are always trying to reach equilibrium

Question 30

What is normal lung compliance?

Answer 30

**5-7 ml/kg** with IBW

Question 31

If your patient is **obese** what will be your TV?

Answer 31

**lowered end of 5-7 ml/kg** so ill use the 5 ml because of abnormal lung compliance (ARDS pulmonarycontusion)

Question 32

**what is the normal MV?**

Answer 32

**5-10 L/ M** MV= TV\*RR

Question 33

**SENSITIVY SLIDE**

Answer 33

also known as trigger and percent trigger

Question 34

Inspiratory flow rate is.. what causes barotrauma?

Answer 34

* **NOT GAS FLOW** * \>75

Question 35

Why do we add **PEEP?**

Answer 35

**GOAL:** To reach the best arterial oxygenation with the least decrease in cardiac output and maintenance of acceptable airway pressure

Question 36

How do we **assess PEEP?**

Answer 36

we are looking for **OPTIMAL PEEP** - point of maximal alveolar recruitment (MAR) * Increase PEEP to point of lung inflation at which compliance decreases * observe airway pressure with each increase in PEEP * PIP should rise only by the amount of PEEP dialed in; when **PIP rises more than PEEP, alveoli overdistended and point of MAR exceeded**

Question 37

What are **SE of PEEP?**

Answer 37

* Barotrauma * Decrease in CO * Incorrect filling pressures * If PEEP applied subtract 1/2 of the PEEP over 5 from PCWP

Question 39

How to increase **MEAN ARTERIAL PRESSURE?**

Answer 39

1. Increase **respiratory flow rate** 2. Increase **peak inspiratory pressure** 3. Increase in **inspiratory time** 4. Increase in **PEEP**

Question 40

**Pressure Support Ventilation** slide\*

Answer 40

Question 41

Pressure- Controlled/ Limited Ventilation

Answer 41

* If you have gradually increasing Peak Inspiratory Flow switch to Pressure Controlled to see how it will decrease it * Dr. Massie use this on her LMA * good for neonatal * good for **NMD with normal lungs**