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module 2 quiz Flashcards

1
Q

What are the main types of flow patterns?

A

Constant = square
Decelerating
Ascending
Sine

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2
Q

What is the equation for determining what FiO2 you should put a patient on who is receiving mechanical ventilation?

A

Desired FiO2 = Desired PaO2 x Known FiO2 / Known PaO2

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3
Q

What are the risks associated with high FiO2s?

A

Oxygen toxicity
Absorption atelectasis

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4
Q

Describe absorption atelectasis

A

Nitrogen is washed out of the alveoli by excess oxygen, oxygen dissolves into the blood resulting in a low partial pressure in the alveoli causing atelectasis

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5
Q

What is extrinsic PEEP?

A

Level of PEEP set on the ventilator

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6
Q

What is intrinsic PEEP?

A

Amount of pressure in the lungs at the end of exhalation

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7
Q

What is total PEEP?

A

Extrinsic PEEP + Intrinsic PEEP

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8
Q

A pulse oximeter reading of 90% indicates a PaO2 of what?

A

At least 60 mmHg

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8
Q

What are the functions of PEEP?

A

maintain/restore FRC
Enhance tissue oxygenation
Recruit alveoli and maintain them in an aerated state

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9
Q

What is the minimum level of PEEP set on most patients?

A

2-6 cm H2O
PEEP usually set to 5

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10
Q

When is PEEP considered therapeutic?

A

When it is greater than 5 cm H2O

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11
Q

When considering patient oxygenation, when should you increase FiO2 and when should you increase PEEP?

A

Patient with a low PaO2 on less than 60% = increase FiO2
Patient with a low PaO2 on more than 60% = PEEP

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12
Q

When performing a vent check, what should you check on the vent and in the room as part of the routine check?

A

Alarm settings
External alarm connection
Air and oxygen connections
Power supply
Resuscitation bag and mask
Suction
ETT secure

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12
Q

What are the two options for humidifying air on a ventilator?

A

Heat moisture exchangers
Heated humidifiers

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13
Q

What is a normal range for triggering a breath using pressure on a ventilator?

A

-0.5 to -2.0 cm H2O

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14
Q

How is a breath triggered with flow?

A

Ventilator has bias flow which is the amount of flow available in the circuit and can recognize when there is an absence of flow due to patient effort

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15
Q

What is auto PEEP and when does it occur?

A

Auto PEEP is air trapping
Occurs in patients with a prolonged expiratory phase

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15
Q

What effect can a leak in the circuit have?

A

A leak in the circuit will cause a pressure change which can result in false or auto triggering of breaths

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16
Q

What issues can auto PEEP create?

A

Will make triggering a breath more difficult for the patient

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17
Q

Where is rise time found?

A

Only found in pressure breaths
PCV
CSV
PRVC
BiPAP

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17
Q

What is rise time?

A

The time in which airway pressure builds to the maximum pressure value set

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18
Q

What are the benefits of a longer Itime?

A

Larger tidal volume
More lung recruitment
Increased mean airway pressure

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19
Q

What are the cons for longer Itime?

A

Shorter time for exhalation can lead to air trapping
Not comfortable for patient

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20
Q

What is the relationship between flow and Itime?

A

Faster the flow = shorter the Itime
Slower the flow = longer the Itime

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21
What is a closed loop mode?
Vent takes information it receives from the patients and alters how it delivers the breath
21
What factors can affect PIP?
Itime Tidal volume Flow Compliance and resistance of patient lungs
22
What is an open loop mode?
Mode delivers a breath based on the information entered by the RT and does not respond to input from the patient
23
Define a set point targeting scheme
RT instructs the ventilator to deliver a certain breath, the vent delivers a breath as it was instructed
24
What are examples of modes with set point targeting schemes?
PC-CMV AC-CMV
25
Define an adaptive targeting scheme
The delivered breath is monitored and the delivery of the next breath will be influenced by the previous breath
26
Define an optimal targeting scheme
Uses an algorithm to determine the best way to deliver breaths based off the patient
27
What are examples of modes with adaptive targeting schemes?
PRVC
28
What are the disadvantages of setpoint targeting?
High PIPs Low tidal volumes Vigilant monitoring with lots of adjustments
28
What are the clinical advantages of adaptive targeting?
Patient comfort Fewer adjustments
29
What are the clinical advantages or PC-CMV and AC-CMV?
Guaranteed volumes Guaranteed pressures
30
What are the clinical disadvantages of PRVC?
Works against and inappropriately chosen patient
31
What are the clinical disadvantages of PC-CMV and AC-CMV?
High PIPS Low tidal volumes Lots of monitoring and adjustment
32
What are the clinical advantages of adaptive PRVC?
Patient comfort Few adjustments
33
What are the settings for VC-MMV?
Vt RR PEEP FiO2 Itime PS Flow cycle sensitivity
34
What does the operator set on VC-MMV?
Operator sets a CMV volume and rate to meet a target minute ventilation
35
Which manufacturer uses VC-MMV?
Drager
36
If a patient triggers a breath on VC-MMV what will the mode do?
Deliver a pressure support breath according to the set level of pressure support
36
How are breaths delivered on VC-MMV?
If the patient meets the minimum minute ventilation target, all breaths will be spontaneous If the patient does not meet the minimum minute ventilation target, mandatory breaths will be given
37
What are the targets set for VC-MMV?
Primary = Volume Secondary = pressure
37
T/F: Mandatory breaths are not synchronized with patient effort in VC-MMV
False. In VC-MMV mandatory breaths are synchronized with patient effort
38
Describe a situation where VC-MMV would be appropriate to use
A patient is sedated and paralyzed. At first the patient is giving no effort because of paralyzation and the vent delivers completely mandatory breaths to meet the set minimum minute ventilation set. As the paralytic wears off, the patient will begin to give spontaneous efforts that will be pressure supported, but not enough to meet MMV so mandatory breaths will continue to be delivered in addition to spontaneously triggered breaths. When the paralytic completely wears off, the patient will be able to trigger and breath more independently resulting in mandatory breaths being reduced as spontaneous supported breaths take over
39
What does automode do?
Provides seamless shifting back and forth between mandatory and spontaneous breaths in response to patient conditions
39
What is automode found on?
Getinge
40
How is automode dissimilar to MMV?
It doesnt target a MV
41
How is automode dissimilar to IMV?
Automode drops mandatory breaths
42
What kind of breaths does automode deliver?
Mandatory and spontaneous
43
How does automode determine whether or not to deliver a mandatory or spontaneous breath?
If the patient is triggering breath at a rate greater than the set rate, all breaths will be spontaneous If the patient is triggering breaths at a rate less than the set rate, some breaths will be spontaneous, others will be mandatory
44
What is ASV found on? What does it mean?
Hamilton vents Adaptive support ventilation
45
How does ASV achieve its target?
ASV achieves it target minute ventilation by using an algorithm to tritrate rate and tidal volume to meet minute ventilation target
45
What is the target of ASV?
Minute ventilation
46
T/F: In ASV, the operator sets the pressure control level
False.
47
T/F: In ASV, the operator does not set the pressure support level
True
48
What default does ASV target for minute ventilation?
100 mL/Kg of IBW Example, 70 kg patient would get 7.0 L/m as MV target
49
What is a safety frame in an ASV mode?
A safety frame defines acceptable combinations of rate and volume
50
How does the vent decide what kind of breath to deliver in ASV?
Patient effort = pressure supported breath Responds to low minute ventilation with mandatory pressure controlled breaths
51
What factors does the ASV algorithm determine?
Determines mandatory rate Determines pressure to achieve Vt Determines inspiratory time Determines start up breath pattern
52
what is the “A” variable on the safety frame in ASV?
Pressure
53
What are the ordered settings for ASV?
Ideal body weigh % minute ventilation PEEP FiO2 Pramp ETS Patient trigger
54
What are the axes present on the ASV graph?
Y axis = volume X axis = RR
55
What are the clinical advantages of optimal targeting?
Is a very comfortable mode for the patient Can potentially be used from intubation to extubation Adapts to changing conditions
56
What pieces of information are related by the safety frame on the ASV graph?
A = pressure B = tidal volume C = frequency D = low rate
57
What types of patients would not be a good fit for ASV?
Patients with restrictive lung diseases Patients in hypercapnic respiratory failure since rates cant be adjusted manually Post cardiothoracic surgery patients
58
How does volume support provide only spontaneous breaths yet reach set tidal volume?
Volume support acts like PRVC in that it provides a titrated pressure support in order to reach a goal tidal volume
59
What is automatic tubing compensation?
A setting that allows you to increase inspiratory pressure to overcome the resistance of an artificial airway
60
How does an operator set up automatic tubing compensation?
Find setting Enter tubing type, diameter, and length of airway
61
What support does automatic tubing compensation offer to a patient who is spontaneously breathing with no other support?
Helps patient overcome airway resistance provided by the artificial airway Theres not really any good evidence that it helps and just adds to complicating the targeting scheme
62
What are the steps smartcare and intellivent use to move the patient throught the weaning process?
Stabilize Wean Challenge
62
Describe the AI ventilation used by dragers smart care and hamiltons intellivent
Essentially offers automated patient weaning by using AI to determine the acceptable ranges of frequency of spontaneous breathing, tidal volume, EtCO2 Titrates pressure support to keep patient in an acceptable zone
63
What concerns do clinicians have regarding smartcare and intellivent?
Relies on SpO2 and EtCO2 which can be spotty at best with their accuracy due to patient movement or medications the patient may be on such as blood pressure medication
64
What is the formula for dynamic compliance?
Cdyn = VT / PIP-PEEP
65
What is the formula for static compliance?
Cstat = VT / PIP-Plat
66
What is the formula for airway resistance?
Raw = PIP-Plat / Flow (Liters per second)
67
What factors can affect a patients PaO2 when they are being mechanically ventilated?
FiO2 MAP Lung Function I:E time PEEP
68
What factors affect mean airway pressure
PIP PEEP I:E ratio RR
69
What is normal airway resistance in non-intubated healthy people?
0.6-2.4 cmH2O/L/sec
70
What is normal airway resistance in healthy intubated people?
5-12 cmH2O/L/sec
71
T/F: Airway obstructions can lead to autoPEEP
True
72
What are the main causes of autoPEEP?
Obstructive diseases Bad vent settings
73

Vent Support + Lab (5 decks)

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