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Anesthesia Technology > Module 5 Ventilation Circuits > Flashcards

Module 5 Ventilation Circuits Flashcards

1
Q

Mechanical Ventilation Requirements Depend On:

A
  1. Type of Surgery 2. Length of Surgery 3. Patient Position 4. ASA Status
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2
Q

Driving Mechanism of Ventilator

A

02 or pressurized air

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3
Q

Piston-Driven Ventilators use _____ Motors and have no ______

A

Electric Motor, No driving gas

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4
Q

Piston-Driven Ventilator positive pressure relief valve opens at

A

Pressure reaches 75+/- 5 cm H2O the positive relief valve opens

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5
Q

Piston-Driven Ventilator negative relief valve opens at

A

If the pressure within the piston declines to - 8 cm H2O, the negative relief valve opens & room air is drawn into the piston

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6
Q

The negative relief valve in piston-driven ventilators protects patients from

A

Protects pt from Negative End Expiratory Pressure (NEEP)

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7
Q

How the anesthetist guards against vent disconnects/ What changes will be noted on disconnect

A

Pressure Changes
Capnography waveforms
Movement of manual breathing bag

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8
Q

In the event of a oxygen pipeline failure. Will the Piston-ventilator continue to work?
(Clinical Pearl)

A

Yes, the driving force of piston-ventilators is electric, NOT gas driven

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9
Q

Advantages of Piston Ventilators

A 
Quiet
No PEEP
Precise TV
Electricity Driving force
Capable of all ventilation modes
Manual bag remain in the breathing circuit during mechanical ventilation
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10
Q

Negatives of Piston Ventilators

A

Lack of visible standing bellows
Harder to hear is regular cycle
Potential for NEEP
+/- Relief valve

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11
Q

Vent high airways pressure alarm causes

A 
Tube in right main bronchus 
Bronchospasm
Mucus plug
Pneumothorax 
Air trapping
Pt. cough, biting tube 
Pt./Vent Dyssynchrony 
High peep
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12
Q

Vent low airway pressure alarm causes

A 
ETT cuff deflation
Esophageal intubation 
TV set too low
Chest wounds/drains allowing air to escape
Disconnect from vent circuit
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13
Q

Safety feature of modern ventilator equipment

Clinical pearl

A

Apnea (disconnect) alarms are enabled with the first breath sensed

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14
Q

Fixed Alarms

A

Disconnection

02 sensor

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15
Q

Set Alarms

A

Volume
Pressure
Rate
Apnea

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16
Q

Apnea/Disconnect alarm is based on:

A

Chemical monitoring (lack of ETCO2)

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17
Q

Tidal Volume settings are according to ____ ideal body weight

A

A setting of 4-8 mL/kg of Ideal Body Weight is considered a safe place to start

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18
Q

Fi02 settings are adjusted to produce a minimum of:

A

SPO2 >90 %
PaO2 > 60 mm Hg
** Airway fires <30%

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19
Q

Normal I:E ratio

A

1:2

Means expiration time twice that of inspiration

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20
Q

Increasing I:E ratio to 1:3 or 1:4 is used in the presence of what disease process

A

Increase E to 1:3 or 1:4 in presence of obstructive airway dz. in order to prevent air trapping- cause auto PEEP-I

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21
Q

Describe Inverse Ratio Ventilation (IRV) and how it applied used in ARDS disease process

A 
ARDS 
Goal is to improve oxygenation
Forced inspiratory time to be greater than expiration time 
Creates auto peep
2:1, 3:1, 4:1
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22
Q

Functions of PEEP

A

Reduces risk of atelectasis
Increase # of open alveoli
Decrease V/Q mismatch

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23
Q

Why do we need PEEP

A

Alveoli recruitment

**Placement of ET tube opens the epiglottis and knocks out physiologic PEEP-5 cm H2O recommended

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24
Q

Physiological PEEP

A

Physiological PEEP (3-5 cm H2O) preserves FRC in normal lungs

25
PEEP works by
Increasing end expired lung volume & reducing airspace closure at the end of expiration. (Maintains alveoli open/promotes gas exchange)
26
Trigger window is only seen what ventilator mode
Synchronized Intermittent Mandatory Ventilation (SIMV)
27
The trigger window controls
the % of time during expiration that the ventilator is sensitive to the patients diaphragm
28
Sensitivity of trigger window controls
how much negative pressure the patient needs to generate before a breath is triggered
29
Volume Control Ventilation (VCV) is most common and has what features
Volume limited Time cycled Constant flow
30
Piston Ventilator delivers exact ____ in comparison to VCV
Tidal volumes
31
Under what vent mode is PIP uncontrolled and vary according to patients compliance and airway resistance (Clinical Pearl)
Volume Control Ventilation
32
PIP is the highest level of pressure applied to the lungs during inhalation and is recommended to be
< 35 cm H2O ( decrease barotrauma)
33
Peak Airway Pressure:
Total pressure needed to deliver the tidal volume. It depends on airway resistance, lung compliance, and chest wall factors
34
Plateau Pressure:
Pressure required to overcome tissue resistance & inflated alveoli *Measurement of lung stiffness
35
Resistive Pressure:
The difference between Peak & plateau pressure is the resistive pressure Elevated resistive pressure > 10 cm H2O
36
High PEEP >10 results in what hemodynamic effects | Clinical Pearl
Increase intrathoracic pressure | Decrease venous return & impair CO
37
Why do mechanical ventilation benefit from the application of PEEP at 5 cm H2O? (Clinical Pearl)
To replace physiological peep
38
Pressure Control Ventilation (PCV):
Inspiratory pressure is controlled rather than volume
39
PCV considerations
Target pressure is adjusted for the desired TV may result in increased TV at a lower PIP Pt. with low compliance PCV provides greater TV
40
PCV standard settings
PCV 20 cm H2O RR 6-12 I:E ratio 1:2 PEEP-may be O
41
During PCV in a laparoscopic case if pulmonary compliance improves (release of pneumoperitoneum) TV may increase substantially. What does the anesthetist do? (Clinical Pearl)
Change mode to pressure control volume guaranteed
42
If airway resistant increase during PCV delivered VT will decrease substantially. What can cause this? (clinical Pearl)
Bronchospasm | Kinked endotracheal tube
43
PCV uses in clinical setting:
``` Pregnancy Laparoscopic surgery Morbid obesity ARDS One-lung ventilation ```
44
Pressure Control Ventilation-Volume Guarantee:
Adjust pressure limits to prevent significant variation in delivered VT
45
One of 3 modes that supports spontaneous breathing. Utilizes trigger window
SIMV | Intermittent mandatory breaths are delivered in synchrony with and triggered by the patients spontaneous efforts
46
SIMV-PSV
Pressure support may be added to assist the patient with any spontaneous breaths
47
Supports spontaneous breathing and protects patient.
PSV-PRO after 10-30 seconds of apnea adjustable, the mode will revert to PCV or SIMV, In newer machines, if the patient begins breathing again in backup mode the ventilator will switch back to PSV-PRO
48
Trigger Window:
Controls the amount of time during each expiratory cycle that the ventilator is sensitive to negative pressure generated by diaphragm
49
SIMV mirrors setting of which other modes
VCV or PCV
50
Support Spontaneous respirations | Clinical pearl
PSV, SIMV, & (bag) valuable in supporting the patient with spontaneous respirations
51
Vent mode with RR of 0 and responds to patients effort
PSV is like PCV in that it is a pressure-targeted ventilation mode- but with a RR of zero PSV is useful to augment the VT of spontaneously ventilating patient during maintenance or emergence Adults start at 10 cm H2O
52
Goldilocks Principle and PSV
“Not to low” “Not to high” “Just Right” Normal WOB
53
If ventilation using PP > 20 torr the stomach may become inflated…Lead to ? (Clinical Pearl)
Aspiration
54
When a change in the patient’s condition is noticed what should you do? (Clinical Pearl)
Think back to the last alteration made to the equipment and determine whether it might have contributed to the change
55
Frequently encountered in ARDS but can occur in any patient receiving mechanical ventilation
Barotrauma
56
Barotrauma is associated with?
high peak inspiratory pressure > 40 cm H2O & plateau pressures > 35
57
02 Flush valve use during inspiration can lead to:
Barotrauma
58
Ventilator relief valve may stick closed and lead to:
Barotrauma

Anesthesia Technology (10 decks)

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