output waveform and monitoring

Question 1

What are the Maneuvers of evita

Answer 1

• “Special Procedures”
• Occlusion Pressure P 0.1
• Rapid Shallow Breathing Index (RSB)
• Negative Inspiratory Force (NIF)
• Intrinsic PEEP

Question 2

What is occlusion pressure P0.1

Answer 2

• Negative mouth pressure after 0.1 seconds
• -> Indicative of drive to breathe
• ->a measurement of diaphragmatic strength

**the inspiratory valve is closed after 1 expiration and measures airway pressure produced by patient’s inspiratory effort during 100ms

Question 3

What is the normal and abnormal occlusion pressure ?

Answer 3

normal: 0 to -2 cmh2o
too high: towards -6 cmH20
–>huge drive can only be maintained for a period of time
–>indicate distress

too low: respiratory muscle fatigue

Question 4

When is occlusion pressure used?

Answer 4

for patient just started weaning

Question 5

How does occlusion pressure work?

Answer 5

exhalation valve is closed during patient inspiratory effort

Question 6

What is the Rapid Shallow Breathing Index

Answer 6

the quotient
of spontaneous respiratory rate and tidal volume

more reliable measurements of weaning status

Question 7

What is the formula of RBSI

Answer 7

Fspn per min over Vt(in liter)

Question 8

What is the implication of low RBSI

Answer 8

lower the RSBi index for a patient with spontaneous
breathing, the more probably he or she can
be weaned successfully

–>that patients who can
be weaned successfully tend to have a lower spontaneous
respiratory rate and a higher tidal volume
than those who are not yet ready to be weaned.

Question 9

What is the criteria of low RSBI

Answer 9

<105
means lower RR and higher Vt
> 105 not likely to wean

Question 10

Which mode can RSBI be used

Answer 10

spontaneous mode

Question 11

What is the NIF

Answer 11

negative inspiratory force after exhaling

aka MIP

Question 12

how is NIF performed

Answer 12

• performed from RV after manually extended exhalation
• no flow during maneuver, max of 15 seconds
• some alarms will be turn off until maneuver is completed
• not allowed to be performed in neonate and NIV

Question 13

What are the 2 possible outcomes of NIF

Answer 13

< -30 cmH2O high probability of an effective cough

> -20 cmH2O unlikely

Question 14

What is occlusion pressure P0.1

Answer 14

• Negative mouth pressure after 0.1 seconds
• -> Indicative of drive to breathe
• ->a measurement of diaphragmatic strength

**the inspiratory valve is closed after 1 expiration and measures airway pressure produced by patient’s inspiratory effort during 100ms

Question 15

What is the normal and abnormal occlusion pressure ?

Answer 15

normal: 0 to -2 cmh2o
too high: towards -6 cmH20
–>huge drive can only be maintained for a period of time
–>indicate distress

too low: respiratory muscle fatigue

Question 16

When is occlusion pressure used?

Answer 16

for patient just started weaning

Question 17

How does occlusion pressure work?

Answer 17

exhalation valve is closed during patient inspiratory effort

Question 18

What is the Rapid Shallow Breathing Index

Answer 18

the quotient
of spontaneous respiratory rate and tidal volume

more reliable measurements of weaning status

Question 19

What is the formula of RBSI

Answer 19

Fspn per min over Vt(in liter)

Question 20

What is the implication of low RBSI

Answer 20

lower the RSBi index for a patient with spontaneous
breathing, the more probably he or she can
be weaned successfully

–>that patients who can
be weaned successfully tend to have a lower spontaneous
respiratory rate and a higher tidal volume
than those who are not yet ready to be weaned.

Question 21

What is the criteria of low RSBI

Answer 21

<105
means lower RR and higher Vt
> 105 not likely to wean

Question 22

Which mode can RSBI be used

Answer 22

spontaneous mode

Question 23

What is the NIF

Answer 23

negative inspiratory force after exhaling

aka MIP

Question 24

how is NIF performed

Answer 24

• performed from RV after manually extended exhalation
• no flow during maneuver, max of 15 seconds
• some alarms will be turn off until maneuver is completed
• not allowed to be performed in neonate and NIV

Question 25

How does intrinsic peep work?

Answer 25

phase 1: - Ventilator implements a pause at PEEP (exp hold) -Pressure equalizes and any intrinsic PEEP is reflected by an elevated baseline phase 2 Once pressure stabilizes, the expiratory valve opens Expiratory flow is measured

Question 26

What is a low flow PV Loop?

Answer 26

Slowly fills lung with low, constant flow | - look at compliance and optimal peep

Question 27

What is the risk when using PV loop?

Answer 27

high risk for air leak and cardiovascular compromise

Question 28

What is the contraindication of PV loop?

Answer 28

not for spontaneous breathing patients

Question 29

What are the PB840 waveform characterisitcs

Answer 29

``` Pressure-time Flow-time Volume-time ***Only two at one time ***are drawn on the screen at the start of a breath, beginning with the last ½ second of the previous breath ```

Question 30

What are PB840 loops?

Answer 30

Pcari : crainal pressure -->estimate of carinal pressure when TC and shadow trace active Plung: lung pressure -->when PA and shadow trace active

Question 31

what are the respiratory mechanics in PB840?

Answer 31

``` Negative Inspiratory Force (NIF) Occlusion pressure (P 0.1) Vital Capacity (VC) ```

Question 32

In what mode is respiratory mechanics is not available?

Answer 32

Bilevel mode

Question 33

What alarms are cancelled when respiratory mechanics are engaged?

Answer 33

P peak alarm, P vent alarm, high tidal volume spontaneous and mandatory

Question 34

What are the manual events

Answer 34

Suctioning, ABG, circuit change, weaning trial

Question 35

What are the loops of avea?

Answer 35

``` Flow – Vt Paw – Vt Pinsp – Vt PTR – Vt* : P tracheal PES – Vt** : P esophageal -->require esophageal catheter PTp – Vt ** : P Transpulmonary -->This requires the use of an optional esophageal catheter and is active for adult and pediatric patients only. ```

Question 36

What is the esophagea ballon test?

Answer 36

esophageal balloon can be placed to measure pressures in the thorax

Question 37

What is the balloon test

Answer 37

verifies the integrity and size of the balloon catheter. The ventilator will display a Pass or Fail message in the message bar at the bottom of the screen. The Balloon Test must be performed without the balloon in the patient

Question 38

What is the the precaution when using esophageal ballon?

Answer 38

Do Not inflate the balloon until after it has been placed in the patient. The balloon should be evacuated prior to removal from patient.

Question 39

What happen when the ballon start to fill

Answer 39

, the ventilator delivers the volume specified below into thecatheter before esophageal pressure measurement commences. Adult Catheter: 0.5 to 2.5 mL Pediatric Catheter: 0.5 to 1.25 mL

Question 40

what alarms are inactive during the MIP manuevr?

Answer 40

Apnea Interval and | Low PEEP.

Question 41

What happens when the inflection point maneuvr is started?

Answer 41

Normal ventilation shall be suspended for the duration of the maneuver. The maneuver will be aborted if a patient effort is detected

Question 42

What waveform is used for infleciton point

Answer 42

square

Question 43

What is the purpose of a pflex maneuver

Answer 43

allows the clinician to determine opening pressures of the lung during a slow flow volume controlled breath. Because this maneuver is performed at a slow inspiratory flow rate the effects of respiratory system resistance are minimized.