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Ventilation Flashcards

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1
Q

What is the VC level of patients with neuromuscular disorders (e.g. Myasthenia Gravis) that indicates the need for mechanical ventilation?

A

10-15 cc/kg

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2
Q

True or false: mechanical ventilation can be a diagnostic tool

A

True

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3
Q

Normal spontaneous breathing is better at aerating what parts of the lung?

A

Posterior and inferior

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4
Q

What areas of the lung are commonly damaged with mechanical ventilation? Why?

A
  • Anterior/superior

- Where gas accumulates when supine

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5
Q

What is the MOA of the iron lung? What is the major issue with this?

A

Decreases pressure surrounding chest

No diaphragm movement

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6
Q

What are the three T’s for volumes and pressure targets?

A
  • Target volume/pressure
  • Trigger (signal to initiate the breath)
  • Termination
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7
Q

What are the two types of triggers for positive pressure ventilation?

A

Flow or pressure

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8
Q

What are mandatory breaths?

A

The guaranteed number of breaths that a ventilator will give no matter what

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9
Q

What is a controlled breath?

A

Breath initiated by the ventilator

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10
Q

What is an assisted breath?

A

Effort can initiate the breath, but ventilatory provides the pressure

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11
Q

What are the two characteristics of assisted breaths that the patient determines?

A

Initiation

Duration

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12
Q

The airway pressure is dependent on what two variables?

A

Ventilatory settings

Mechanics of lung and chest wall

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13
Q

What is the most common type of target for a ventilator?

A

Volume

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14
Q

What is the typical inspiratory flow rate?

A

30-80 L/min

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15
Q

What are the three patterns of delivery?

A
  • Square wave
  • Sine
  • decelerating/ramp pattern
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16
Q

Vt with a ventilatory is determined by what?

A

Inspiration pressure and time

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17
Q

True or false: Vt is variable, and not guaranteed. Why or why not?

A

True–changes in lung mechanics can have significant impacts

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18
Q

What is the most common mode used for a ventilator? What is involved with this mode?

A

Assist control mode

Breaths are assisted with a either a volume or pressure target

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19
Q

What are the four variables that determine the frequency of ventilations?

A
  • signals to initiate breaths
  • Mode of ventilation
  • Min set rate
  • pt effort
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20
Q

What are the disadvantages of assist control mode?

A
  • Respiratory Alkalosis

- Hyperinflation

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21
Q

How is VACV used as a diagnostic tool? (2)

A
  • If pressures needed to get a given volume in are high, it may point to a restrictive lung disease
  • If there is a large gap between park and plateau pressure, may point to bronchospasm
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22
Q

What is intermittent mandatory ventilation (IMV)?

A

Effort beyond set rate delivers spontaneous breath from a reservoir bag that contains gas with the same FiO2

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23
Q

What are the downsides of intermittent mandatory ventilation?

A
  • Uncomfortable

- Inferior for weaning patients

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24
Q

What is spontaneous ventilation (PSV)?

A

Initiation and duration of breath are patient determined

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25
What is the most comfortable mode for the alert patient?
PSV
26
What are the ways to improve oxygenation with a ventilator?
- Increase FiO2 | - Adjust airway pressure of the ventilator
27
What is PEEP? What is the use of this?
Positive end expiratory pressure Adding 5-20 cm H2O to keep alveoli open
28
What are the drawbacks to increased airway pressure? (3)
- Overdistention of the alveoli - Decreases venous return - Increased dead space from over distending functional alveoli
29
What determines the PCO2? What is the equation for this value?
Minute ventilation (=TVxRR)
30
What are the two variables of pressure control/assist?
RR | Pressure target
31
What are the two variables of volume cycled ventilation?
RR | TV
32
What is the optimal tidal volume for ARDS? Everyone else?
- ARDS = 4-6 cc/kg/IBW | - Everyone else= 6-8 cc/kg/IBW
33
What is the ideal body weight equation?
50 kg for 5 foot males 45 kg for 5 feet 2.3 kg for every inch above
34
Why are targeted tidal volumes important?
Prevent hyperinflation of the lung
35
What is the target of the plateau pressure?
Less than 30 cm H2O
36
What is the pH goal for ventilation?
Greater than 7.1
37
What is the TV goal for ventilation?
Less than 8 cc/kg/IBW
38
True or false: the longer someone is on the ventilator, the worse the survival
True
39
What are the three oxygen requirements for ventilator weaning (PEEP, FiO2, and PF values)?
- PEEP 5-8 cm H2O - FiO2 less than 50% - PF greater than 150
40
What is the cutoff for the rapid shallow breathing index for weaning?
f/VT less than 105
41
What fraction of extubations will fail?
1 in 5
42
Who usually fails extubation?
age greater than 65
43
What are the criteria for "difficult" extubation patient?
Fails 1-3 trials up to 7 days
44
What are the criteria for "prolonged" extubation patient?
Greater than 7 days
45
What is BiPAP?
Positive pressure through a mask
46
True or false: NIVs after extubation can help people get off of a ventilator
True
47
True or false AECOPD is appropriate for NIMV
True
48
True or false: comatose pts is appropriate for NIMV
False
49
True or false: Acute cardiogenic pulmonary edema is appropriate for NIMV
True
50
True or false: pts with excess secretions are appropriate for NIMV
False
51
True or false: pts with bleeding are appropriate for NIMV
False
52
True or false: pts with vomiting are appropriate for NIMV
False
53
True or false: pts with neuromuscular failure are appropriate for NIMV
True
54
True or false: pts with immunocompromised pneumonia are appropriate for NIMV
True
55
True or false: pts with hemodynamic instabilityare appropriate for NIMV
False
56
What are the benefits of NIV in AECOPD?
- Improves hospital mortality - Decreased LOS - Decreases risk of intubation
57
What is high flow nasal cannula oxygen?
Humidified air via NC
58
True or false: HFNCO is appropriate for shock
False
59
True or false: HFNCO is appropriate for hypercapnia
False
60
True or false: HFNCO is appropriate for Neuromuscular respiratory failure
False
61
True or false: HFNCO is appropriate for tachypnea
False
62
What are the three determinants of weaning off of a ventilator?
Pain Agitation Delirium
63
When is ECMO used?
-PaO2/FiO2 less than 150
64
What is the difference between ECMO and CBP?
- Closed chest cannulation - Less anticoag - Anesthetized, not sedated

Respiratory (34 decks)

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