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Flashcards in Ventilation Deck (64):
1

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

10-15 cc/kg

2

True or false: mechanical ventilation can be a diagnostic tool

True

3

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

Posterior and inferior

4

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

-Anterior/superior
-Where gas accumulates when supine

5

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

Decreases pressure surrounding chest

No diaphragm movement

6

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

-Target volume/pressure
-Trigger (signal to initiate the breath)
-Termination

7

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

Flow or pressure

8

What are mandatory breaths?

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

9

What is a controlled breath?

Breath initiated by the ventilator

10

What is an assisted breath?

Effort can initiate the breath, but ventilatory provides the pressure

11

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

Initiation
Duration

12

The airway pressure is dependent on what two variables?

Ventilatory settings
Mechanics of lung and chest wall

13

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

Volume

14

What is the typical inspiratory flow rate?

30-80 L/min

15

What are the three patterns of delivery?

-Square wave
-Sine
-decelerating/ramp pattern

16

Vt with a ventilatory is determined by what?

Inspiration pressure and time

17

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

True--changes in lung mechanics can have significant impacts

18

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

Assist control mode

Breaths are assisted with a either a volume or pressure target

19

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

-signals to initiate breaths
-Mode of ventilation
-Min set rate
-pt effort

20

What are the disadvantages of assist control mode?

-Respiratory Alkalosis
-Hyperinflation

21

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

-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

22

What is intermittent mandatory ventilation (IMV)?

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

23

What are the downsides of intermittent mandatory ventilation?

-Uncomfortable
-Inferior for weaning patients

24

What is spontaneous ventilation (PSV)?

Initiation and duration of breath are patient determined

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