Ventilator Management Flashcards Preview

CCP-C/FP-C Certification Review > Ventilator Management > Flashcards

Flashcards in Ventilator Management Deck (47):
1

Tidal Volume (Vt)

How much air the patient breathes in a normal breath.

(Excessive Vt can cause ventilator-induced lung injury)

2

Inspiratory Reserve Volume (IRV)

The amount of air that can be forcefully inhaled in addition to a normal tidal volume breath

3

Expiratory Reserve Volume (ERV)

The amount of air that can be forcefully exhaled after a normal tidal volume breath.

4

Vital Capacity (VC)

Vt + IRV + ERV

5

Residual Volume (RV)

The amount of air left in the respiratory tract following forceful exhalation.

6

Total Lung Capacity (TLC)

IRV + Vt + ERV + RV

7

Dead Space

The surfaces of the airway that are not involved in gas exchange

Dead Space = 2mL/kg

8

Central Chemoreceptors

Located in the medulla/pons

Driven by CO2 and H+ levels

9

Peripheral Chemoreceptors

Located in the aortic arch/carotid bodies

Response is driven by O2, CO2 and H+

10

Fick Formula

Used to tell how much O2 a person is using.  Cardiac ouput measurement based on the principle that oxygen uptake by the lungs equals oxygen delivery.

11

V/Q Scan

Nuclear medicine study used to evaluate circulation of air and blood within the lungs to determine the V/Q ratio.

12

Hypercarbic Respiratory Failure

Inability to remove CO2

Indicated By - Respiratory Acidosis

Treatment - Increased Vt then rate

13

Hypoxic Respiratory Failure

Inability to Diffuse CO2

Indication - Low PaO2

Treatment - Increased Vt, O2 concentration, then rate

14

Apneustic Breathing

Abnormal breathing pattern characterized by a deep, gasping inspiration with a pause at full inspiration, followed by a brief, insufficient release.

(Associated with decerebrate posturing)

15

Ataxic Respirations

Abnormal pattern of breathing characterized by compolete irregularity of breating, with irregular pauses and increasing periods of apnea.

(Caused by damage to the medulla)

16

Biots Breathing

Abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.

17

Cheyne-Stokes Respirations

Progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in temporary apnea.

(Brainstem herniation, decorticate posturing)

18

Kussmaul's Respirations

Respirations gradually become deep, labored and gasping.  Associated with DKA.

19

Controlled

The patient's breathing rate (F) and tidal volume (Vt) is controlled completely.

20

Intermittent

The patient can take intermittent breaths (between the controlled breaths).

21

Synchronized

The ventilator synchronizes delivery of breath with the patient's inspiratory drive.

22

Assist

The ventilator assists the patient with their breathing (must have intact respiratory drive).

23

Ventilator Acquired Pneumonia (VAP)

#1 cause of iatrogenic death in the US

24

Curare Cleft

Tick marks seen on capnography, patient is choking.  Check ETT.  Patient needs to be resedated and reparalyzed.

25

Tidal Volume (Vt) Setting

6-8mL/kg

26

F (Rate)

8-20 breaths/min

27

Minute Volume (Ve)

F x Vt (4-8 L/min)

28

Inspiratory: Expiratory Ratio (I:E)

1:2

29

Fraction of Inspired Oxygen (FiO2)

0.21-1.0

30

Plateau Pressure (Pplat)

< 30 - respresents the static ensd inspiratory recoil pressure of the respiratory system, lung and chest wall respectively.

31

Positive End Expiratory Pressure (PEEP)

Keeps alveoli so that oxygen can diffuse, prevents atalectasis.

32

Peak Expiratory Flow Rate (PEFR)

500 to 700 L/min for males, 380 to 500 L/min for females.

A person's maximum speed of expiration, as measured with a peak flow meter.

33

Controlled Mandatory Ventilation (CMV)

  • Used in sedated, apneic or paralyzed patients
  • All breaths are triggered, limited, and cycled by the ventilator
  • Patient has no ability to initiate own breaths

34

Synchronized Intermittent Mandatory Ventilation (SIMV)

  • Assisted mechanical ventilation synchornized with the patient's breathing
  • Ventilator senses the patient taking a breath, then delivers a breath.
  • Spontaneous breathing by the patient occurs between the assisted breaths which occur at preset intervals
  • Preferred in patients with an intact respiratory drive

35

Assist-Control Ventilation (AC)

  • The trigger for delivery of a breath can be either the patient or elapsed time
  • Ventilator supports every breath, whether it's initiated by the patient or the ventilator
  • Used in ARDS, paralyzed or sedated patients
  • Anxious Patient - can breath-stack/auto-PEEP - Can cause VILI

36

Pressure Support Ventilation (PSV)

  • Makes it easier for the patient to overcome the resistance of the ETT and is used during weaning
  • Reduces work of breathing
  • Patient determines tidal volumes, rate (minute volume)
  • Requires consistent ventilatory effort by the patient

37

CPAP/BIPAP

Similar to SIMV because they are all spontaneously triggered by the patient

38

CPAP

The use of continuous positive pressure to maintain a continuous level of PEEP.  Mild air pressure to keep an airway open.

39

BiPAP

Uses alternating levels of PEEP to maintain oxygenation, commonly used in pneumonia, COPD, asthma, etc.

40

Low Pressure Alarm Causes

  • Patient disconnection from machine
  • Chest tube leaks
  • Circuit Leak
  • Airway Leak
  • Hypovolemia

41

High Pressure Alarm Causes

  • Kinked Line
  • Coughing
  • Secretions
  • Patient biting the tube
  • Reduced lung compliance
  • Increased Airway Resistance

42

DOPE Mnemonic

Displacement

Obstruction

Pneumothorax

Equipment

43

"Blue Bloaters"

COPD patients with chornic bronchitis

44

"Pink Puffers"

COPD patients with emphysema.  Color is pink due to polycythemia vera.

45

COPD CXR Findings

Flattened diaphragm, chest cavity is over expanded due to air trapping.

46

Pneumonia

  • Often viral, sometimes bacterial
  • CXR shows pleural effusions, lobar consolidation
  • Right middle lobe pneumonia is most common site

47

ARDS

Acute Respiratory Distress Syndrome

  • CXR - ground glass appearance, patchy infiltrates, bilateral diffuse infiltrates
  • Swann-Ganz - increased PAWP (high pressure because right heart is pumping against increased pressure in the lung vasculature)
  • Tx: High PEEP, High Vt