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Anesthesia Principles > Ventilators > Flashcards

Ventilators Flashcards

1
Q

Ventilation eliminates what?

A

CO2

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2
Q

What are the 2 major functions of the lung?

A

ventilation
oxygenation

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3
Q

The CO2 gas of metabolism enters ______, and the CO2 gas is expelled form the lungs on exhalation.

A

the alveoli of the lungs

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4
Q

What is one method to start waking people up?

A

Increase their CO2 to stimulate them to breath

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5
Q

How is oxygenation best represented?

A

the partial pressure of O2 in the arterial blood (PaO2)

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6
Q

What normally dictates the minute ventilation?

A

quantity of CO2 produced

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7
Q

In the absence of dx, high altitude, and pharmacologic intervention, what is the PaCO2 of spontaneous ventilation?

A

40 mmHg

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8
Q

The force exerted by the ventilator is measured by what?

A

pressure

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9
Q

What 2 things must pressure overcome that impede motion during inspiratoin?

A

compliance
resistance

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10
Q

When mechanical ventilation is used, exhlaation is passive or active?

A

passive

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11
Q

Compliance and resistance may be regarded as the “load” facing the inspiratory pressure that results in the 2 fundamental varialbes:

A

TV
inspiratory flow

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12
Q

WHen inspiratory flow is matched to a desired TV, the inspiratory _____ varies to the given load.

A

pressure

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13
Q

When the inspiratory flow is matched to a desired inspiratory pressure, the ___ varies to the given load.

A

TV

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14
Q

Cough suppression can cause?

A

retention of secretions in tube

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15
Q

What occurs d/t changes in physiologic and mehcanism dead space?

A

V/Q mismatch

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16
Q

What are 2 cons to suctioning the tube?

A

it can cuase negative pressure - results in atelectasis and entrainment of Nitrogen that reduces teh fraction of inspired O2

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17
Q

___ causes an increase in intrathoracic pressure during inspiration.

A

IPPV

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18
Q

What can elevated intrathoracic pressures decrease?

A

blood flow returning to heart, (& CO)

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19
Q

PEEP can decrease ____

A

venous return

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20
Q

What is an injury r/t pressure of mechanical ventilation?

A

barotrauma

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21
Q

What are s/s of barotrauma if a full pneumo does not occur?

A

physiologic and pathologic changes r/t alveolar overstreatching

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22
Q

What is injury r/t volume and mechanical ventilatioN?

A

volutrauma

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23
Q

What is damage r/t shear stress from the opening and closing of alveoli durign mechanical ventilation called?

A

atelectrauma or shear trauma

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24
Q

What causes atelectrauma?

A

pressure and volume related changes

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25
Q

What is optimal PEEP usually?

A

5-15 cmH20

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26
Q

What is recommended TV?

A

6-8 mL/kg

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27
Q

What is TV based off of ?

A

IBW

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28
Q

What is a typical I:E ratio?

A

1:2 or 1:4

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29
Q

Inverse Ratio VentilatioN: The objective is to _____ mean airway pressure and minimize _____ pressure with a desired outcome of recruiting collapsed alveoli w/o _____.

A

increase
peak
overdistention

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30
Q

What vent pressure directly corresponds w/ alveolar recruitment, reduction in shunt fraction, and increased oxygenation?

A

Mean airway pressure

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31
Q

What should you keep your peak pressure less than?

A

40

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32
Q

What pushes or drives the gas to the patient in a ventilator?

A

bellows or piston

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33
Q

The desgination of ascenidng or descending bellows was based on bellows movemnt on _____.

A

exhalation

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34
Q

An ascending bellow ___ during exhalation

A

rises

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35
Q

A descending bellow ___ during exhalation

A

falls

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36
Q

In the event of a circuit disconnect or significant leak, what bellow (asending or descending) would not fill or would improperly fill udring exhalation?

A

ascending

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37
Q

What type of bellow could fill whether a circuit disconnect, leak, or normal exhalation was present?

A

hanging

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38
Q

Hanging bellow ventilators must rely on a ____ to detect leaks and inadequate FGF.

A

separate reservoir bag

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39
Q

___ pressure gas typically is used to drive the bellows.

A

high

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40
Q

A hole or perforation in the bellows can subject the patient to driving gas pressures and result in _____.

A

barotrauma

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41
Q

With a piston ventilator, what is used to drive or displace the piston within the cylinder to cause gas flow?

A

electric motor

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42
Q

What is believed to be improved with piston vs. bellows d/t precise postion of piston?

A

TV accuracy

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43
Q

A leak occuring at the piston diaphragm could cause a loss of circuit gas to the room with _____ during inspiration.

A

hypoventilation

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44
Q

Piston ventilators use what to monitor for circuit leaks or inadequate FGF?

A

Fresh gas decoupling w/ a separate reservoir bag

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45
Q

What does a turbine ventilator rely on to produce a drive gas pressure?

A

spinning turbine

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46
Q

With turbine ventilators, higher revolutions per minutre are associated with _____, while lower RPMs are associated w/ _____.

A

higher pressures
lower circuit pressures

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47
Q

What ventilator type is associated with circuit dead space reduction, improved gas mixing, and rapid establishment of desired gas concentrations?

A

Turbine b/c constant flow of turbine

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48
Q

What two significant events occur in a normal ventilator breath?

A

inspiration
exhalation

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49
Q

____ describes the event that transitions the ventilator from exhalation to inspiration and from inspiration to exhalation.

A

cycling behavior

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50
Q

A sensor can be used to initiate inspiration on spontaneous patient effort in what vent mode?

A

pressure support ventilation (PSV)

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51
Q

The trigger, an observed parameter to allow inspiration to occur, can be ___, ___, or ____.

A

pressure
volume
flow values

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52
Q

Cycling from inspiration to exhalation can occurs as a result of achieving a _____, ___, ___, or ____.

A

set volume, pressure, flow, or time

53
Q

Exhalation is typically a ____ event.

A

passive

54
Q

Pressures in the airway can be manipulated during exhalation by the addition of ____

A

PEEP

55
Q

A _____ is used in ventilation when the inspiratory flow waveform is controlled around the use of a high-pressure source; the source in this case is typically greater than 5x the airway pressure.

A

flow generator

56
Q

A _____ is used when the pressure waveform is controleld around the use of a low-pressure source, usually near or moderately higher than the airway pressure.

A

pressure generator

57
Q

When a ____ source is used, changes in patient compliance and resistanc ehave little effect on the inspiratory flow waveform.

A

high pressure

58
Q

With a ____ source, changes in compliance and resistance affect the inspiratory flow waveform.

A

low-pressure

59
Q

Constant flow generator is a ___ pressure ventilator???

A

high

60
Q

Constant pressure generator is a ___ pressure ventialtor???

A

low

61
Q

A variable flow generator can provide different flow waveforms such as ___, ___, or ____ flow.

A

increasing/ascending ramp
Decreasing/descednign ramp
sinusoidal flow

62
Q

What accompanies high pressure ventilation?

A

hypotension

63
Q

Declining inspiratory flow settings allow time for ____ at the end of ____

A

gas redistribution
inspiration

64
Q

An accelerating inspiratory flow setting is intended to achieve ventilation while minmizing the effect on _____

A

intrathoracic pressure

65
Q

The prolongation of the ____ period maximizes the time for venous return.

A

expiratory

66
Q

What flow setting incorporates:
prolonged exhalation
Rapid inspiration w/ no plateua

A

accelerating inspiratory flow

67
Q

What flow setting incorporates:
normal flow until lungs are filled
plateua for distribution

A

Declining inspiratory flow

68
Q

A TV maintained after inspiratory flow ceases, a so-called ___ or _____, provides the opportunity for gas to redistribute within the lung.

A

plateau
inspiratory hold

69
Q

Inspiratory hold settings on ventilators improve what?

A

gas exchange

70
Q

IRV is a means of increasing mean airway pressures w/o increasing what?

A

peak airway pressure

71
Q

IRV is defined as an I:E ratio greater than ___.

A

1:1

72
Q

What are two concerns with IRV?

A

breath stacking
auto-peep

73
Q

At the end of each breath, the pressure is commonly maintained at an end-expiratory pressure of ___ above 0 b/c of the weight of valves and bellows, although some ventilators provide direct control to set additional PEEP.

A

2-4 cmH2O

74
Q

Dr. White’s recommendation is that if you use a PEEP >___, you should transport to ICU with PEEP valve.

A

10

75
Q

PEEP can affect what?

A

venous return to the heart

76
Q

The introduction of a constrictive orifice during exhalation can benefit some patients with advanced lung disease d/t the fact that the expiratory retard will ___ expiratory flow rate and allow more ____ flow to better empty the lungs.

A

decrease
laminar

77
Q

When might the introduction of expiratory retard/constrictive orifices be beneficial?

A

with severe bronchoconstriction (status asthmaticus)

78
Q

Why is expiratory retard rarely used?

A

can cause breath stackign and potentially dangerous high pressure

79
Q

In combination w/ O2, anesthetic gas typically flows continuosly from where?

A

common gas outlet

80
Q

T/F: FGF commonly contributes to actual delivered TV if it continues to flow into the breathing circuit during the inspiratory phase.

A

True - however newer vents offer fresh gas uncoupling by electronically interrupting or diverting FGF during inspiratory phase

81
Q

___ and ___ caused by expanding hoses explain why delivered TV are frequently less than desired.

A

gas compression

compliance volume losses

82
Q

Loss of ___ is greatest and most variable in machiens that have an external ventilator connected to a circuit that includes a soda lime absorber and humidifer.

A

TV - the total volume of gas that may be compressed in the circuit often exceeds 6 L

83
Q

For every 10 cmH2O pressure, approximately ___% of the compressible volume is lost from teh circuit.

A

1%

84
Q

These TV losses typically are overcome by default of FGF (in a fresh gas uncouple ventilator), which at ____L/min would add 100 mL to the circuit during a _ second of inspriation period.

A

3 L/min

2 second

85
Q

What are the 3 ventilaotr mode categories?

A

controlled breathing

assisted or supported

spontaneous breathing

86
Q

___ is the fixed parameter in VCV.

A

volume

87
Q

With VCV what other vent parameters must be set?

A

TV
RR
I:E ratio

88
Q

With VCV, airway pressure rises ____ with time as the gas volume is pushed into the lung.

A

linearly

89
Q

With VCV, the peak airway pressure is direclty r/t ____ and inversely r/t ____.

A

airway resistance

lung compliance

90
Q

With PCV, the fixed parameter is what?

A

pressure

91
Q

In pressure control ventilation, the ____ is controlled.

A

peak airway pressure

92
Q

What ventilator parameters must be set with PCV?

A

peak airway pressure
RR
I:E ratio

93
Q

With PCV, ____ are delivered at the start of inspiration, and the flow is rapidly diminished with maintaining _____.

A

high flows

constant pressure

94
Q

With PCV, flow tends to decrease ___.

A

exponentially

95
Q

With PCV, the TV is directly proportional to ____ and inversly proportional to _____.

A

lung compliance

airway resistance

96
Q

Which vent mode allows the ventilator to change the inspiratory pressure dynamically based on the compliance fo the respiratory system?

A

Volume guarantee PCV

97
Q

In a steady-state system using PCV, a sudden increase in pulmonary compliance would lead to what?

A

Large TV

hyperventilation

98
Q

What mode decreases patient-ventilator dyssynchrony and minimizes coughing, bucking, and straining?

A

Assisted and support ventilator mdoes

99
Q

The transition from effortless breathing to spontaneous breathing during emergence is commonly associated w/ risks of ___, ___, and ____

A

hypoxemia
hypercarbia
dyssynchrony

100
Q

In assisted control ventilation (ACV), the patient’s effort to breath is manifested as ______in the airway pressure, and a predetermined negative pressure triggers the vent to deliver a ____.

A

a negative deflection

set TV

101
Q

W/ ACV, as long at the patient triggers the vent more than the interval defined by the set control rate, a controlled breath _____ delivered.

A

will not

102
Q

ACV minute ventilation =

A

sum of delivered control breaths + patient’s triggered breaths

103
Q

With proportional assisted ventilation (PAV), the ____ correlates with respiratory effort.

A

TV

A more negative effort is rewarded w/ greater TV.

104
Q

Pressure support ventilation (PSV) is the pressure equivalent of ___.

A

AV

105
Q

What vent parameters are set with PSV mode?

A

inspiratory time
peak airway pressure
trigger

106
Q

In ______, the clinician sets mandatory ventilator breaths by either volume or pressure at a defined rate and inspiratory time.

A

Intermittent mandatory ventilation (IMV)

107
Q

What is the problem with IMV mode?

A

risk of patient receiving a mandatory breath while not having completed a spontaneous or assisted breath

108
Q

To avoid breath stackin in IMV mode, what was created?

A

SIMV

109
Q

What parameters must be set with SIMV mode?

A

mandatory volume or pressure

RR
inspiratory time

110
Q

With SIMV, if the pressure or flow does not exceed the set limit parameters, teh mandatory breath is delivered at _____.

A

the beginning of the respiratory interval

111
Q

With SIMV, if the pressure or flow exceeds the set parameter, teh mandatory breath is delivered at ___.

A

the end of the respiratory interval

112
Q

____, ___, ___, ____ can be monitored for all phases of anesthetic managment in which the patient spontaneously breaths.

A

pressure
volume
flow
RR

113
Q

the CPAP number represents the ____ between exhalation adn inhalation, when the gas flow within the airway is zero

A

airway pressur

114
Q

With CPAP, when the pt inhales, a ___ is created within the airway in relation to the set CPAP number, allowing gas to flow into the patient.

A

relatively negative pressure

115
Q

With CPAP, when the patient exhales, the airway pressure ____ the set CPAP number allowing gas to exit.

A

exceeds

116
Q

On the anesthesia workstation, how is CPAP set?

A

manually w/ the adjustable pressure-limiting valve (APL)

117
Q

What can CPAP help do?

A

recruit alveoli

facilitate oxygenation

118
Q

On the pressure-volume curve, CPAP can shift function to the ___ and allow the best compliance characteristics of the lung to be manifested.

A

right

119
Q

CPAP can decrease what?

A

venous return adn CO

120
Q

High-frequency ventilaiton is generally defined as ____ breath cycles/min but has technically been defined by the FDA as a rate exceeding ___ breath cycles per minutes.

A

60-3000

150

121
Q

____ uses a nasotracheal tube or catheter w/o side holes to insufflate a controlled anesthestic gas mix. Small TV and rates of 60-120 breaths/min are used. Inspiration is active and exhalation is passive.

A

high frequency positive pressure ventilation(HFPPV)

122
Q

What are the 3 types of high frequency ventilations?

A

HFPPV
High frequency jet ventilation (HFJV)
High frequency oscillatory ventilation (HFO)

123
Q

____ uses the highest frequencies, smallest volumes, and active expiratory phase through oscillation using piston pumps or diaphragms

A

HFO

124
Q

HFO has rate of ____ cycles/min

A

400-2400

125
Q

T/F: in HFO, sinusoidal waveforms w/ I:E ratio of 1:1 are generated

A

true

126
Q

What are 3 advantages to high frequency ventilation?

A

low airway pressures for bullous lung dx

small excursions for peripheral lung surgery

prevention of barotrauma in neonates

127
Q

With airway pressure-release ventilation (APRV), during the inspiratory cycle, _____ is delivered for a preset period of time.

A

high pressure CPAP

128
Q

WIth APRV, during expiration, ____ is released to a lower pressure for the time of exhalation.

A

airway pressure

129
Q

When can overpressurization of the airway occur? (3 things)

A

coughing against the vent

vent settings excessive for the first breath

when the O2 flush button is pressed during inspiratory phase

Anesthesia Principles (10 decks)

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