Week 3 - PPV and Intensive Care

Question 1

What are the main problems with intubation?

3 major, 3 minor

Answer 1

Impairs secretion clearance (no glottis closure, dry secretions, mechanical barrier, decreased ciliary action)
Damages the airway (abrasion of mucosa, trauma, necrosis)
Decreases EFR (narrower tube, bronchospasm)
Bypasses humidification
Increases deadspace
Increases risk of infection

Question 2

What are the pulmonary effects of PPV?

3 points

Answer 2

• Decreased lung compliance due to monotonous pattern and reduced FRC
• Reduced FRC due to ventilation goes to non-dependent areas because they have less resistance, which may cause atelectasis in the dependent areas
• Risk of barotrauma and volumtrauma

Question 3

What can you do to offset the pulmonary effects of PPV?

Answer 3

PEEP

Opens the closed alveoli and may promote sighs so stretch/surfactant production

Question 4

What are the CV effects of PPV?

3 points

Answer 4

Increased intrathoracic pressure causes:

• Decreased CO
• Decreased venous return
• Less blood flow to pulmonary arteries/capillaries means less perfusion

Question 5

What are the other bad effects of PPV?

2 points

Answer 5

• Immobilisation

- Diaphragm deconditioning

Question 6

What can the physio do about PPV?

3 and a half…

Answer 6

• Positioning - frequently change if possible
• encourage breathing and coughing spontanously
• mobilise limbs
• Other- talk to patient, monitor, assess, reasses??

Question 7

Re-read the page about monitoring in ICU.

Answer 7

I hope this was covered enough in the assessment…

Question 8

What are Lyndals four questions for the case studies in intubation, MV?

Answer 8

Does he have an upper airway obstruction?
Does he have reduced desire to breathe?
Does he have pump problem?
Does he have a lung problem?