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ARTP > 09: Vent Initiation > Flashcards

09: Vent Initiation Flashcards

1
Q

Clinical goals of CMV

A

Improve ventilation and oxygenation
Decrease WOB and myocardial work

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2
Q

How to achieve CMV goals

A

Normalize pH
Improve alveolar ventilation
Arterial oxygenation
Increase lung volume

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3
Q

Four broad indications for CMV

A

Apnea
Acute hypercapnic failure
Impending acute ventilator failure
Acute hypoxemia respiratory failure

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4
Q

Acute hypercapnic respiratory failure signs

A

Respiratory acidosis
PaCO2 55 or greater
pH 7.20 or less

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5
Q

How to determine impending acute ventilatory failure

A

Serial ABGs

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6
Q

acute hypoxemia respiratory failure signs and systems and disease process this is common in

A

PaO2 <60
Increased WOB
Inefficient breathing pattern
Common in ARDS

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7
Q

Five steps in ventilator commitment

A

patent airway (artificial aw or ambu)
Stabilize cardio (hypotensive and arrhythmias)
baseline vitals
Respiratory pattern (initial parameters)
Connect pt to vent

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8
Q

Effect of peak flow on ventilation and I:E (increasing or too high)

A

Increasing peak flow -> decreases I time, increases E time, improve venous return
Too high peak flow -> increase PIP, turbulence, but decrease venous return

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9
Q

Artificial airway complications/hazards and how to manage

A

Tube disconnection -> set alarms, ambu bag
Sore throat, edema, etc -> use less than 25-30 mmHg of cuff pressure
Cuff over-inflation -> deflate, reintubate
Loss of cuff seal -> reinflate
VAP -> HOB 30 degrees, oral care, hi-lo eval secretions

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10
Q

Machine failure complications/hazards and how to manage

A

System leak -> locate leak, bag pt
Machine failure -> immediately remove pt from vent

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11
Q

Hypotension/hypovalemia in CMV cause of and effect on venous return

A

Tidal volume >8 ml/kg and pressures >7cmH2O cause decreased venous return

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12
Q

Pulmonary barotrauma in CMV complications/hazards, cause of, and what to do if pneumo is suspected

A

Pneumo, subq emphysema
PIP>50 and/or PEEP >20
Call dr/nurse, needle decompression for tension

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13
Q

Atelectasis in CMV: cause of and how to manage

A

Inefficient tidal volume (keep between 6-8 ml/kg IBW)
Change body positioning
Fluid management

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14
Q

Pulmonary infection in CMV:
Cause of
Immunosurpressed?
How to prevent
Signs to look for
Common site?

A

Direct contact w pt aw
Immunosuppressed? Get sick quick
Aw care/aseptic
Change in sputum
Common site? Headed humidifier

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15
Q

GI problems in CMV complications/hazards and how to manage

A

Acute ulcerations with bleeding -> HOB 30 degrees

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16
Q

Renal problems in CMV complications/hazards and how to manage

A

Fluid retention from increase in ADH
Mgmt: daily kg body wt check

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17
Q

O2 toxicity in CMV:
Cause of
Leads to
How to manage

A

FiO2 > 50% for 24-72 hrs
Absorption atelectasis
Hyaline membrane formation
Mgmt: ween FiO2 to 50% then PEEP

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18
Q

Hemodynamic changes in CMV:
Effect on blood flow
Bedside monitor?

A

L ventricle cannot pump blood to body -> cannot return to R side
Bedside monitor? BP

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19
Q

CNS (ICP) in CMV

A

Increased ICP (NV: 5-15) with PEEP and increased intrathoracic pressure
decreased CO -> decreased Cerebral perfusion -> increased ICP

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20
Q

Human error in CMV complications/hazards and how to manage

A

R main stem intubation
Poor sx technique
Inefficient alarms/parameters

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21
Q

Prolonged full ventilatory support in CMV complications/hazards

A

Atrophy
Fatigue

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22
Q

Insufficient alveolar ventilation parameters

A

PaCO2 >55
pH <7.20

23
Q

Insufficient lung expansion parameters

A

Vt <5
VC <10
RR <8 or >35

24
Q

Insufficient muscle strength parameters

A

MIP/NIF > -20
VC <10

25
Q

Increased WOB (labored/distressed)

A

VE >10
VD/Vt >0.6

26
Q

Hypoxemia parameters

A

P(A-a)O2 on 100% >350
PaO2/FiO2 <200

27
Q

PIF/NIF tests

A

Respiratory muscle strength

28
Q

What might prevent improved ventilation in CMV

A

Severe obstruction
Reduced LC beyond capability of vent (ARDS)

29
Q

As alveolar ventilation decreases, PaCO2

A

Increases

30
Q

As VA increases, PaCO2

A

Decreases

31
Q

Alveolar ventilation equation

A

(Vt - VD) x RR

32
Q

Vd =

A

1 ml/lb IBW

33
Q

MAP or PAW =

A

Result of duration and amount of positive pressure in lung

34
Q

Initial vent settings

A

FiO2: 100%
Mode: Control
Rate: 12-20 or rate needed to correct acidosis/alkalosis
Vt: 6-8 ml/kg IBW

35
Q

How to alleviate cuff leak from severed pilot line

A

Reinflate w needle

36
Q

O2 toxicity S&S

A

Nausea
Substernal chest pain

37
Q

Ventilation strategy for increased ICP

A

Deliberate hyperventilation (PaCO2 30-35) for first 24-48 hrs to decrease swelling and ICP

38
Q

Effect of subnormal workload on respiratory muscle

A

Atrophy

39
Q

Effect of excessive workload on respiratory muscle

A

Fatigue

40
Q

NIF normal range

A

-80 to -100

41
Q

Acute hypoxemic RF ABG

A

PaO2 <60

42
Q

Hypercapnic respiratory failure ABG

A

Uncompensated pH
Increased CO2

43
Q

Acute on Chronic hypercapnic respiratory failure

A

Alveolar hyperventilation

44
Q

CMV effect on WOB

A

Decreases

45
Q

What effects MAP

A

PEEP

46
Q

How does air trapping occur in CMV and how does it effect I and e time

A

Too low of flow -> increase I time decrease E time

47
Q

Airtrapping results in

A

Decreasing pulmonary capillary blood flow
Increasing risk for barotrauma

48
Q

Positive pressure effect on venous return

A

Decreases

49
Q

Overly/more compliant lung and PPV

A

Emphysema
Worsen impact on cardiovascular

50
Q

Stiff lung and PPV

A

ARDS
Less transmission of pressure, less effect on venous return

51
Q

Kyphoscoliosis and CMV

A

Rapid transmission of pressures -> decreases venous return

52
Q

Pt fighting ventilator? (Asynchronous)

A

Increases WOB -> increases intrapulmonary pressures -> decreases venous return

53
Q

Status asthmaticus and circulation effect

A

No evidence of circulatory depression w high Raw

54
Q

Fatigue in CMV: caused by and leads to

A

failure to provide adequate vent support or strenuous weaning, leads to hypoventilation/inadequate lung expansion and atelectasis

ARTP (9 decks)

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