295 Mech Vent

Question 1

Primary indication for initiation of MV

Answer 1

Respiratory failure

Question 2

Two types of Respiratory failure

Answer 2

Hypoxemic

Hypercarbic

Question 3

Respiratory failure that presents when arterial O2 saturation is less than 90% despite increased inspired O2 fraction and usually results form ventilation perfusion mismatch or shunt

Answer 3

Respiratory failure type 1 hypoxemic

Question 4

Respiratory failure that is characterized by elevated arterial carbon dioxide pressure of more than 50 mmHg decreasing minute ventilation or increase physiologic dead space

Answer 4

Respiratory failure Type 2 hypercarbic

Question 5

Most common reason for instituting MV which accounts for 65% Examples

Answer 5

Acute Respiratory failure with hypoxemi

Examples: ARDS, heart failure with pulmonary edema, pneumonia, sepsis, complications of surgery or trauma

Question 6

Causes of hypercarbic Respiratory failure

Answer 6

Coma
COPD in AE
Neuromuscular disease

Question 7

Primary objective of MV

Answer 7

Decrease work of breathing
Avoid Respiratory muscle fatigue
Reverse life threatening hypoxemia and progressive Respiratory acidosis

Question 8

Two basic methods of MV

Answer 8

NIV

Invasive ventilation

Question 9

Most important group who benefit from trial of NIV

Answer 9

COPD exacerbations and Respiratory acidosis pH less than 7.35

Question 10

Good clinical indicator of therapeutic benefit of NIV

Answer 10

Reduction in Respiratory rate

Decrease in use of accessory muscle (scalene, sternomastoid and intercostal)

Question 11

Good choice for pre intubation sedation

Answer 11

Opiates and benzodiapines

Question 12

Why is morphine not used as pre intubation sedation?

Answer 12

Morphine promote histamine release from tissue mast cells and may worsen bronchosoasn in patients

Question 13

Acceptable alternatives to morphine pre intubation sedation

Answer 13

Fentanyl
Sufentanil
Alfentanil

Question 14

Why is ketamine not used pre intubation sedation?

Answer 14

Increases arterial pressure and has been associated with hallucinatory response

Question 15

Contraindications to NIV

Answer 15

Cardiac or Respiratory arrest
Severe encephalopathy
Severe GI bleed
Hemodynamic instability
Unable angina and myocardial infarction
Facial surgery or trauma
Upper airway obstruction
High risk for aspiration or inability to protect airways
Inability to clear secretions

Question 16

Refers to the manner in which Ventilator breaths are triggered, cycled and limited

Answer 16

Modes

Question 17

Either an inspiratory effort or a time based signal when ventilator senses to initiate an assisted breath

Answer 17

Trigger

Question 18

Refers to factors that determine the end of inspiration

Answer 18

Cycle