4- resp/vents Flashcards
indications for intubation
VOPS – ventilation problems (not breathing, respiratory distress and fatigue),
oxygenation problems (PNA, atelectasis, etc),
airway protection,
secretions
Besides its use in acute on chronic respiratory failure (i.e., COPD exacerbations), what are the clinical settings in which CPAP and/or BiPAP have been studied and shown to be potentially advantageous?
COPD exacerbation,
pulmonary edema (PEEP pushes fluid out of interstitial space),
PNA in bone marrow unit (try to avoid intubation at any cost, 99% mortality),
neuromuscular problems
what do you set for AC/SIMV vs Pressure support
AC/SIMV: RR, TV
PS: PEEP
what do you set for pressure control
set RR, Peak Inspiratory Pressure (PIP) and Inspiratory Time (IT).
Patient-ventilator dyssynchrony can be a sign that you should switch over to
PS
values for TV, PEEP, RR, FiO2
a. TV: 7cc/kg IBD (500 ml)
b. PEEP: 5 cmH2O
c. Rate: 12
d. FIO2: 100%. Non-toxic is <60% FiO2.
what do you set for volume control
TV and RR
benefit of volume control
used to allow patient to rest their respiratory muscles
benefits of pressure control
minimizes risk of barotrauma; increases length of time alveoli are open; used in refractory hypoxemia and patient comfort;
caution of pressure control in which population
don’t use in asthmatics; risk is no guaranteed volume and may create auto PEEP from gas trapping if there is not enough time for exhalation
benefits of PS
minimizes barotauma, more comfortable;
caution of PS in
don’t use if heavily sedated or brain injured because there is no backup rate
How would you assess the appropriateness of your ventilator settings in addition to (and while waiting for) the results of an ABG?
If pressure is too high, the machine will be beeping. If too little, pt will be showing signs of not getting enough air.
What would be your explanation if immediately after intubation the patient’s BP were high
inadequate sedation; increase sedation
What would be your explanation if immediately after intubation the patient’s BP were low
too much sedation, ventilator causes an increase positive thoracic pressure, causing decreased venous return which is opposite that of spontaneously breathing; give fluids
What type of respiratory failure is a patient with COPD most likely to develop and why?
ventilation; narrowed airways and poor mechanical ventilation
resistance equation
Resistance = (Peak Pressure – Plateau pressure) / Flow Rate (usually 60L/min) =
normal resistance value
<10
compliance equation
Compliance = delta V / Delta P
= TVcc / (Pplataeu – PEEP)
nl compliance
> 60
Is the peak to plateau pressure gradient most consistent with increased airways resistance or diminished lung compliance?
resistance
What are the clinical criteria for ARDS?
PaO2/FiO2 < 200,
CXR with diffuse infiltrates,
pulmonary edema is not fluid overload or CHF (Pcwp is not elevated if SGC is in place).
The three most common causes of ARDS are
sepsis, pneumonia and aspiration.
treat ARDS
fix cause and increase FiO2.
diuresis until hypotensive and either back off diuresis or add pressors
Increase the PEEP to force O2 through the fluid. 15-25 of PEEP
prone position -> inc PaO2 via blood to the less damaged sides of the lungs
optimize mixed venous O2
consider ECMO
