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RET 2264 Advanced Modalities > Advanced Modalities > Flashcards

Advanced Modalities Flashcards

1
Q

What is Closed Loop System?

A

Is when the machine adjust some setting to match however was priviosly set.

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2
Q

what triggers, targets and cycles PRVC mode?

A
  • Is a Pressure Targeted
  • Time Cycled Breaths
  • Time or patient triggered
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3
Q

How Closed Loop Ventilation mode (PRVC) works?

A

By measuring the Vt delivered with the Vt pre-set on the controls.

If the Vt volume is less or more, the ventilator will ↑or ↓ pressure untill it match the set Vt

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4
Q

What type of patient will PRVC mode best indicated?

A
  • Patient whom required the lowest possible Pressure and a gurantee delivered Vt
  • Patient requiring high and/or variable Inspiratory Flow.
  • CL and RAW changing patients.

Here on this mode Flow is Variable

  • Faster breathing = faster flow;
  • slow breathing = low Flow
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5
Q

What is the diference on Flow between VC mode and PRVC mode?

A
  • On VC mode Flow is not Variable.( here Flow is pre-set and it won’t change)
  • On PRVC mode Flow is Variable. (Here It will depend on the breathing pattern slow breaths equal slow Flow, fast breaths equal fast Flow)
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6
Q

If you see a patient on VC that is suffering for Air hunger, what would you recommend?

A

Switch to PRVC mode, Because is an Spontaneous mode and Pt can breath faster if he needs more air.

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7
Q

What cause Minute Ventilation to go up?

A

↑ Metabolic Rate

  • ↑ O2 demand
  • ↑ CO2 production
  • ↑ RR
  • ↑ HR
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8
Q

What is the benefits of decelerating wave form.

A

Improve gas distribution, better oxygenation

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9
Q

Advantage of PRVC.

A
  • Variable Flow
  • Guarantee Vt
  • Reduced WOB
  • Better distribution of gas Flow
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10
Q

What patient particulary will need PRVC mode?

A
  • Every patient
  • Neurological patient with
  • Irregular respiratory drive Patients
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11
Q

Other names for PRVC?

A
  • vc + (Puritan Bennet 840, 960)
  • AutoFlow (drager Evita E -4)
  • Adaptive Pressure ventilation (Hamilton Galileo, GS)
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12
Q

On Galileo, PRVC mode will be found as?

A

APV (Adaptive Pressure Ventilation)

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13
Q

Volume Support Ventilation (VSV)

is?

A
  • Is a Spontaneous mode
  • Volume targeted
  • Flow cycle breaths
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14
Q

Indication for VSV?

A
  • Spontaneous breathing patient who require minumum Vt
  • Patient who have inspiratory effort who need support
  • Patient who are asynchronous with ventilator
  • Patient who are ready to wean,
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15
Q

Advantages of VSV:

A
  • Guarantee Vt and VE
  • Pressure support breaths using the lowest require pressure
  • Decreases the patient’s spontaneous RR and WOB
  • Alows patients conrol Inspiratory and Expiraory time.
  • Variable Inspiratory Flow to meet patient demands.
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16
Q

How we set Inspiratory Time on Spontaneous Mode?

A

We don’t, patient does it (patient can take little or Large Breaths)

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17
Q

PRVC mode can ↑ pressure if is need it to match the preset Vt.

when the machine stop ↑ pressure and also how low this pressure could get?

A

The machine stop ↑ pressure 5 cmH2O bellow the upper limit, and can go down until match PEEP pressure

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18
Q

Disadvantages of VSV?

A
  • Spontaneous ventilation required
  • Patient who assist the ventilator by taking larger Vt, will cause the inspiratory pressure to drop.
  • If the patient tires, the ventilator could be delivering as low as the baseline pressure (PEEP).
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19
Q

Disadvantages of PRVC?

A

If patient takes larger Vt will cause the inspiratory pressure to drop, If the Patient then tires the ventilator can deliver low as PEEP pressure at the time when the patient most need the support.

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20
Q

Febrile and septisemia patient, Metabolic rate will go up or down?

A

It will Increase

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21
Q

On APV ( Adaptive Pressure Vetilation) what is the maximun and lower pressure alarm setting?

A
  • The Hiegh pressure is 10 cm h2o bellow maximun Pressure set.
  • The Lowest Pressure is 5 cm h2o above PEEP.

​ (And pressure is titrated by increments of 1 cm h2o)

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22
Q

On the Hamilton Gallileo ventilator PRVC mode wil be found aun what mode?

A

APV (Adaptive pressure ventilation)

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23
Q

What type of mode is commonly used on non-invasive ventilation?

A

VAPS (Volume Assure Pressure Support)

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24
Q

Advantages of VAPS

A
  • Volume Guaranteed with each breath
  • High variable Flow with improved syncrony
  • ↓ WOB
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25
Q

What is the mode that provide two levels of CPAP?

A

APRV(Airway Pressure Release Ventilation)

  • High level of CPAP
  • Low level of CPAP

Both pressures time triggered and time cycle

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26
Q

Indication for APRV mode

A
  • Partial to full ventilatory support
  • ARDS patients
  • Patient with refractory hypoxemia
  • Patient with massive atelectasis
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27
Q

what is mean airway pressure?

A

Is the average of all pressure during one minute, MAP is use to fascilitate Oxygentation.

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28
Q

How you facilitate Oxygenation on APRV mode?

A

By increasing MAP

  • ↑ pressure
  • ↑# of breaths
  • ↑ PEEP
  • IRV
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29
Q

What mode allows IRV use?

A

APRV mode

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30
Q

APRV mode is primarily use for:

A

Recruit alveoli and increase mean airway pressure to facilitate Oxygenation?

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31
Q

Why APRV mode is not recommended to COPD patients?

A

COPD patient usually trapped air and APRV mode increase PEEP which can increase Air trapping.

32
Q

TRUE or FALSE

Spontaneous Breathing augments venous return and improves CO.

33
Q

APRV initial setting for Phigh:

A
  • Newly intubated patients, set to 20 - 30 cm h2o
  • VC: set to approximating to Pplat pressure unless Pplat is >30 cm h2o
  • PC: set to prior to PPEAK unless PPEAK is >30 cm h2o
34
Q

How you set Thigh on APRV mode setting?

A

4 -6 sceconds

35
Q

What is the diference between Phigh and Plow on APRV mode?

A

Tidal Volume

36
Q

What is the initial setting for Tlow on APRV mode?

A

0.2 - 08 sec. or 1 Time constant or set >50% and 75% of PEFR?

37
Q

How you increase PaO2 on APRV mode?

A

By increasing:

  • ↑Fio2
  • ↑PHigh
  • ↑THigh
  • ↓T<em>LOw</em>
38
Q

How you drecrease PaCO2 on APRV?

A

BY:

  • ↓T High
  • ↑ T <em>low</em>
39
Q

TRUE or FALSE

On APRV mode by ↓P<em>high</em> and ↑Thigh patient can be simultaneously weaning whe SpO2>95% and FiO2 <40%

A

TRUE

(Dropped and stretched)

40
Q

HFOV is defined us:

A

Mechanical Ventilation support using higher than normal breathing frequencies

41
Q

TRUE or FALSE

HFOV was created to ventilate in a safety winwow avoiding Volutrauma (over distention of the Lungs) and Atelectotrauma (colapsing of the Alvioli)

42
Q

BIAS Flow is?

A

Continous Flow of fresh supplied through the ventilator circiut.

(Set at 25 - 40 lpm)

43
Q

What is the primary control to fix Oxygenation on HFOV mode?

A

↑FiO2, is the primary control

44
Q

what is the secondary control to fix oxygenation on HFOV mode?

A

MAP (mean airway pressure)

45
Q

What control ventilation on HFOV mode?

A

Ventilation is controlled by the movement of the piston mechanism “Stroke Volume”

46
Q

1 Hertz is equal to?

A

One cycle per second

ex:

1HZ = 1 cycle/sec

  • 1 min = 60 cycle/sec
  • 2 HZ = 120 cycle/sec
  • 10 min = 600 cycle/sec
47
Q

If we raise the amplitud on HFOV mode, what will hapen to Stroke Volume?

A

It will increase but, frequency will decrease.

(↑amplitud = ↓ Frequency)↓

48
Q

How will CO2 be afected when we ↑ or ↓ frequency on HFOV mode?

A
  • ↓ frequency = ↑ blow off CO2.
  • ↑ frequency = Retain CO2
49
Q

The movement of the piston back and front creates?

A

Whiggle.

  • Neonate up to the Umbilical
  • Pediatry up to the hip
  • Adult up to the upper legs
50
Q

What is the primary control to fix CO2 on HFOV mode?

A

Amplitud

  • ↑ amplitud will blow off more CO2
  • ↓ amplitud will retain more CO2
51
Q

What will be the visual assesment of the patient on HFOV mode?

A

The Wiggle

52
Q

If we increase Inspiratory time on HFOV mode, how will CO2 be affected?

A

↑ Ti will assist with CO2 elimination

53
Q

What is the secondary control to fix CO2 on HFOV mode?

A

Frequency

  • ↑HZ setting will ↑CO2 production (less time to blow off CO2)
  • ↓HZ setting will ↓CO2 production (more time to blow off CO2)
54
Q

Indication for HFOV mode?

A
  • ARDS, Broncho Pleural fistula
  • Inadecuate oxygenation that cannot be treated safely.
55
Q

Contraindication for HFOV mode?

A

No contraindication

56
Q

Precaution for HFOV mode use?

A
  • Unstable cariovascular status
  • Acute Broncospasm
  • Sevre Acidosis
  • COPD, Asthma
57
Q

HFOV mode initial setting:

A
  • Bias Flow 25 - 40
  • Amplitud 45 - 60
  • Ti 33%
  • Frequency 5 cm h2o
  • FiO2 100%
  • High Pressure 5 cm h2o above MAP
  • Low Pressure 5 cm h2o bellow MAP
58
Q

This mode drained the blood from the patient throuth a large bore cannula into a central vein, pumping that blood throught an artificial gas exchanger, and returning the oxygenated/ventilated blood to the patient.

59
Q

The strategy that has made the greatest impact on survival in ARDS patients is?

A

Lung Pretective ventilation

Now lung protection is equal if not more important than oxygenate the patient propertly.

60
Q
  • Avoid over distension (Pplat <30 cm h2o)
  • Tidal Volume (4-8 ml/Kg IBW)
  • Ph (7.15)
  • FiO2 (<0.50)
  • SaO2 (88-95)
  • PaO2 (55-80 mm Hg)

This is stragety is use for :

A

Lung Protection Strategies

61
Q

When we have a patient with very bad condition where Lung Protective strategy is not longer sufficiente what would be a safe alternative to this patient?

A

ECMO

Here we keep:

  • Pplat <30 cm H2O
  • FiO2 <0.50

(With this mode we give the patients the necesary gas exchange that they need without damaging their lungs by increasing Pressure or FiO2)

62
Q

What are the two ways that ECMO can supply gas exchange?

A
  • Venous: Here the blood is take from the vein and return to the vein.
  • Arterial: Here the blood is taken from Arterial and return to the Arterial
63
Q

VV Ecmo acts as a:

A

Third Lung

64
Q

The porpose of the third Lung (VV ECMO) is?

A

To augment the gas exchange on patient with Respiratory failure and minimizing Ventilator Induced Lung injury (VILI)

65
Q

What makes VA ECMO diffent from VVA ECMO or A ECMO by it selves?

A

VA ECMO beside oxygenate the blood it directly support Cardiac Ouput.

66
Q

Indication for ECMO

A
  • ARDS
  • Persisten pulmonary hypertension
  • Pulmonary emboli
  • Air Leak
  • O2 Index ↑40
67
Q

ECMO 50% of mortality is associated with:

A

PaO2/FiO2 < 150 on FiO2 > 90% and/or Muray score 2-3

68
Q

ECMO 80% mortality is associated with:

A

PaO2/FiO2 < 100 on FiO2 > 90% and/or Muray score 3-4

69
Q

ECMO contraindications:

A
  • Irreversable coagulopathy
  • Severe neurologic injury
  • Futility
  • Inability to cannulate
70
Q

ECMO complications:

A
  • Bleeding
  • Neurologic Injury
  • Infection Ischemia
71
Q

ECMO Outcome:

A
  • Comulative survival is 61%
  • VV ECMO survival improve 5% - 15% cmpare to VA ECMO
72
Q

What is LVAD (Left Ventricular Assist Devise)

A

Is a surgical implanted pump that provides temporary ventricular support in patients with depressed Heart Function.

73
Q

LVAD is use for:

A
  • Bridge to Transplant
  • Restore heart functioning
  • Prolong live
74
Q

Intra-Arterial Ballon pump (IABP)

is:

A

Is a devise that is inserted into the desending Aorta use to increase coronary perfusion

75
Q

Where is the IABP inserted?

A

Is inserted into the descending Aorta, at 2 cm from the left subclavian artery.

76
Q

IABP indications:

A
  • Failure to wean from cardiopulmonaru bypass
  • Heart Failure
  • Acute Heart Atack
77
Q

In PRVC mode, what happen to Inspiratory pressure if the patient takes largest tidal volume?

A

PI will drop, because the ventilator does not need to add pressure during inspiration since the patient is doing it all.

(The bad thing about this is, if the patient gets tired then the ventilator could deliver as low as PEEP pressure, at the time when the patient most need it)

RET 2264 Advanced Modalities (5 decks)

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