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Semester 2 > Advanced Ventilation > Flashcards

Advanced Ventilation Flashcards

1
Q

Platue Pressue

A

Is defined as airway pressure during the end expiratory pause and roughly reflects the level of alveolar over distension

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2
Q

Obstructive lung diseases

A

Cystic Fibrosis
Asthma
COPD
Bronchiectasis

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3
Q

Restrictive lung diseases

A

Lungs are restricted from fully expanding, making it difficult to inhale and fully expand the lungs
Interstitial lung disease
Sarcoidosis
Neuromuscular disease
Pulmonary fibrosis
Asbestosis

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4
Q

Plateau Pressure

A

Pressure in the alveolar at the end of inspiration prior to expiration
A useful marker of lung hyperinflation and should be maintained at less than 30cmH2O- if greater than 30 there is potential for alveolar injury

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5
Q

What does it indicate If there is an increasing plateau pressure?

A

Reducing lung compliance

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6
Q

An increased Peak pressure (PIP) and normal plateau pressure indicates

A

An increase in airway resistance

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7
Q

If peak pressure (PIP) and plateau pressure and increased what does this indicate?

A

A decreased lung compliance

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8
Q

Causes of increased airway resistance

A

Bronchospasm
Excessive secretions
Mucus plug
Foreign body aspiration
Extrinsic airway compression/biting the ETT

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9
Q

Causes of decreased compliance

A

Pulmonary oedema
Pleural effusion
Pneumothorax
Right main stem bronchus intubation
Ascites or other abdominal distension

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10
Q

Shunt

A

Perfusion without ventilation

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11
Q

Dead space

A

Ventilation without perfusion

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12
Q

Restrictive disease ventilation management

A

Increase inspiratory time
Look at pt position
Reduce PIP’s
Change to pressure control
PEEP to recruit alveoli
Permissive hypercapnia

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13
Q

Inspiratory hold on MV

A

Demonstrates compliance and any airway resistance:
Plateau pressure (P.Plat)
PIP/P.Plat
Difference

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14
Q

PIP

A

Caused by inspiratory flow rates
Tidal volume
Increased airway resistance
Decreased lung compliance
Decreased chest wall compliance
Normally set to 20-30cm

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15
Q

RAW

A

= resistance

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16
Q

Permissive hypercapnia

A

Deliberate limiting of ventilation with low tidal volumes (5mls/kg), in order to decrease alveolar overdistention
Gradual increase of PaCO2 by gradually decreasing Vt/rate
Gas tracheal insufflation may be used to reduce effects

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17
Q

Advantages of permissive hypercapnia

A

Reduction of barotrauma/voluntarism
Increased PaCO2 enhances oxygen unloading at the tissue level
Adverse effects of acidosis minimised with gradual rise of PaCO2 as metabolic compensation occurs

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18
Q

Disadvantages of of permissive hypercapnia

A

Acute rises in PaCO2 causes depressive effects on the CNS and CVS
Reduces the affinity of Hb for oxygen uptake in the lungs
Rapid rise in CO2 leads to respiratory acidosis

19
Q

Prone positioning

A

May improve oxygenation and decrease the degree of shunt

20
Q

Adverse effects associated with prone position for ventilation

A

Decreased enteral nutrition
ETT obstruction or dislodgement
Increased ICP
Difficulty monitoring the pt
Labour intensive
Facial oedema

21
Q

Mechanical Ventilation in Asthma

A

Increase expiratory time:
Slow respiratory rate
Fast flows
No unnecessary inspiratory pauses
Decreased tidal volumes of plat pressure rising
Aim for MV approx 6L/min

22
Q

Asthma management

A

Bronchodilators
Corticosteroids
NIV/NIPPV
?heliox

23
Q

COPD management

A

Oxygen
NIPPV/NIV
Bronchodilators
Steroids
?heliox
Early nutrition
Physio therapy
Antibiotics if infective component

24
Q

Mechanical ventilation in COPD

A

PEEP may be helpful to:
Decrease WOB
stents collapsible airways
Increases expiratory flow

25
Q

Extubation

A

Can the patient ventilate and oxygenate?
Do they have a gag reflex
Are vitals WNL
Resolution of the process necessitating intubation
Can pt be easily roused and follow commands
Was it a difficult intubation

26
Q

Minute ventilation

A

Vt x RR

27
Q

PIP (peak pressure)

A

Is the highest pressure measured during the respiratory cycle.
PIP reflects airway resistance

28
Q

Factors that generate PIP

A

Inspiratory flow rate
Tidal volume

29
Q

Strategies to minimise barotrauma in obstructive lung disease

A

Reduce tidal volume
Reduce breath rate
Increase expiratory phase

30
Q

Strategies to minimise barotrauma in restrictive lung disease

A

Pressure control
PEEP
inverse ratio ventilation
Prone positioning

31
Q

Vent settings VC

A

Volume control- the ventilator delivers a preset Vt

32
Q

Vent settings - PC

A

Pressure control- preset maximum pressure is delivered during inspiration

33
Q

CMV

A

Continuous mandatory ventilation- preset number of mandatory breaths at a preset volume/pressure

34
Q

Volume assist/control ventilation (A/C)

A

Preset mandatory breaths at preset volume/pressure; patient can trigger spontaneous breaths between mandatory breaths. Spontaneous breaths are “topped up” to match volume of mandatory breath.

35
Q

SIMV

A

Synchronised intermittent mandatory ventilation. Preset number of breaths of a preset volume/pressure; patient triggers spontaneous breaths which are variable

36
Q

I:E ratio

A

The shorter the inspiratory time the longer the expiration time
Generally set at 1:2
Eg: 1:2 means 33.33% breath cycle is inspiration and 66.66% is expiration

37
Q

Flow Rate

A

Speed at which the Vt is delivered
Average settings 40-60L/min
High flow rate classified as >60L/min
*flow rate changed by altering inspiratory time
Decrease inspiratory time= increase flow rate
Increasing inspiratory time = decreases flow rate

38
Q

Pressure support

A

Support spontaneous breaths when SIMV used
Generally set at 5-10cmH20

39
Q

Disadvantages of Positive pressure ventilation

A

Decrease cerebral perfusion (CCP)
Raised ICP
Cerebral hypoxia

40
Q

Lung protective strategy

A

Focused on low tidal volume ventilation to reduce ventilator associated lung injury such as barotrauma and volutrauma. Can be chosen on any pt except pts who have obstructive disease ( asthma, COPD)

41
Q

High plateau pressures

A

Decrease the tidal volume 1ml/kg until plateau pressure of less than 30cmH2O is achieved. Tidal vols of 4ml are accepted.
In such cases you will likely need to increase RR to maintain PaCO2 goals.
Consider permissive hypercapnia if RR limits reached

42
Q

Paediatric ventilation settings

A

Mode: PCV
PEEP - 5-15 (should not exceed 15)
PiP - determines the pts Vt. Can start between 15 And 20 cmH20 greater than PEEP (should not exceed 30 cmH20)
Observe chest rise and fall
The achieved Vt should be approx 6-8ml/kg IBW (lung protective ventilation)

43
Q

Increased airway resistance

A

Asthma/bronchospasm- administer bronchodilators
Mucus plugging - airway clearance therapy
Kinked or obstructed tube

44
Q

Indications for MV

A

Apnoea
Inability to protect airway
Respiratory distress
Inability to sustain adequate oxygenation
Respiratory acidosis
Post op respiratory failure
Shock states

Semester 2 (6 decks)

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