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Anesthesiologist Assistant > AMDS Y1FA23 > Flashcards

AMDS Y1FA23 Flashcards

1
Q

Lung Compliance Formula

A

ΔVolume/ΔPressure (mL/cmH2O)
Change in volume/ Change in pressure

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2
Q

Decreased compliance means what in terms of Ventilation?

A

a greater change in pressure is needed for
a given change in volume

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3
Q

Examples of decreased lung compliance

A

atelectasis, edema, fibrosis, pneumonia,
or absence of surfactant

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4
Q

Static Compliance

A

= Exhaled Tidal Volume (Vte)/Plateau Pressure (Pplat) – Positive End Expiratory Pressure (PEEP)

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5
Q

Dynamic Compliance formula

A

Exhaled Tidal Volume (Vte)/Peak Inspiratory Pressure (PIP) – Positive End Expiratory Pressure (PEEP)

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6
Q

Normal Adult Lung Compliance

A

40-70 mL/cmH

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7
Q

Normal Child lung compliance

A

About 1mL/cmH2O/kg

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8
Q

Lung Elastance formula

A

ΔPressure/ ΔVolume (cmH2O/mL)
Change in pressure over the change in volume

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9
Q

How are lung compliance and Elastance related?

A

Compliance and elastance are inversely related
* If compliance increases, then elastance decreases
* If compliance decreases, then elastance increases

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10
Q

Elastance Definition

A

A measure of the tendency of something to recoil toward its
original dimensions upon removal of a distending or
compressing force

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11
Q

Lung Compliance Definition

A

A measure of the ease of expansion of
the lungs and thorax, determined by
pulmonary volume and elasticity

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12
Q

A high degree of compliance in the lungs indicates

A

a loss of elastic recoil of the lungs, as in
old age or emphysema

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13
Q

Airway pressure formula

A

Δ Pressure/Flow (cmH2O/L/sec)
Change in pressure over flow

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14
Q

Airway Resistance

A

the friction caused by the movement of air throughout the respiratory system

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15
Q

Types of Flow:

A

Laminar
Turbulent
Tracheobronchial

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16
Q

Laminar Flow

A

Smooth, even non-tumbling flow

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17
Q

Turbulent Flow

A

Rough, tumbling uneven flow pattern
– The pressure gradient necessary to maintain turbulent flow is much higher than that necessary to maintain laminar flow

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18
Q

Tracheobronchial Flow

A

A combination of laminar and turbulent flow which is maintained throughout the respiratory system

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19
Q

Airway resistance decreases with

A

increased airway diameter, bronchodilation, laminar flow and increase in lung volume

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20
Q

Airway resistance increases with

A

decreased airway diameter, bronchoconstriction, turbulent flow and decrease in lung volume

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21
Q

Normal airway Resistance:

A

0.5-2.5cmH2O/L/sec at a flow rate of 0.5 L/sec

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22
Q

Types of Manual Ventilation

A

Control Modes
Synchronized Modes
Support Modes

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23
Q

Control mode of Ventilation

A

Positive pressure ventilation in which the ventilator is in control mode, with its cycle entirely controlled by the apparatus and not influenced by the patient’s efforts at spontaneous ventilation

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24
Q

Synchronized mode of Ventilation

A

Synchronized Intermittent Mechanical
Ventilation is a variation of IMV, in which
the ventilator breaths are synchronized
with patient inspiratory effort, with
added pressure support.

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25
Q

Support Mode of Ventilation

A

The patient initiates every breath and
the ventilator delivers support with the
preset pressure value. With support
from the ventilator, the patient also
regulates his own respiratory rate and
tidal volume.

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26
Q

VCV Primary Setting

A

Tidal Volume
Constant inspiratory Flow

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27
Q

PCV-VG primary Setting

A

Tidal Volume
Decelerating inspiratory Flow

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28
Q

PCV Primary Setting

A

inspiratory pressure
Decelerating inspiratory Flow

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29
Q

Synchronized Ventilation modes

A

SimV-VCG
SIM-V- PCVVG
SIM V- PCV

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30
Q

Support modes of Ventilation

A

CPAP/ PS (PEEP)
PSV-PRO (Pressure Support)

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31
Q

Trigger Window in Mechanical Ventilation

A

A percentage of end expiratory time that a patient
can trigger a mechanical breath – Adjustable from 0-80%

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32
Q

If the ventilator senses the beginning of inspiration
within the trigger window, what happens?

A

it delivers the next volume, pressure or PCV -VG breath and inspiratory time set on the ventilator

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33
Q

If the patient does not make an inspiratory effort
within the trigger window, what happens?

A

the ventilator will deliver a machine breath to the patient

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34
Q

Any breath outside of the trigger window will be

A

a pressure supported breath, if set

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35
Q

Trigger window settings are available on which ventilator modes?

A

all SIMV modes

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36
Q

Flow Triggering:

A

Synchronizes SIMV and
Pressure supported breath delivery with the
patient’s effort

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37
Q

Flow Trigger:

A

Adjustable negative flow (0.2 – 10
L/min) needed to trigger a mechanical breath

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38
Q

How is Flow trigger measured?

A

by the inspiratory flow sensor

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39
Q

How does the flow trigger work?

A

Improves synchronization of breaths
decreasing a patient’s tendency to fight the
ventilator

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40
Q

Volume Control Ventilation (VCV)

A

The ventilator delivers mechanical breaths of the set tidal
volume at intervals based on the set respiratory rate
– The amount of pressure required to deliver the tidal volume
depends on the patient’s lung compliance and resistance

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41
Q

VCV is ideal for what kind of patient?

A

a patient with normal compliance, low airway
resistance and need for consistent, non-synchronized
breaths

42
Q

Pressure Control Ventilation (PCV)

A

The ventilator delivers mechanical breaths at the set
inspiratory pressure level during inspiration
* The ventilator calculates the inspiratory time from the
frequency and I:E ratio settings
– The tidal volume delivered depends on the patient’s
lung compliance

43
Q

In PCV, the volume delivered depends on what?

A

patient’s lung compliance

44
Q

Pressure Control Ventilation-Volume Guarantee (PCV-VG)

A

The ventilator delivers mechanical breaths of the set tidal
volume at intervals based on the set respiratory rate. For each
breath, the ventilator adjusts the inspiratory pressure to use
the lowest pressure required to deliver the tidal volume
– Delivers breaths with the efficiency of pressure controlled ventilation
– Compensates for changes in the patient’s lung characteristics

45
Q

In PCV-VG, To determine the patient’s lung compliance, the ventilator

A

the ventilator
delivers volume-controlled breath
– Based on the patient’s lung compliance, the inspiratory pressure is
established for subsequent breaths
– When adjusting the inspiratory pressure the following pressure range is
used:
* Low end: PEEP+2 cmH2O
* High end: Pmax-5 cmH2O
– The difference in inspiratory pressure between breath
does not exceed +/- 3 cmH2O

46
Q

Best clinical situations for PCV-VG

A

Laparoscopic
Major Trauma
Cardiac

47
Q

SIMV VCV

A

Synchronized Intermittent Mandatory Ventilation
Volume Control Ventilation

48
Q

SIMV VCV

A
  • The ventilator delivers synchronized mechanical breaths of a set
    tidal volume at intervals based on a set respiratory rate. All other
    spontaneous efforts are delivered as pressure-supported breaths
    – The amount of pressure required to deliver the tidal volume depends on
    the patient’s lung compliance and resistance
    – The ventilator will always deliver the specific number of breaths per
    minute the clinician has set
    – I:E is replaced by an inspiratory time (Tinsp)
    – Between machine breaths, the patient can breath spontaneously at the
    rate, tidal volume and timing that the patient desires
49
Q

In SIMV-VCV, The ventilator calculates an inspiratory flow based on

A

the set tidal
volume, inspiratory time and Tpause, if set
– Flow is constant and maintained during the inspiratory phase while
airway pressure is below the pressure limit
– Adjustable pressure limit terminates the breath if peak pressure is
reached

50
Q

In SIMV-VCV, a color change in the waveform indicates

A

Spontaneous breaths from the patient

51
Q

Trigger window, Rise Rate, Flow Trigger and End of Breath are all
active in this mode of ventilation?

A

SIMV-VCV
SIMV-PCV-VG
SIMV-PCV
PSV-Pro
CPAP-PSV

52
Q

SIMV PCV

A

Synchronized Intermittent Mandatory Ventilation
Pressure Control Ventilation

53
Q

SIMV PCV

A

The ventilator delivers synchronized mechanical breaths at the set
inspiratory pressure level for a set inspiratory time at intervals based on
the set respiratory rate. All other spontaneous efforts are delivered as
pressure-supported breaths
– The tidal volume delivered depends on the patient’s
lung compliance
– The ventilator will always deliver the specific number of breaths per minute the clinician has set
– I:E is replaced by an inspiratory time (Tinsp)
– Between machine breaths, the patient can breath spontaneously at the rate, tidal volume and timing that the patient desires

54
Q

In SIMV-PCV, the tidal volume delivered depends on what?

A

the patient’s lung compliance

55
Q

True/False:
In SIMV-PCV, the patient cannot take spontaneous breaths

A

FALSE:
Between machine breaths, the patient can breath spontaneously at the rate, tidal volume and timing that the patient desires

56
Q

SIMV PCV-VG

A

Synchronized Intermittent Mandatory Ventilation Pressure Control
Ventilation-Volume Guarantee

57
Q

SIMV-PCV-VG

A

The ventilator delivers synchronized mechanical breaths of the set tidal volume at
intervals based on the set respiratory rate. For each mechanical breath, the
ventilator adjusts the inspiratory pressure to use the lowest pressure required to
deliver the tidal volume. All other spontaneous efforts are delivered as pressure supported breaths

58
Q

In SIMV-PCV-VG
To determine the patient’s lung compliance, the ventilator does what?

A

delivers volume-controlled breath

59
Q

In SIMV-PCV-VG

A

0.5 cmH2O less than the current breath’s pressure target

60
Q

PSVPro

A

The ventilator provides a constant support pressure once it senses the
patient has made an inspiratory effort

61
Q

PSVPro is intended for what type of patient?

A

Intended to be used on spontaneously breathing patients

62
Q

What is the apnea mode as a backup to PSVPro

A

An apnea backup mode of SIMV PCV is provided if the patient stops
breathing
– Backup time can be set between 10-30 seconds

63
Q

After the patient is apneic on PSVPro and goes into backup mode (SIMV-PCV), When does PSVpro resume?

A

PSVPro automatically resumes when the ventilator registers the number of
consecutive patient triggered breath set for Exit Backup
* Exit Backup range Off, 1-5 spontaneous breaths
* When Exit Backup is set to off, the user must reselect PSVPro mode to reactivate PSVpro

64
Q

When in PSVPro and the vent is triggered to backup mode (SIMV-PCV), what setting prevents the ventilator from returning to PSVPRO?

A

When Exit Backup is set to off, the user must reselect PSVPro mode to reactivate PSVpro

65
Q

CPAP + PSV

A

Continuous Positive Airway Pressure + Pressure Support
Ventilation

66
Q

CPAP + PSV

A

The ventilator provides a constant support pressure once it senses the
patient has made an inspiratory effort
– Intended to be used on spontaneously breathing patients
– The clinician sets the pressure support and PEEP levels
– Patient initiates spontaneous breaths and determines respiratory rate, timing, and tidal volume

67
Q

In CPAP- PSV
If the spontaneous inspiratory effort does not occur within the delay
period, the ventilator

A

delivers pressure controlled breaths at the preset
inspiratory pressure to meet the set minimum rate
– The delay period calculation is 60s/minimum rate + ([60s/minimum rate] –previous measured breath period)

68
Q

PSVPro and CPAP + PSV indications

A

All operations where spontaneous breathing does not
interfere with surgical procedure
Cases with spontaneous breathing using an artificial
airway
Ideal for laryngeal mask (Ppeak reduced compared with
mechanical ventilation with equal TV)

69
Q

Advantages of Volume Controlled Ventilation

A
  • Constant tidal volume
  • Consistent alveolar ventilation
  • Easily identify changes in PIP and Pplat as respiratory
    mechanics change
70
Q

Advantages of pressure controlled ventilation

A
  • PIP and peak alveolar pressures are constant
  • Flow varies with patient demand
71
Q

Advantages of Pressure Control Ventilation-Volume Guarantee

A
  • Targeted tidal volume
  • Pressure automatically adjusts based on
    lung compliance and airway resistance
  • Decelerating waveform
  • Variable inspiratory flow to meet
    patient’s demand
72
Q

Disadvantages of VCV modes

A

Constant flow rate
* Increase in potential asynchronies
* Varying pressures

73
Q

Disadvantages of PCV modes

A

Varying tidal volumes

74
Q

Disadvantages of PCV-VG Mode

A

Pressure adjusts based on the tidal volume
of the last breath
* Asynchronies may occur with variable
patient effort

75
Q

How is tidal volume changed in reduced lung compliance?

A

Smaller Tidal Volume delivered

76
Q

How do ventilators generate gas flow?

A

by creating pressure gradient between the proximal airway and the alveoli.

77
Q

four phases of the ventilatory cycle:

A

Inspiration
◦ Transition from inspiration to expiration
◦ Expiration
◦ Transition form expiration to inspiration

78
Q

Termination of the inspiratory phase can be triggered
by what and depends on?

A

Preset limit of time
◦Set inspiratory pressure that must be reached
◦Predetermined tidal volume that must be delivered

depending on the ventilators mode at that moment.

79
Q

In the expiratory phase, flow out of the lungs is determined by

A

Airway resistance and lung compliance

80
Q

This phase, together with the transition
from I to E phase, determine the
ventilator mode

A

transition from E: I

81
Q

VCV
◦ Vt and RR are

A

Fixed

82
Q

PCV
◦ PIP and RR are

A

Fixed

83
Q

Double circuit system ventilator
Contains a free breathing valve that allows

A

outside air to enter the rigid drive chamber and the bellows to collapse if the patient generates negative pressure during mechanical ventilation.

84
Q

Peak Inspiratory Pressure (PIP)

A

Is the highest pressure generated during an inspiratory cycle

85
Q

PIP is an indication of

A

Dynamic Compliance

86
Q

Plateau pressure (PP) is measured
during

A

an inspiratory pause (a time of no gas flow)

87
Q

Plateau pressure is an indication of

A

static compliance

88
Q

Pulmonary edema
◦ T-berg
◦ Pleural effusion
◦ Ascites
◦ Peritoneal gas insufflation
◦ Tension pneumothorax
◦ Endobronchial intubation
all indicators of

A

decreased pulmonary compliance

89
Q

Kinked ETT
◦ Bronchospasm
◦ Secretions
◦ Foreign body aspiration
◦ Airway compression
◦ ETT cuff herniation
All indicators of

A

Increased airway resistance

90
Q

Increased PIP and PP indicates

A

Increased Vt
◦ Decreased pulmonary compliance

91
Q

Increased PIP and unchanged PP

A

◦ Increased inspiratory gas flow rate
◦ Increased airway resistance

92
Q

A target variable

A

one that can reach and maintain a preset level before inspiration
ends, it does not end inspiration
◦ Also known as limit variables

93
Q

In PCV, Tidal Volume (Vt) is

A

variable

94
Q

In VCV, Tidal volume (Vt) is

A

Constant

95
Q

In PCV, PIP is

A

Constant

96
Q

In VCV, PIP/ Pplat is

A

Variable

97
Q

In PCV, flow pattern and peak flow are

A

Variable

98
Q

In VCV, Flow pattern and peak flow are

A

Set

99
Q

In PCV and VCV, inspiratory time is

A

SET

100
Q
A
101
Q
A

Anesthesiologist Assistant (12 decks)

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