Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RTH 236 > APRV > Flashcards

APRV Flashcards

1
Q

What are the advantages of APRV?

A
  • uses lower peak and mean airway pressures
  • increases cardiac index
  • decreases central venous pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the open lung approach?

A

high peep, low lung pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the best mode to help limit lung damage?

A

low volume settings adjusted to maintain plateau pressures between 25-30 cmH2O simulating PCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some lung protective strategies?

A
  • ALI and ARDS
  • keep plateau pressures <30 cmH2O
  • low tidal volume ventilation (4-6 mL/kg)
  • peep to restore FRC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the current strategies for ventilating between upper and lower inflection points?

A
  • increase MAP while limiting peak alveolar pressure
  • preventing alveolar collapse by ventilating above the lower inflection point
  • preventing over distention by ventilating below the upper inflection point
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is BiLevel in comparison to APRV?

A

a form of pressure ventilation designed to embrace dual peep levels and inspiratory/expiratory times that allow traditional PC-like breath delivery to APRV-like breath delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the four main settings in APRV?

A

P-high
P-low
T-high
T-low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

P-high and P-low are specific independent settings, therefore what happens to P-high when you raise P-low?

A

does not change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If your P-low is set to 5 and you P-high is set to 15, what is your set PS?

A

15 cmH2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If your P-low is set to 5, your P-high is set to 15 and your PS is 15, what are all spontaneous breaths at P-high supported by??

A

5 cmH2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does bilevel look similar to PCV-SIMV?

A

by setting P-high, T-high and frequency close to typical ventilation settings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the clinical advantages to spontaneous breathing at 2 peep levels?

A
  • a potential decrease in sedation (sedation due to patient/ventilator dyssynchrony may be kept at a lower level)
  • less sedation could result in: less interaction with other organ function, patients can be mobilized easier, an active cough may improve secretion removal, inability to identify complications that can be masked by sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does spontaneous breathing ventilation differ from paralyzed patients?

A

it provides ventilation to dependent lung regions which get the best blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does paralyzed ventilation differ from spontaneous breathing?

A

during PPV for paralyzed patients, the anterior diaphragm is displaced towards the abdomen with the non-dependent regions of the lung receiving the most ventilation where the perfusion is the least

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is there mechanical breathing in APRV?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is APRV?

A

utilizes very short expiratory time. this short time at a low pressure allows for exchange of gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the critical setting in APRV?

A

T-low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is T-high used in APRV?

A

it varies with frequency changes and merely determines the interval that the lungs are held at P-high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When should you consider APRV?

A
  • bilateral infiltrates
  • p/f ratio <300 and falling
  • plateau pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the goals with APRV? (first five)

A
  • to prove LPV supported by the ARDSnet research
  • minimize alveolar over distension
  • avoid repeated alveolar collapse and reexpansion
  • restore FRC through recruitment and maintain FRC by creating intrinsic peep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the goals with APRV? (last five)

A
  • lower FIO2
  • protect lungs
  • make patient comfortable
  • use less sedation
  • wean patient off the ventilator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the three types of lung units in ARDS pattern?

A
  • normal region (primarily non-dependent area)
  • consolidated, edematous, atelectatic region (dependent area)
  • region that is collapsed during exhalation and recruitable during inspiration
23
Q

What are the clinical advantages to spontaneous breathing in ARDS during APRV?

A
  • APRV with spontaneous breathing showed a decrease in V/Q mismatch that increased over time
  • spontaneous breaths in APRV as small as 70-150 mL in adults improved oxygenation and CO2 removal
24
Q

What are the similarities of APRV to high frequency ventilation?

A
  • both hold lungs at near constant lung MAP, limiting pressure swings
  • both shown to be effective in decreasing dead space, improving gas exchange, increasing cardiac output
  • APRV is accomplished with a conventional ventilator, a conventional circuit and is less technically challenging
25
Q

What is high frequency ventilation?

A

breathing in and out at the same time. like filling a glass all the way and still put in water so it over flows

26
Q

Who are poor candidates for APRV?

A
  • patients with increase RAW
  • patients who are unable to empty their lungs in 2 seconds
  • asthma and COPD patients
27
Q

What is a reliable indicator that tells if a patient is a poor candidate for APRV?

A

examine their expiratory flow pattern to determine increased resistance

28
Q

What are the APRV clinical guidelines?

A
  • APRV has been suggested for restrictive patients only (obstructive easily develop air trapping)
  • start early with CPAP and switch to APRV as CO2 clearance and/or decreased work of breathing is desired
29
Q

How do you set up APRV?

A
  • P-high: set so plat is not above 30
  • P-low: 0
  • T-high: start at 5
  • T-low: start at 0.5
30
Q

Initial settings of P-high

A

typically about 20-25, however in patients with play at or above 30, set at 30 (in desperation can go to 35)

31
Q

What are the exceptions to setting really high P-high settings?

A
  • morbid obesity

- decreased thoracic or abdominal compliance

32
Q

What should you set P-low to and why?

A

zero because it creates the greatest pressure gradient and fast expiratory flows

33
Q

What is T-high and how should you set it?

A

the inspiratory time that is set to a minimum of 5 seconds, and is progressively increased. do NOT use rate of over 15. its target is oxygenation

34
Q

Establishing T-low

A

do not want to let exhalation go to complete emptying and regional auto-peep is desirable outcome

35
Q

How would you set T-low?

A

set time low so that expiratory flow from patient ends at about 75-50% of peak expiratory flow OR one time constant (i.e, if peak expiratory flow is 80 L/min, then “dump” should end when flow is between 60-40 L/min

36
Q

How would you improve oxygenation with APRV?

A
  • reduce sedation
  • re-assess peep (move towards 75%)
  • decrease T-low
  • increase P-high, T-high, FIO2
37
Q

What should you NOT do if a patient has a high CO2?

A

increase T-high

38
Q

What should you do if your patient has PaO2 that is too low?

A

decrease T-low

39
Q

What should be your goal for all oxygenation choices?

A

increase MAP

40
Q

How could you improve CO2?

A
  • reduce sedation
  • upper pressure is adjusted to maintain dec WOB or O2 delivery goals
  • increase T-low and PS of spontaneous breaths
  • decrease T-high
41
Q

What are you doing when you increase P-high?

A

increasing the pressure gradient which increases flow

42
Q

What should you do to decrease CO2?

A
  • decrease T-high
  • increase P-high to increase change in pressure and volume exchange
  • check T-low and increase if possible
43
Q

What should you do to increase CO2?

A
  • increase T-high
  • decrease P-high to decrease change in pressure
  • it may be better to accept hypercapnia than to reduce P-high so much that oxygenation decreases
44
Q

What are the disadvantages of APRV?

A
  • potential for alveolar de-recruitment during the pressure release
  • APRV is affected by changes in lung compliance
  • if release phase is not synchronous with patient’s effort, discomfort may result
45
Q

What patients should you be cautious with using APRV?

A
  • patients that have COPD, asthma or any other type of air trapping disease
  • barotrauma could be a side effect
46
Q

What are the overall advantages?

A
  • spontaneous breathing
  • maintains peak airway pressures at CPAP levels (over distention minizmed)
  • continuous lung recruitment maneuver
47
Q

What should you accomplish before weaning from APRV?

A
  • FIO2 40-50%
  • reduce P-high by 2 until it is below 20
  • increase T-high to change vent set rate by 5 releases/time
48
Q

What is DROP and DRAG?

A

DROP- drop P-high in increments of 1-3 (usually about 2)
DRAG- increase T-high
^do the above until it looks just like CPAP

49
Q

For a P/F ratio of greater than or equal to 300, what should your estimated MAP requirements be?

A

10-15 cmH2O

50
Q

For a P/F ratio of greater than or equal to 250, what should your estimated MAP requirements be?

A

15-20 cmH2O

51
Q

For a P/F ratio of greater than 200, what should your estimated MAP requirements be?

A

20-25 cmH2O

52
Q

For a P/F ratio of greater than 150, what should your estimated MAP requirements be?

A

25-30 cmH2O

53
Q

For a P/F ratio of greater than 100, what should your estimated MAP requirements be?

A

30-35 cmH2O

RTH 236 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions