APRV Flashcards
Why would a person use APRV?
A. Increase oxygenation by increasing plateau & mean pressures
B. increasing MAP without excessively increasing Plateau
C. Using protective lung strategies for ards or ali
D. All of the above
E. A & B only
F. A & C only
G. B & C only
G: used to increase MAP without excessively increasing plateau pressures
Which of the following would suggest that a patient is ready to be weaned from a vent? A. VC of 8 ml/kg IBW B. Pimax of -15 cmH2O C. Vd/Vt of 0.75 D. f/Vt of 90 breaths/min/l
D. f/Vt of 90 breaths min/l
or aka RSBI
All of the following are closed loop weaning modes except? A. VSV B. ASV C. MMV D. Tpiece trials
D. T-piece trials
A resp therapist should consider ending an SBT under which circumstance?
A. RR increases from 20 to 25 b/min
B. The Vt decreases from 350 mL to 200 mL
C. Systolic blood pressure decreases from 150 to 135 mmHg
D. HR increases from 90-100 bpm
B. Vt decreases from 350 to 200
Which of the following would indicate the potential for airway edema after extubation? A. Pimax B. VC C. Cuff leak test D. SpO2
C. Cuff leak test
What is the first recommendation to be followed by ACCP/SCCM/AARC in weaning a patient?
Resolution of the problem which caused the mechanical ventilation
A patient has ALS and has a trach in place; He has been unable to perform an SBT and has been on mechanical ventilation for 4 months. A good recommendation for the patient is which? 1. Transfer to long term care facility 2. Evaluation for use of NIV 3. Termination of ventilation 4. Waiting until the primary cause of respiratory failure has been resolved A. 1 and 2 B. 2 and 3 C. 1, 2, and 3 D. 1, 2, and 4
A. 1 and 2
Once a patient has been successfully weaned from vent support, assessment of the airway for extubation would include all of the following except: A. ability to mobilize secretions B. Presence of strong cough C. Successful cuff leak test D. Normal breath sounds
D. Normal breath sounds
A patient has the following numbers on vent support and is being evaluated for possible weaning. Male: 5'6" tall and on VC-SIMV; No spont resp efforts; Vt=650, f=6, FIO2=.40, Ph=7.3; PaCO2=58; PaO2=75; What is the most appropriate ventilator change at this time? A. Implement PEEP B. Increase Vt C. Increase f D. Begin SBT
C. increase f
Which of the following are advantages of MMV?
1. The machine responds automatically to changes in Ve
2. Abrupt changes in CO2 from a drop in spontaneous ventilation can be avoided
3. Alveolar ventilation is monitored
4. Much lower FIO2 can be used
A. 1 and 2
B. 2 and 3
C. 1, 2, and 3
D. 2, 3, and 4
A. 1 and 2
If a patient fails and SBT what should the clinician do?
A. Determine the cause of the failure and correct if possible
B. Place the patient on full support for 8 hours & then repeat
C. Obtain an ABG
D. Switch to artificial intelligence system for weaning
A. determine cause and corrrect
ATC can best be described as?
A. Variable PS with variable inspiratory flow compensation
B. Low level PS with fixed flow cycling criteria
C. MMV
D. Adaptive support using PS
A. variable PS with variable inspiratory flow compensation
Compared to PCIRV – Advantages of APRV include: 1. APRV uses lower peak and mean airway pressures, 2.Increases cardiac index, 3. Decreases central venous pressure 4. Higher oxygenation of dependent regions A. 1 and 2 B. 1, 2, and 4 C. 1, 2, and 3 D. 2, 3, and 4
C. 1, 2, and 3
T or F: During PPV (paralyzed patient), the anterior
diaphragm is displaced towards the abdomen
with the non-dependent regions of the lung
receiving the most ventilation where
perfusion is the least.
True
T or F: Spontaneous breathing vs PPV is best for getting ventilation to the independent lung regions where perfusion is needed.
False
Spontaneous breathing provides ventilation to
dependent lung regions which get the best blood flow,
as opposed to PPV with paralyzed patients
Where is perfusion best in terms of zones of the lungs?
A. In non dependent regions such as zone 1
B. In zone 2
C. In zone 3 the dependent regions
D. All are equally useful in perfusion
C. in zone 3 the dependent lung regions
When instituting lung protective strategies what is the correct method when looking a pressure? A. Keep MAP below 30 cm H2o B. Keep PIP below 30 cm H2o C. Keep MAP between 30-35 cmH2o D. Keep Plateau less than 30 cmH2o
D. Keep Plat pressure less than 30 cmH2o
Where should tidal volume be set when using lung protective strategies?
Between 4-6; starting at 6 and titrating down as needed to keep plat below 30
What purpose does PEEP have in lung protective strategies?
restoring FRC
What is a way that you can use PS to overcome Raw in APRV setting?
A. Set your PS 5 below your P high
B. Set your PS to equal the difference of P high and P low
C. Set PS at same level of your P high
D. Set PS at same level of your P low
C. Set PS at same level of your P high to overcome airway resistance
What is the earliest method to determine the onset of ARDS? A. Evaluation of xray B. Change in Saturation C. Increase in PaCO2 D. Change in compliance
D. Change in compliance is the first indicator to the onset of ARDS
T or F; With APRV we do not want intrinsic Peep
False
In an adult patient if you have a PC of 20; RR 15 and PEEP of 5 what would you expect your platform pressure to be?
25 cmH2O
T or F: If a patient is not spontaneously breathing than you cannot use an APRV mode
False;
The point at which alveoli will remain open is called?
Historesis
In APRV you would expect your pressure gradient to go from:
1. High to low
2. Low to high
3. Spontaneous breathing to occur at the upper points
4. Higher mean airway pressures than with conventional ventilation
A. 1, 3, and 4
B. 1 and 3
C. 1 and 4
d. 2 and 3
A. 1, 3 and 4
Advantages of APRV over conventional ventilation in ARDS patients include: 1. Improved v/q 2. Spontaneous breathing 3. Larger VT 4. Smaller breaths used to remove CO2 but steady stream of gas with high frequency of HFO A. 1 only B. 1 and 2 C. 1, 2, and 3 D. 1, 2 and 4
D. 1, 2 and 4
Poor candidates for APRV include all of the following except:
A. Patients with increased airway resistance
B. Patients with ALI
C. Asthma & COPD patients
D. Patients who cannot empty their lungs in less than 2 seconds
B. patients with ALI are good candidates for APRV
Where should you set your 4 settings initially on APRV?
P high = 30
P low = 0
T high = 5
T low = 0.5
T or F: an obese person may need higher p high settings possibly above 30.
True
T or F: A patient with obstructive lung disease may need a longer t low setting possibly at 0.5 to 1.5 seconds
True
In order to optimize your I time you should have it at _____% of peak pressure in conventional ventilation; but in APRV want I time set at ______% of peak
25%
75% of peak in aprv
T or F: In press control bi level PEEP H does not change if PEEP L is raised
True
T or F: APRV would not be a good mode to use during weaning of an ARDS patient; they should be changed to a different weaning mode.
False
T or F: During APRV all spontaneous breathing is done at the lower pressure level.
False: All spontaneous breathing is done at upper pressure level
APRV normally uses a _______ expiratory time.
A. Shorter
B. Longer
A. Shorter
APRV is similar but utilizes a very short expiratory time
for PRESSURE RELEASE
T or F: In APRV T high will vary with frequency changes
True
T or F: One way to determine if someone may have right heart failure is if there pulmonary artery occlusion pressure (PAOP) is greater than 18 mm Hg
False: PAOP is used to determine left heart failure in which you may not want to use APRV
T or F: Reasons to consider APRV would be if bilateral infiltrates are detected and P/F ratio is less than 300, and plat pressure is greater than 30.
True
The main causes of hypoxemia in ARDS patients is: 1. Alveolar Collapse 2. Reduction FRC 3. Reduction of Vt 4. Reduction of VC A. 1, 2, and 3 B. 1, 3, and 4 C. 1 and 2 D. All of the above
C. Alveolar collapse and reduction in FRC are main causes of hypoxemia in Ards
T or F: APRV has been suggested for restrictive patients
only
True: Obstructive patients may develop severe air trapping
Your respiratory rate determines your dumps in APRV and should be no greater than ______.
15
If you have 50% decelerating and you want to get it to 75% how can you fix?
Shorten your t-low
T-low is: A. Frequency of dumps B. Size of dumps C. Amount of pressure D. Amount of PaCO2
B. Size of dumps
T high is: A. Respiratory Rate B. Number of dumps C. Size of Dumps D. A & B E. A & C
D. T high is RR & number of dumps
To improve oxygenation what can you do: 1. Remove a dump 2. Add a dump 3. Increase t high 4. Increase p high 5. Increase t low 6. Decrease t high A. 1, 2, 3, 4, and 5 B. 1, 3, 4 C. 4, 5, 6 D. 5 and 6
B. To improve O2: Increase t high; this will remove a dump; Increase p high
When you set T high what variable are you targeting?
Oxygenation
If T high increases what happens to your frequency?
Decreases RR and removes a dump
What important variable can you affect when you change the duration of Plow?
Your decelerating wave form
What is the function of P high? 1. Maintains adequate lung volumes 2. Facilitates dumping 3. Promotes alveolar recruitment 4. Allows reduction in the lung for exhale A. 1, 2 and 3 B. 1, 3, and 4 C. 1 and 2 D. 1 and 3
D. 1 and 3
P high maintains adequate lung volume and promotes alveolar recruitment
Where does dumping take place?
A. P high
B. P low
B. P low
To decrease PaCO2 you can: 1. Decrease T high 2. Increase T high 3. Increase P high 4. Decrease P high 5. Increase T low A. 1, 3, 5 B. 1 and 3 C. 1 and 4 D. 1, 4, and 5
D. 1, 4 and 5
To decrease PaCO2 you can decrease T high
Increase P high
Increase t low to allow more time for exhale
What would you do to increase your alveolar ventilation?
Increase P high
To increase PaCO2 you would: 1. Increase t high 2. Decrease T high 3. Decrease P high 4. Increase P high A. 1, 4 B. 1, 3 C. 1 D. 4
B. To increase PaCO2 you increase t high and decrease p high
When you increase oxygenation what happens to pressure?
MAP increases
What problem with decreasing P high to increase PaCO2 is?
A. Increases oxygenation & MAP
B. Can decrease oxygenation
B. Decreases oxygenation; better to have hypercapnia than take a hit on oxygenation
\_\_\_\_\_\_ is identical to CPAP? A. P high B. P low C. T high D. T low
A. P high
\_\_\_\_\_\_\_\_ is pressure level in which lung is released down for exhale, aka end exp peep A. P high B. P low C. T high D. T low
B. P low
\_\_\_\_\_\_\_ is where dumping takes place. A. P high B. P low C. T high D. T low
B. P low
______ is set at 75% of peak and affects your duration of P low
A. P high
B. T high
C. T low
C. T low
\_\_\_\_\_\_\_ is synomynous with RR. A. P high B. P low C. T high D. T low
C. T high; It is inversely related to RR
If you increase T high you decrease RR
If you increase your T-high you: 1. Increase oxygenation 2. Increase MAP 3. Decrease number of dumps 4. Decrease PaCO2 A. 1, and 2 B. 1 and 3 C. 1 and 4 D. 1, 2, and 3 E. 1, 3, and 4
D. Increase of T high will:
Increase oxygenation
Increase MAP
Decrease number of dumps (reducing RR)
T or F: Increasing your PS of spontaneous breaths and reducing sedation are another way of improving ventilation.
T
T or F: An increase in T high will decrease PaCO2
False, an increase in T high will decrease RR and increase PaCO2
When weaning from APRV you want to _____ and _____.
Drop and Drag
Drop P high and Drag T high
In weaning from APRV you want your P high to be below ______.
20
In weaning you want your to high to change how?
You want T high increased as such as to change vent rate by 5 releases a minute
T or F: if a patients Respiratory Rate increases then the T high level can vary and would decrease?
True
One of the most critical settings in APRV is?
T low
______ determines level where lungs held at peep high.
T high
The pressure gradient in APRV is ____ to ____.
High to low
T or F: ASV is a form of volume ventilation ventilation where instead of guessing at a pressure (and
VT) - a minimum minute ventilation is set for the
patient
False: ASV is a pressure ventilation
What is only knob you set in ASV?
% Min Vol
If your graphic in ASV shows a vertical/rectangular box what condition does the patient have?
A. Obstructive
B. Restrictive
C. Normal
A. Obstructive
If your graphic shows a square box what condition does your patient have?
A. Obstructive
B. Restrictive
C. Normal
C. Normal
If your graphic in ASV shows a horizontal, long or wide in length what condition does your patient have?
Restrictive
If you need to reduce the WOB what would you do in ASV mode? A. Decrease % Min Vol B. Increase % Min Vol C. Increase RR D. Change Modes
B and Possibly D if cannot correct
What setting would you adjust and how if you PaCO2 were too high in ASV?
Increase % MV
Pay attention to
inspiratory pressures
If your patient has a high respiratory drive what can you do in ASV?
Consider Increase in
%MinVol or sedation
If your saturation is too low in ASV how would you correct?
Add PEEP or increase your FIO2
When setting ASV what determines the Min Volume?
IBW and Min Vol %
What Min Vol % should you use with COPD or HME?
100 - 110%
How does the vent in ASV meet its goals?
It does 5 test breaths
T or F: ASV is can be used for full support or weaning
True
If % MV is decreased what happens to VT and rate?
They will also decrease
T or F: A drawback of ASV is that it may allow shallow breathing if rates fall below target
False; ASV will not allow due to PS
What is the best way to monitor patients in ASV?
Via Graphics
T or F: In ASV spontaneous and mechanical breaths are all pressure controlled.
False: Spontaneous breaths are pressure support and mechanical are pressure controlled
When ready to wean from ASV what do you do?
Change MV% to 50%
T or F: In ASV the focus in weaning is to decrease the PS as much as possible
False; Focus in ASV is to focus on patient tolerance
