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Mechanical Ventilation > Basics of Mechanical Ventilation > Flashcards

Basics of Mechanical Ventilation Flashcards

1
Q

What are the indications for intubation/mechanical ventilation?

A

1) airway protection 2) hypoxemic and/or hypercarbic respiratory failure 3) elective procedures

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2
Q

What is the control variable in assist control pressure control (ACPC) ventilation?

A

The clinician sets the designated pressure delivered with every breath

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3
Q

What is the control variable in assist control volume control (ACVC) ventilation?

A

The clinician sets the tidal volume of each breath

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4
Q

What are conditional variables?

A

They are the dependent variables in mechanical ventilation (e.g. in volume control, tidal volume is the set paramter and the pressure is the conditional variable (as it varies from breath to breath while tidal volume remains constant)

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5
Q

What is the trigger?

A

The factor that initiates inspiration (pressure-trigerred, flow-triggered, vs time-triggered)

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6
Q

What is the cycle?

A

The determination of the end of inspiration, and the beginning of exhalation (the vent can be volume, pressure, or time cycled)

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7
Q

What is airway resistance, and the normal value?

A

Resistive forces encountered during mechanical respiratory cycle. Normal airway resistance is <5 cmH2O

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8
Q

What is lung compliance?

A

Elasticity of the lungs, or the ease with which they stretch and expand to accomodate a change in volume or pressure

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9
Q

What is an example of poor lung compliance?

A

Difficulty with INHALATION process from HIGH elastic recoil (restrictive lung disease, such as pulmonary fibrosis)

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10
Q

What is an example of high lung compliance?

A

Difficulty with EXHALATION process from LOW elastic recoil (obstructive lung disease, COPD/asthma)

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11
Q

What is decruitment?

A

Loss of gas exchange surface 2/2 atelectasis, minimized by increasing PEEP

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12
Q

What is recruitment?

A

Restoration of gas exchange surface area by applying PEEP to re-open collapsed or atelectatic areas of lung

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13
Q

What patient factor should be used in determining ventilator settings?

A

PREDICTED body weight

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14
Q

T/F - ventilator settings are determined using actual body weight

A

FALSE – never use actual body weight to determine vent settings

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15
Q

What is the formula for predicted body weight (PBW) for men?

A

PBW (kg) = 50+2.3 (height(in)–60)

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16
Q

What is the formula for predicted body weight (PBW) for women?

A

PBW (kg) = 45.5+2.3 (height(in)–60)

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17
Q

what is the initiation phase of mechanical breathing?

A

start of the mechanical breath, triggered by the patient or the machine (with a patient triggered breath, you will notice a slight negative deflection)

18
Q

What is the inspiratory phase of a mechanical breath?

A

portion of mechanical breathing during which there is a flow of air into the pt’s lungs to achieve PIP (peak inspiratory pressure, or Ppeak) and TV (tidal volume)

19
Q

What is the plateau phase?

A

can be checked as a diagnostic maneuver to assess the plateau pressure, but does not routinely occur in mechanically ventilated breaths

20
Q

What is mechanical exhalation?

A

The passive process in mechanical breathing, can be volume cycled (when a maximum TV is achieved), time cycled (after a set number of seconds), or flow cycled (after achieving a certain flow rate)

21
Q

What is PIP (or Ppeak), and the target value?

A

Peak Inspiratory Pressure, the maximum pressure in the airways at the end of the inspiratory phase. Determined by both airway resistance and compliance. Target is <35 cmH20

22
Q

What is Pplat, and the target value?

A

Plateau pressure, the amount of pressure that remains in the alveoli during the plateau phase during which there is a cessation of air flow, or with a breath-hold. It reflects compliance in the airways. Target is <30 cmH2O

23
Q

What is PEEP?

A

Positive End Expiratory Pressure, the positive pressure that remains at the end of exhalation, prevents atelectasis. Target is 5 cmH20 or greater

24
Q

What is instrinsic PEEP?

A

The pressure that remains in the lungs due to incomplete exhalation (air trapping). Also called auto-PEEP

25
Q

How can intrinsic PEEP be measured on the vent?

A

Press the “expiratory pause” or “expiratory hold” button on the ventilation

26
Q

What is driving pressure? delta P

A

the pressure exerted to expand the lungs (delta P = Pplat - PEEP)

27
Q

What is iTime?

A

Inspiratory time, the time allotted to deliver the set VT or pressure

28
Q

What is eTime?

A

Expiratory time, the time allotted to fully exhale the delivered mechanical breath

29
Q

What is I:E ratio?

A

Inspiratory to expiratory ratio, usually expressed as 1:2, 1:3, etc. Can be set directly on the vent, or indirectly by changing the inspiratory time, the inspiratory flow rate, or RR

30
Q

How does one decrease the I:E ratio?

A

Increasing the expiratory time by convention (e.g. divide by a greater number)

31
Q

What is peak inspiratory flow, and a common target?

A

the rate at which the breath is delivered expressed in L/min, usually 60L/min. Can indirectly affect I:E ratio – increasing the flow rate delivers the breath faster, leaving more time for exhalation

32
Q

What is VT, or TV?

A

Tidal volume, the volume of gas delivered to the pt with each breath, expressed in both mL and mL/kg of PDW

33
Q

What is RR, or f?

A

Respiratory rate, the mandatory number of breaths delivered by the vent per minute which can vary from actual pt’s respiratory rate and both should be reported on rounds

34
Q

What is VĖ, Vė, or MV, and the target?

A

Minute ventilation, the ventilation the pt receives in one minute calculated by VT x RR expressed in L/min. Target is 4-6L/min in normal healthy adults, but may require 12-15L/min in critical illness

35
Q

What is FiO2?

A

Fraction of inspired O2 delivered during inspiration, expressed as a percentage, the vent can deliver up to 100% FiO2 (room air is 21%)

36
Q

What is AC ventilation?

A

Assist control (either AC/PC or AC/VC), one of the safest modes of ventilation, the patient receives the same breath each time determined by clinician parameters. The patient can over-breathe the set rate

37
Q

What is SIMV?

A

Synchronized intermittent mandatory ventilation, can be volume or pressure controlled (SIMV-VC vs SIMV-PC). Unlike AC, additional breaths triggered by the patient will only receive pressure support or CPAP (vs AC where additional pt breaths they receive what the vent gives)

38
Q

What s PRVC?

A

Pressure Regulated Volume Control, type of assist control that combines the best attributes of volume control and pressure control to reduce lung injury from excessive pressure. Tidal volume is set at the lowest possible pressure. If pressure reaches a predefine maximum level, the vent will stop airflow and cycle into exhalation. Pressure target is adjusted based on lung compliance

39
Q

What is Pressure Support?

A

Patient triggered breaths, partial support mode in which the pts receives a constant PEEP as well as a supplemental “supporting” pressure set by the clinician, dependent variables are peak inspiratory flow, RR, and TV determined by pt effort

40
Q

What is NIPPV?

A

Noninvasive positive pressure ventilation, either CPAP or BiPAP and pt’s airway is not secured with an endotracheal tube but given either by facemask or nasal prongs

41
Q

What is CPAP?

A

Continuous Positive Airway Pressure, a partial support mode of ventilation, the pt receives a constant airway pressure throughout the respiratory cycle. Driven by pt effort, thus pt must be awake, minimally sedated, and able to take spontaneous breaths

42
Q

What is BiPAP?

A

Bilevel Positive Airway Pressure, in which pt receives two levels of airway pressure throughout the respiratory cycle. The higher pressure IPAP (inspiratory) is similar to the peak airway pressure setting, and the lower pressure EPAP (expiratory) is similar to PEEP and helps maintain alveolar distention

Mechanical Ventilation (1 decks)

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