Block 2 Unit 2- Mechanical Ventilations Flashcards
What is Tidal Volume?
Amount of air (mL or cc) delivered to the patient in a single inspiratory breath
Tidal Volume averages for males are ___mL and females ___mL
Tidal Volume averages for males are 500mL and females 400mL
What is Minute Ventilation?
The amount of air breathed per minute
Calculated by Tidal volume x respiratory rate
(TV x RR)
Minute Ventilation average is _ liters
Minute Ventilation average is 6 liters
What is Peak Inspiratory Pressure?
During inhalation, the highest level of pressure applied to the lungs
Average PIP is __ mmHg
Average PIP is 12 mmHg
What is Plateau Pressure?
The pressure that is left in the lung after the tidal volume has been delivered
What is indicated for this patient?
mechanical ventilation
What is respiratory failure type 1?
Type I Hypoxia- PaO2 < 60 mmHg with a normal or subnormal PCO2 (35-45 mmHg)
Shunting, dead space, hypoventilation, diffusion and asthma
What is respiratory failure type 2?
Type II- PCo2 > 50mmHg, Poor gas exchange
What is the lab value for mild hypoxemia?
Mild Hypoxemia: 60-80 mmHg
What is the lab value for moderate hypoxemia?
Moderate Hypoxemia: 40-60 mmHg
What is the lab value for severe hypoxemia?
Severe Hypoxemia < 40 mmHg
What is V/Q Mismatch?
lung receiving oxygen without blood flow or blood flow without oxygen
What is the percentage of O2 in room air?
21%
What can occur in patients receiving FiO2 > 60% for prolonged durations?
oxygen toxicity
Which setting of the vent maintains positive airway pressure to prevent alveolar collapse?
Positive End Expiratory Pressure (PEEP)
What are the Non-Invasive modes on a ventilator?
• Bi-level Positive Airway Pressure (BiPAP)
• Continuous Positive Airway Pressure (CPAP)
What indications would place a patient on a Continuous Positive Airway Pressure (CPAP)?
• not able to maintaining saturation levels on nasal cannula
• Tachypnea and Dyspnea due to hypoxic or hypercapnic respiratory failure
• Patient able to maintain their airway
• Patients control their own Respiratory rate and Tidal volume
Why is the BiPAP more comfortable for patients instead of the CPAP?
BiPAP can be more comfortable than CPAP because oxygen is delivered with each breath instead of continuously. It also allows for a higher pressure support if needed.
What dose Assist control do for the patient?
Patient receives a fixed tidal volume at set intervals and when they attempt to take a breath on their own.
Inspiratory pressure is controlled with the use of what?
PEEP
Control of peak pressure protects from what?
barotrauma (alveolirupture)
What does the ventilator do while on volume control?
Ventilator delivers a preset tidal volume with a constant flow during the preset inspiratory time at the preset respiratory rate.
What is VC primarily used in?
Utilized primarily in Pulmonary Fibrosis or ARDS due to ineffective elastin fibers/rigid lungs.
Assist Control (AC) primarily used in what?
ineffective lung compliance disorders.
What does the ventilator do during Synchronized Intermittent Mandatory Ventilation (SIMV)?
delivers a fully supported breath when time triggered.
When vent set to time-triggered ventilation, it will measure a period of time since last expiration and then delivera breath.
However, when breath is patient triggered, ventilator delivers pressure- supported breath (at a level set by the clinician).
size of the patient-triggered breath depends on lung compliance and patient’s effort.
What is Inverse-ratio Ventilation?
Inspiratory time exceeds expiratory time to improve oxygenation at the expense of ventilation
Most commonly used in ARDS
What is Airway Pressure Release Ventilation (APRV)?
An extreme version of IRV; inspiratory pressure applied for a prolonged period of time with a short expiratory time to allow for ventilation
When a mechanical ventilation breath is forced into the patient, the positive pressure tends to follow the path of least resistance to the normal or relatively normal alveoli, potentially causing over distention. What can happen to the alveoli when this occurs?
This over distention sets off an inflammatory cascade that augments or perpetuates the initial lung injury.
Cycle repeats causing trauma, which is called VOLUTRAUMA
What causes Barotrauma?
Excessive pressure in positive pressure ventilation as evidence by pneumothorax, pneumomediastinum, emphysema on chest x-ray
High pressure in the lungs usually from high PEEP
What causes Atelectotrauma?
Cyclical open and close of the recruitable lung area
What does PEEP do and help prevent?
PEEP is used to prevent alveolar collapse on exhalation, helping to prevent lung derecroupment and atelectotrauma
One of the most common causes of ventilator associated lung injury is?
Ventilator Associated Pneumonia (VAP)
__% of nosocomial (hospital acquired) pneumonias are associated with mechanical ventilation
80% of nosocomial (hospital acquired) pneumonias are associated with mechanical ventilation
with an incident rate of 5 to 10 cases per 1000 hospital admissions.
You have a vented patient who develops the following Sx:
• Fever
• Leukocytosis (increased white blood cell count)
• Decreased oxygenation with increasing O2 demands
• Increased tracheal secretions
• Chest x-ray will show a lot of white space
What is the Dx?
Ventilator Associated Pneumonia (VAP)
How is Ventilator Associated Pneumonia (VAP) Tx?
• Antibiotics
• Chest percussion as needed
• Continued VAP bundle
Weaning is the gradual withdrawal of the mechanical ventilator and the re-establishment of spontaneous breathing. Weaning starts by what?
lowering the FiO2, PEEP and sedation as tolerated by the patient.
What are the subjective assessment for weaning parameters?
Does the patient have:
• Adequate cough
• Absence of excessive secretions
• Reversal of the underlying cause for respiratory failure
• No continuous sedation infusion
What are the objective assessment for weaning parameters?
• Stable cardiovascular status
• No or minimal vasopressor or inotrope
• Adequate Oxygenation and Ventilation
*Weaning is a continuous process using the above criteria and individualized for each patient.
When a patient is agitated, what can happen to the ventilator?
it can cause ventilator Dyssynchrony- when the patient and ventilator are not in synchronization with ventilations, which triggers the alarm.
What is ventilator Dyssynchrony?
when the patient and ventilator are not in synchronization with ventilations, which triggers the alarm.
What is DOPE used for?
to troubleshoot ventilator alarms.
What is D stand for in the acronym DOPE?
Displacement – Improper placement or dislodgement of endotracheal tube will result in air going to the wrong place.
What is O stand for in the acronym DOPE?
Obstruction – Obstructions can occur due to buildup of fluid/mucus, as well as a restriction in the pathway of the tube such as water, or a kink in the ventilator tubing, or if the patient is biting on the ETT.
What is P stand for in the acronym DOPE?
Pneumothorax – Absent breath sounds, tracheal deviation, and jugular veindistention are all signs of a pneumothorax.
What is E stand for in the acronym DOPE?
Equipment – If none of these signs are present, a malfunctioning ventilator may be responsible for the problem. The patient should be disconnected and bag- valve mask ventilation should be used until the malfunction is either resolved or a new machine can be obtained
What is a normal PEEP for regular patients on room air?
5-10
