CC 02 advanced mechanical vent modes

Question 1

In PCV, when does the vent cycle the breath into exhalation?

Answer 1

It will maintain the pressure until the i-time has been reached at the **end of inspiration.

Question 2

4 advantages of PCV

Answer 2

increased oxygenation/gas exchange, lower peak pressures, lower peep, decreased chance of CV effects

Question 3

2 main disadvantages of PCV

Answer 3

barotrauma and auto-peep

Question 4

What PiP do you want to stay under in PCV to avoid barotrauma

Answer 4

<50-60 cmH2O

Question 5

If auto PEEP occurs, what setting do you need to change if in PCV

Answer 5

decrease the i-time

Question 6

If the pt is getting better while in PCV, what will change on the vent?

Answer 6

The vent will show an increase in the Tidal volume given to the pt while at the same dialed in pressure

Question 7

What type of LC will you see in pt that will be on Pressure control

Answer 7

Pt with low compliance such as ARDS

Question 8

What are the ways to change minute ventilation in pressure control?

Answer 8

decrease the PiP, decrease the i-time, decrease RR

**These can all be manipulated to lower minute ventilation

Question 9

How to go from volume control to pressure control (3 ways)

Answer 9

1. Obtain a plateau pressure (by using inspiratory hold
2. Look at the PiP value in VC and subtract 5 from it
3. Increase the PiP gradualy to reach target Tidal Volume

Question 10

When swapping to pressure control, what three settings remain the same

Answer 10

1, The rate

2. PEEP
3. FiO2

Question 11

If you have a SET I-TIME, increasing the RR will do what?

Answer 11

shorter because more breaths will equal shorter breaths, but the i-time is pre-set so the E TIME will decrease.

Question 12

with a SET I:E RATIO how will decreasing RR change the ratio?

Answer 12

Decreasing the RR will increase i AND e time

Question 13

How is auto PEEP measured?

Answer 13

using an expiratory hold

Question 14

What is PEEP that we did not set on the ventilator?

Answer 14

this is called auto-PEEP

Question 15

If someone is in inverse ratio ventilation, what must be done?

Answer 15

the pt requires sedation because of how uncomfortable it is

Question 16

Three settings that are put in by the RT for PCV

Answer 16

rate, i-time, and inspiratory pressure

Question 17

Why do patients in pressure control usually need to be babysat?

Answer 17

As their disease process changes, the lung compliance will also change allowing for varying tidal volumes

Question 18

Is there a set rate in APRV?

Answer 18

No

**This is calculated by adding the t high and t low parameters

Question 19

In APRV what is the P-high that we want to avoid distension?

Answer 19

Want to keep it less than 35

Question 20

4 modes that you can extubate from

Answer 20

1 CPAP
2 SIMV (with low rates)
3 PS
4 Flow-by

Question 21

Which vents have ‘automodes’

Answer 21

The Servo I & U ventilators

Question 22

three partner modes on the Servo (automodes)

Answer 22

PCV —-> PSV
AC-VC —-> VS
PRVC —- VS

Question 23

What three criteria determine the ‘optimal PEEP’

Answer 23

best LC, with least negative CV effects, and best PaO@

Question 24

biggest problem with nitric oxide therapy

Answer 24

Nitrogen binds with oxygen creating NO2 (nitrogen DIOXIDE)

Question 25

How do you prevent nitrogen dioxide development?

Answer 25

before you put the line on the ventilator, you will ‘bleed out’ what is currently sitting in the line (this is what is most likely to contain the nitrogen dioxide)

Question 26

When hooking up the NO line to the vent, where is it connected?

Answer 26

it will attach to the DRY SIDE of the vent, before the humidifier

Question 27

How can iNO therapy lead to pulm edema, hemorrhage, and death?

Answer 27

By creating nitrogen dioxide (oxygen combining with nitric oxide).
**Becomes a problem when NO2 levels become greater than 10ppm

Question 28

iNO is indicated for what pt?

Answer 28

ARDS or primary pulmonary HTN

Question 29

P high and P low starting values

Answer 29

These settings are only in the APRV mode
P-high = 15-30cmH2O
P-low = 0-15cmH2O

Question 30

Time low/Time high initial settings

Answer 30

APRV mode:
T-low = 0.5-1.0 seconds
T-high = 4 sec minimum
**can increase T-high to 12-15 seconds but in small increments until increase in oxygenation occurs

Question 31

What values in APRV will help oxygenation?

Answer 31

Time high

Question 32

What can be changed in APRV to effect PaCO2 levels?

Answer 32

Time low

Question 33

Two side effects of iNO

Answer 33

methemoglobin and development of NO2

Question 34

Inverse ratio ventilation improves…..

Answer 34

oxygenation and recruitment