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BCAS CCP Program > CCP 108 - Fundamentals Of Mechanical Ventilation > Flashcards

CCP 108 - Fundamentals Of Mechanical Ventilation Flashcards

1
Q

Define “PEEP”

A

Peak End Expiratory Pressure

Prevents complete exhalation of volume to reduce atelectasis.

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2
Q

Define “SIMV”

A

Synchronized Intermittent Mandatory Ventilation

  • Guarantees a MINIMUM set breath rate at set volume or pressure and allows patient triggered breaths with pressure support (usually lower to facilitate pulmonary PT)
  • Patient triggered breaths are patient initiated and patient terminated
  • Settings: Mode - SIMV/CPAP, Pressure/Volume
    Breath rate: desired minimum, TV/Pressure control: desired for mandatory breaths, Insp time: desired per flow, Pressure support: desired insp support, O2 %: desired FiO2, Sensitivity: 1 - 9, PEEP - desired PEEP
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3
Q

Define “Pressure Support (PS)”

A

Pressure Support (PS)

  • Supports patients inspiratory effort and reduces/prevents atelectasis with PEEP
  • Breaths are patient initiated and patient terminated
  • Settings: Mode - SIMV/CPAP
    Breath rate: “–”, Pressure support: desired pres, O2%: desired FiO2, Sensitivity: 1 - 9, PEEP: desired PEEP
  • Apnea Backup: Volume/Pressure mode: desired Pressure/Vol
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4
Q

Define “NIPPV”

A

Non-Invasive Positive Pressure Ventilation

  • Used for ventilation/BiPAP/CPAP with face mask
  • Turns on leak compensator
  • NIPPV button will continue to blink until PS and PEEP are set
  • Settings: Mode - NIPPV
    Pressure Support: desired Insp Support, PEEP: desired PEEP, Sensitivity 1 - 9 (if no pressure support entered = CPAP)
  • Apnea backup as set Volume/Pressure control & Breath rate if > 12/min
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5
Q

LTV 1000 vs LTV 1200

A
  • Non-PEEP compensated vs PEEP compensated
    ie: non-PEEP compensated you will need to set pressure support/control with ΔP + PEEP combined

PEEP compensated you set your desired pressure in Pressure support/control and the ventilator will deliver that pressure + desired PEEP

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6
Q

Define “Apnea Backup”

A
  • If no breath detected within 20 seconds apnea backup will trigger and alarm will sound
  • Default rate is 12 breaths/min unless breath rate is set higher (ie: NIPPV)
  • Will use selected mode (Volume/Pressure) and entered value for any delivered breaths
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7
Q

Define “Bais Flow”

A
  • Constant 10 LPM flow in the circuit

- Assists with patient breath triggering

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8
Q

Define “CPAP”

A

Continuous Positive Airway Pressure

  • Continuous flow of air to splint alveoli open and prevent atelectasis
  • Used with face mask ventilation
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9
Q

List the items needed to set up the LTV Ventilator

A
  • LTV 1000 or 1200
  • Battery pack and/or AC Power for LTV
  • Ventilator circuit (LTV 1000 style)
  • x2 Heat/Moisture Exchanging (HME) filters
  • EtCO2 filter line
  • Balard ETT suction with corrugated tubing
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10
Q

Can you use a LTV 1200 vent circuit on an LTV 1000

A

No, there is no CPAP valve on a LTV 1200 type vent circuit

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11
Q

What is the difference between an adult and pediatric ventilator circuit

A

The pediatric ventilator circuit is smaller tubing to reduce circuit dead space

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12
Q

What did Dr. Eric Vu say regarding mechanical ventilation?

A

“There is nothing good that comes from Mechanical Ventilation”

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13
Q

What ventilator did BCAS CCP’s use before the LTV?

A
  • Autovent 3000

- AKA “The Lungbuster 3000”

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14
Q

How did BCAS get the first LTV’s?

A
  • BCAS was repatriating a patient from BC to the USA, after seeing the need for equipment the patients father bought BCAS 2 LTV’s
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15
Q

What effect can mechanical ventilation have on cerebral hemodynamics?

A
  • High PEEP causing decreased venous return resulting in decreased MAP and CPP
  • Cerebrovascular constriction due to too little CO2
  • Ventilator asynchrony increasing pain/anxiety
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16
Q

What effect can mechanical ventilation have on cardiovascular system?

A
  • Decreased venous return = decreased preload
  • Hypotension
  • Increased myocardial O2 demand
  • Can IMPROVE left ventricular function due to it no longer needing to overcome negative pressure in thorax
17
Q

What effect can mechanical ventilation have on respiratory system?

A
  • Barotrauma
  • Volutrauma
  • Atelectotrauma
  • Biotrauma
  • O2 Toxicity
  • Acid/Base balance
18
Q

What effect can mechanical ventilation have on GI/GU system?

A
  • Renal Failure due to decreased blood flow, hypoxia, hypercapnia or inflammation due to tidal volume
  • Infection due to hypomotility of GI system
  • Ulcers due to hypoperfusion of gut
19
Q

To what values do we set our High pressure/Low pressure/Low Minute volume alarms on the LTV

A
  • High Pressure: 10 mmHg over PIP levels
  • Low Pressure: 5 mmHg above current PEEP value
  • Low Minute Volume: 10% below our current VE value
20
Q

Define “Pressure Control (PC) and Assist/Control Pressure (AC-P)”

A

Pressure Control (PC) and Assist/Control Pressure (AC-P)

  • Mandatory breath rate set Pressure (volume is variable), machine initiate and machine terminated, can allow patient breaths if in AC-P
  • In AC-P patient triggered breaths are patient initiated and machine terminated
  • Settings: Mode - Assist/Control, Pressure
    Breath rate: desired rate, Pressure control: desired pressure, Insp time: desired per flow, O2 %: desired FiO2, Sensitivity: (PC: “-“, ACP “1 - 9”), PEEP - desired PEEP
21
Q

Define “Volume Control (VC) and Assist/Control Volume (AC-V)”

A

Volume Control (VC) and Assist/Control Volume (AC-V)

  • Mandatory breath rate set Volume (pressure is variable), machine initiate and machine terminated, can allow patient breaths if in AC-V
  • Complete Inspiratory hold to determine P plat and ΔP
  • In AC-V patient triggered breaths are patient initiated and machine terminated
  • Settings: Mode - Assist/Control, Volume
    Breath rate: desired rate, Volume control: desired volume, Insp time: desired per flow, O2 %: desired FiO2, Sensitivity: (PC: “-“, ACP “1 - 9”), PEEP - desired PEEP
22
Q

Define “PIP”

A
  • Peak Inspiratory Pressure
  • PIP = Flow x Resistance + alveolar pressure
  • Ideally kept <35 cmH2O to prevent lung injury
23
Q

Define “P plat”

A
  • Plateau Pressure
  • An approximation for alveolar pressure
  • Ideally kept <30 cmH2O to prevent lung injury
24
Q

Define “ΔP”

A
  • Delta Pressure

- The difference between P plat and PEEP

25
Q

Define “Vt”

A
  • Tidal volume

- Volume of delivered air, measured in millilitres (mL)

26
Q

Define “VE”

A
  • Minute volume of exhaled air, measured in litres (L)

- Calculated based on last 8 breaths

27
Q

Define “Vte”

A
  • Tidal Volume Exhaled

- Volume of exhaled air, measured in millilitres (mL) at end of expiration

28
Q

Define “f”

A
  • Breath frequency, the number of machine and patient triggered breaths
29
Q

Define “I:E”

A
  • Inspiratory/Expiratory ratio, normal I:E = 1:4
30
Q

What settings are used to complete a recruitment maneuver?

A
  • Pressure Control Mode
  • Breath Rate: <10
  • Inspiratory rate: >1 second
  • Pressure control and PEEP to get PIP to 40cmH2O
  • Clamp endotracheal tube for 40 seconds
  • Monitor vital signs and treat hypotension if required
31
Q

When a ventilator alarm sounds what should you do first?

A
  • Check the patient and work backwards towards the ventilator
32
Q

What causes the “High Pressure” alarm and what will it to?

A
  • Causes: tube/circuit occlusion/kinking, ventilator asynchrony, pneumo thorax
  • When the High Pressure value is reached the ventilator will “dump” the breath and prevent exceeding that value
33
Q

What causes the “Low Pressure” alarm?

A
  • Causes: endotracheal tube cuff rupture, endotracheal tube dislodgement, circuit disconnection, open cap/port
34
Q

Define “vCalc”

A
  • Calculated flow rate of delivered breath in millilitres (mL)
  • vCalc = Vt x Insp time
  • Normal value 50-60ml
35
Q

What causes the “Low Minute Volume” alarm?

A
  • Calculated minute volume drops below set level

- Check patient

36
Q

Define “Barotrauma”

A
  • Caused by ventilation with too much pressure

- Can be caused even with low volumes

37
Q

Define “Volutrauma”

A
  • Caused by ventilation with too much volume

- Related to poor distant ability of lung tissues

38
Q

Define “Atelectotrauma”

A
  • Repeated opening and closing of alveoli causing shear stress and trauma
  • Prevented with PEEP
39
Q

Define “Biotrauma”

A
  • Inflammation and cytokine release due to mechanical stress and Atelectotrauma

BCAS CCP Program (13 decks)

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