Ch. 25 Part 2: VENTILATORS Flashcards
What are the ARDSNet protocol for ARDS in relation to ventilator settings?
Plateau pressures lower than 30 cm H2O
Reduce the FiO2 to 50%
Maintain Vt at 5-6mL/kg ideal body weight or less
Maintain PEEP to avoid collapse of alveoli
Assist Control (AC) mode (CMV [continuous mandatory ventilation])
Volume Ventilator mode
Often initial mode of ventilation. Patient can trigger breaths, but vent will always deliver a set number of breaths/min at a set Vt. This is the setting in which the vent can do all the work.
Synchronized Intermittent Mandatory Ventilation (SIMV)
Volume ventilator mode
Often used as initial or beginning weaning mode of ventilation. Patient can breathe spontaneously, but when they do, it does not trigger a breath with the ventilator, they just breathe through the tubing. Has set rate and Vt.
Types of mechanical ventilators
Volume, pressure, high-frequency
Volume ventilators
Gives preset Vt regardless of airway pressures. Rate, Tinsp, and Vt are preset. Need to watch peak pressures.
Pressure ventilators
Gives tidal volume until a pressure is achieved that holds throughout inspiration. Need to watch Vt. Decreases risk for barotrauma with low compliance lungs.
High-frequency ventilators
Gives 100 breaths/min with low tidal volumes. Think of this like a panting dog, patient must be paralyzed. Purpose is to have lower pressures while ensuring patient gets enough O2.
Pressure-support ventilation (PSV)
Assists spontaneous breathing efforts by delivering high flow of gas to a selected pressure level early in inspiration and maintaining that level throughout inspiration. Patient needs to have somewhat normal Vt and RR, used in conjunction with volume modes for weaning.
Pressure-controlled ventilation (PCV)
Used to control plateau pressures in conditions (ARDS) in which compliance is decreased and the risk for barotrauma is high. Must monitor Vt and RR. Used for ARDS with already high FiO2 and PEEP.
Peep this PEEP, peep.
Positive end expiratory pressure.
Keeps alveoli stent open and recruits alveoli units that are totally or partially collapsed during any mode of ventilation.
High PEEP can cause decreased CO and barotrauma
CPAP
Continuous Positive Airway Pressure
Exerts positive pressure throughout respiratory cycle.
Patient must have spontaneous Vt and RR
What does the Dr. order when it comes to vent settings?
Rate, Vt (5-8mL/kg), FiO2, PEEP (typically 5-10), Pressure support
What sets off high pressure alarms?
Possible pneumo, blocking secretions, messed up settings, kinked tubing.
Suction patient, assess for pneumo, admin beta agonist, evaluate ABG, check peak flow settings
What sets off low pressure alarms?
Disconnection of tubing from patient.
Check for leaks around ET/ETT tubes, check for loss of Vt, also may be d/t clearing of secretions and/or relief of bronchospasm.
Nursing interventions, think CHOOSE NO VAP
Cuff pressure HOB 45 degrees Oral care (2-3 times a day or q4h) O - enteral feeding Suction oral secretions E - special ET tube for suction No lavage Oral intubation is best Vent circ change as needed Ambu bag new with each patient Proper hand washing
