Ch. 5 Selecting the vent and the mode Test 2

Question 1

During Full ventilatory support, the ventilator

Answer 1

provides all the energy necessary to maintain effective alveolar ventilation

Question 2

Full vent support results in PaCO2 values ____ or PaCO2 that is ________ for the pt (eucapnic breathing)

Answer 2

<45;
normal

Question 3

Full vent support is provided when the vent rates are

Answer 3

high (8breaths/min or more) and Vt is adequate for the pt

Question 4

Any degree of MV in which set machine rates are lower than 6 breaths/min and the patient participates in the WOB to help maintain effective alveolar ventilation

Answer 4

Partial ventilatory support

Question 5

With partial support, the pt must actively

Answer 5

participate in ventilation to maintain adequate levels of PaCO2

Question 6

What are some partial support modes

Answer 6

• SIMV
• PSV
• VSV
• PAV
• MMV

Question 7

Partial support mode should be avoided in pts with

Answer 7

ventilatory muscle fatigue and when a pt has a high WOB level

Question 8

Example of full and partial vent support:
A patient who is unconscious, comatose, or has experienced a cardiac arrest will receive full support. A patient who is partially awake, waking up from surgery, or weaning, will be placed on partial support mode

Answer 8

Something to know

Question 9

The breath type and pattern of breath delivery during MV constitute the

Answer 9

mode of ventilation

Question 10

The mode is determined by the following factors:

Answer 10

• Type of breath (mandatory, spontaneous, assisted)
• Targeted control variable (volume or pressure)
• Timing of breath delivery (CMV, IMV, CSV)

Question 11

_______________ breaths are breath for which the vent controls the timing, the Vt, or inspiratory pressure

Answer 11

Mandatory

Question 12

Example for mandatory breath:
A pt-triggered, volume-targeted, volume-cycled is a mandatory breath. The vent controls the Vt delivery

Answer 12

Something to know

Question 13

For this type of breath, the pt controls the timing, and the Vt

Answer 13

Spontaneous breaths

Question 14

For spontaneous breaths the volume or pressure (or both) delivered is not set by the RT, but rather is….

Answer 14

based on pt demand and pt lung characteristic

Question 15

Assisted breaths have characteristics of both

Answer 15

mandatory and spontaneous breaths

Question 16

_____ or _______ of the breath is generated by the vent, which does part of the WOB for the pt in assisted

Answer 16

All or part

Question 17

If the airway pressure rises above baseline during inspiration the….

Answer 17

the breath is assisted

Question 18

Example of Assisted breaths:
1. VCAC, the pt can start the breath and the machine can end it

2. During the pressure support mode the RT sets the target pressure but the pt initiates the breath (pt triggered)

Answer 18

Something to know

Question 19

During the pressure support mode, the vent delivers the set pressure above the….

Answer 19

baseline pressure to assist the pt’s breathing; the pt cycles the breath

Question 20

Control variables are

Answer 20

independent variables

Question 21

What is the primary advantage of volume-control ventilation?

Answer 21

It guarantees a specific volume delivery and volume of expired gas (VE), regardless of changes in lung compliance and resistance or pt effort

Question 22

What is the goal of volume-controlled ventilation?

Answer 22

To maintain a certain level of PaCO2

Question 23

What is a disadvantage of volume-controlled ventilation

Answer 23

ventilation becomes evident when lung condition worsens, which can cause the peak and alveolar pressure to rise, leading to Barotrauma (alveolar distention)

Question 24

When lung conditions improve,

Answer 24

less pressure is required to deliver the volume and ventilating pressure decline

Question 25

Other disadvantages in volume-controlled breaths are related to

Answer 25

flow and sensitivity settings

Question 26

If the sensitivity level is not set appropriately for the pt, it can make it more difficult for the pt to trigger inspiration, which can result in

Answer 26

patient-ventilatory asynchrony and pt discomfort

Question 27

This is a lung protective strategy

Answer 27

Pressure-control ventilation

Question 28

Pressure-control ventilation allows the RTto set the pressure as the

Answer 28

independent variable... the pressure remains constant but volume (the dependent variable) changes as lung CharacterIstics change

Question 29

What are some advantages of pressure-control ventilation?

Answer 29

1st- it allows the RT to set a maximum pressure, which reduces the risk for overdistention of the lungs by limiting the amount of positive pressure applied to the lungs 2nd- the vent delivers a decelerating flow pattern during pressure-control ventilation

Question 30

Pressure control may be more

Answer 30

comfortable for pts who can breathe spontaneously

Question 31

What is a disadvantage for pressure control ventilation?

Answer 31

Volume delivery varies as the pt's lung CharacterIstics (lung compliance and Raw) change

Question 32

During pressure control, when the pt makes an inspiratory effort, the negative pressure produced at the upper airway causes the vent to vary

Answer 32

gas flow to match the pt's needs. This helps reduce WOB, particularly in pts w/ ARDS

Question 33

What are the 3 breath delivery times?

Answer 33

1. Continuous mandatory ventilation (CMV) 2. Intermittent mandatory ventilation (IMV) 3. Continuous spontaneous ventilation (CSV)

Question 34

With CMV, what is the pt not doing?

Answer 34

generating spontaneous breaths

Question 35

With IMV, the pt receives a

Answer 35

set number of breaths each mandatory breath each minute but is also allowed to breathe spontaneous breaths between mandatory breaths

Question 36

All breaths are spontaneous and therefore pt triggered

Answer 36

CSV; (these spontaneous breaths may be assisted (PSV) or unassisted CPAP

Question 37

With this all breaths are mandatory and can be volume or pressure targeted

Answer 37

CMV

Question 38

In CMV breaths can be

Answer 38

time triggered or pt triggered

Question 39

When the breaths are time triggering, the breaths are described as

Answer 39

controlled ventilation or the control mode

Question 40

When the breaths are pt triggered during CMV the breaths are described as

Answer 40

assisted ventilation

Question 41

When is controlled ventilation appropriate to use?

Answer 41

When a pt cannot make an effort to breathe

Question 42

What pt population would controlled ventilation be appropriate for b/c they are not able to make voluntary efforts?

Answer 42

- Obtunded b/c of drugs - Cerebral malfunction - Spinal cord - Phrenic nerve - Motor nerve paralysis

Question 43

This is described as a time-triggered or pt-triggered CMV mode in which the RT sets a minimum breathing rate, sensitivity level and a breath (volume or pressure)

Answer 43

Assisted ventilation