Ch.4 Pilbeams Flashcards
What does impending mean?
Trending (getting worse)
What are the objectives of mechanical ventilation?
Physiological objectives
1. Support or manipulate pulmonary gas exchange
2. Increase lung volume
3. Reduce the work of breathing
Clinical objectives
1. Reverse acute respiratory failure
2. Reverse respiratory distress
3. Reverse hypoxemia
4. Prevent or reverse atelectasis and maintain FRC
5. Reverse respiratory muscle fatigue
6. Permit sedation or paralysis (or both)
7. Reduce systemic or myocardial oxygen consumption
8. Minimize associated complications and reduce mortality
What are some disorders associated with hypoventilation and respiratory failure?
• Reduced drive to breathe
• Increased drive to breathe
• Neuromuscular disorders
• Disorders that increase the WOB
All of these are CNS disorders
What are conditions seen with hypoxemia and hypercapnia?
What are indications of ARF?
What is the criteria for mechanical ventilation?
- Support the pulmonary system so it can maintain an adequate level of alveolar ventilation
- Reduce the work of breathing until the cause of respiratory failure can be identified and treated
- Restore arterial and systemic acid–base balances to levels that are normal for the patient
- Increase oxygen delivery to and oxygenation of body organs and tissues
- Prevent complications associated with mechanical ventilation
What are the specific tx for arterial hypoxemia?
What is the standard criteria for instituting mechanical ventilation?
What are the indications for invasive mechanical ventilation w/ARF?
- Apnea or impending respiratory arrest.
- Acute exacerbation of COPD with dyspnea, tachypnea, and acute respiratory acidosis.
- Acute ventilatory insufficiency in cases of neuromuscular disease.
- Acute hypoxemic respiratory failure with tachypnea, respiratory distress, and persistent hypoxemia despite administration of a high FiO2 with high flow oxygen devices.
- Need for endotracheal intubation to maintain or protect the airway or manage secretions.
What are some common settings that are seen on a vent?
Rate, Vt, PEEP, FiO2, PS, Ti, pressure gradient, PaO2>60, SpO2 >92
PEEP can be in increments of 3-5
What is the normal Vt for an adult (not on a vent)?
5-7mL/kg
What is the normal RR for an adult pt not on a vent?
12-20bpm
What is the Vt for ventilated pts?
6-8
What is the Vt for infants and children?
4-6mL/kg
Lower Vt rates have been successfully used for ventilation of the lungs of adult patients with _____?
ARDS
These lower Vt rates minimize the damaging effect associated with….?
Overdistention of the alveoli
Heavier pts will have a higher _______ rate and thus a higher _______?
Metabolic; Ve
What are some meds for anti-anxiety?
Ativan, Valium, Versed
What can versed also be used for?
Anesthesia
What are some neuromuscular blocking agents?
• Anectine (short term)
• Pavulon (long term)
• Nocuron (long term)
What is a med used for anti-seizures and convulsions?
Benzodiapine
What is a med used for crazy people (psych-ward).
Haldol
What is a sedative that is usually give with an analgesic?
Propofol
pt can still hear and see but they just can’t move
What is the primary concern when putting a pt on a vent?
Pt comfort
What is the second concern when putting a pt on a vent?
Monitor and evaluate response to the vent
Who is in charge of managing the vent system safely and preventing complications?
RT, RN, MD
What are some ways to improve ventilation?
- Dec the Vt = inc PaCO2
• Dec Va & Ve - Inc Vt & dec PaCO2
• Inc Va & Ve
Flow is normally set to deliver inspiration in about _____?
1 sec (0.8-1.2 sec)
What is the initial peak flow setting?
60L/min (range 40-80)
What is a second method to initiate pressure ventilation?
Start at low pressure (10-15cmH2O) and check the Vt before readjusting to attain desired volume.
It is easier to set the initial PSV levels equal to the _____ after establishing these values with VC-CMV.
Transairway pressure (PIP-Pplat)
T or F If the patients PaO2 is within the desired range before beginning vent support the FiO2 that the patient is receiving at the time of the baseline ABG can be used when mechanical ventilation is initiated.
True
T or F if the baseline ABG is not available, it is advisable to select a high initial FiO2 setting (> or =0.50) for pts with presumed severe hypoxemia.
True
T or F Clinicians often start with an FIO2 of 100 and then reduce it as quickly as possible. Extended use of 100% O2 is not recommended because it can quickly result in absorption atelectasis and in the long term can lead to O2 toxicity.
True
An SpO2 greater than _____ (PaO2 ≥60 mm
Hg) is a common and acceptable goal.
92%
In most situations it is appropriate to use a minimum level of PEEP of?
3-5cmH2O
What is the formula for IBW?
105 + 5 (H-60)/2.2 (F)
106 + 6 (H-60)/2.2 (M)
What is the normal CO2 for COPD?
50-60 mmHg
What do you do for a COPD patient?
• increase mechanical rate
• increase tidal volume
• reduce dead space
• high frequency jet or oscillatory ventilation
