Chapter 11 Flashcards
Pressure controlled ventilation is used for adults
with what lung condition?
ARDS
on delivered VT in a neonate receiving pressure-
limited ventilation?
Decrease VT
for weaning so that airway resistance is
5-10cmH2O
As the oxygenation status of a patient worsens
while using an oxygen mask at what point
Patient who cannot maintain normal limits
using a 50 to 60% oxygen mask and has normal
should CPAP be started?
or low CO2 levels.
How is minute volume calculated?
VT x RR
On the initial ventilator set up at what range
should the ventilator rate be?
10 to 16
How should the appropriate ventilator title
volume be determined?
6 to 8 mL/kg of IBW
List indications for the use of PEEP?
Decreased FRC
List 4 hazards of PEEP?
Decreased venous return
Decrease cardiac output
Define optimal PEEP?
The level of peep that improves compliance
without cardiac compromise
determined that cardiac output has been
Decreased PVO2 < 35 and drop in BP
How may the ventilator low pressure alarm be
Ruptured ET tube cuff
activated?
Inadequate cuff pressure
List ways that the vent high pressure alarm may
be activated?
Decreased compliance
Increased airway resistance
How should the high pressure alarm be set?
10 above PIP
List some factors that affect airway resistance?
Condensation in the vent circuit
What is normal PeTCO2?
35-45
List four conditions that result in decreased
Apnea
PeTCO2?
Total airway obstruction
List 2 conditions that result in increased
Hypoventilation
PeTCO2?
Hyperthermia
List criteria that indicate mechanical ventilatory
assistance is necessary?
VC < 10-15 (normal 65-75)
A-a gradient > 450 with use of 100% FiO2
(normal 25-65)
List complications of mechanical ventilation?
Pulmonary O2 toxicity
List some conditions that result in decreased
Atelectasis
compliance?
Air-trapping
What is indicated if PIP pressures are increased
but Pplat is not?
Increased static compliance
List 3 advantages of high frequency ventilation?
Reduced risk of cardiac side effects
On a volume time waveform, if tracing does not
return to baseline, what does this indicate?
Air-trapping (auto PEEP)
What are some indications for mechanical
Acute ventilatory failure
ventilation?
Impending acute ventilatory failure
What is acute ventilatory failure?
PaCO2 > 50 mmHg and pH < 7.30
What might the rate be for impending acute
ventilatory failure?
30-40/min
In a patient with neuromuscular disease what
should be monitored?
Muscle involvement
How do we do parameters?
We measure the MIP and the VC to help
determine muscle strength
A patient who’s on an O2 mask of 50-60% but is
not oxygenated enough is experiencing what?
Large intrapulmonary shunt
What are some common criteria for initiation of
mechanical ventilation?
VC < 10-15
P(A-a)O2 > 450 with the use of 100% O2;
(normal 25-65)
normal for ambient conditions and the patient’s
Hypoventilation
When the PaO2 is low and the P(A-a)O2 is high
for ambient conditions and the patient’s age,
hypoxemia is most likely the result of…
ventilation/perfusion (V/Q) mismatch
diffusion defect
shunting
In this situation, the patient may be
hyperventilating to compensate for the
hypoxemia
What is dead space normal ratio?
60% (25-35)
What is the formula for VD?
PaCO2 -PeCO2/PaCO2
What MIP should the patient obtain and what is
-20
the normal?
-50 to -100
What are some lung protective strategies for
ARDS?
Maintain VT between 6-8mL/kg of IBW
Maintenance of plateau pressure < 30
What is the initial IPAP setting?
10-15
What is the initial EPAP setting?
4-5
What is the difference between IPAP and EPAP?
Pressure Support
A patient triggered, pressure limited, flow cycled
breath is augmented with what?
SIMV & CPAP
How much pressure support is needed to
overcome tubing resistance.
5-10
The A/C mode is what?
Patient triggered, & time triggered
Patients who cannot maintain O2 sats of 50-
60% must be placed on what?
CPAP
CPAP is also indicated for what patients?
They gain benefit from the positive airway
pressure
In volume controlled ventilation increased VT
increases _____?
Ti
Exhaled VT is measured by what?
Respirometer placed between ETT and
vent Y adapter on exhalation valve
To most accurately measure the VT delivered by
the vent what should you do?
Place a respirometer directly on the vent outlet.
What is the normal rate for ARDS pt?
20-35
What is normal rate for COPD pt?
10-12
What is the formula for I:E ratio?
I:E ratio = Inspiratory flow rate (L/min)/MVe
(L/min) - 1 (for inspiration)
What is the formula for I-time?
1 time = TCT/ sum of I:E ratio parts
What is normal PvO2?
35-45
A PvO2 < 35 indicates what?
decreased cardiac output
If the PvO2 decreases after the initiation of PEEP,
Reduced venous return and cardiac output
it is an indicator of what?
caused by PEEP.
The PvO2 value indicates what?
The adequacy of tissue oxygenation.
PaO2 does not determine what?
Optimal PEEP
What is the formula for dynamic compliance?
VT/PIP-PEEP
What is the formula for static compliance?
VT/Pplat-PEEP
What is the formula for OI?
FiO2 x MAP/PaO2 x 100
Generally, an OI less than _____ is acceptable?
5
An OI index of 10 to 20 indicates what?
Impaired oxygenation
An OI > 25 indicates what?
Severe oxygenation issues with poor clinical
outcomes
You should maintain the CO2 between 25 and
30 to reduce what?
ICP by vasoconstriction of cerebral vessels.
ICP should be maintained below what?
15mmHg
What is normal ICP?
< 10mmHg
To decrease CO2 level you should always
increase what?
Ventilator rate
What should the respiratory rate be in order to
wean?
< 35
What is HFV?
A type of mechanical ventilation that utilizes
high respiratory frequencies usually specified in
Decreasing the frequency or hertz for HFV
increases what?
Delivered VT which increase PaO2
To decrease the CO2, the amplitude or strength
of oscillation should be____?
Increased
Flow settings range from_____?
10-20L/min
What is the formula for desired FiO2?
PaO2 (desired)x FIO2 (current)/ PaO2 (current)
What is the formula for desired rate?
Rate (current) x PaCO2 (current)/ PaCO2
(desired)
What is the formula for desired Mve?
Ve(current) x PaCO2 (current)/ PaCO2 (desired)
What is the formula for desired alveolar MVe?
Va (current) x PaCO2 (current)/ PaCO2 desired
What is the formula for alveolar ventilation?
VT-VDxRR
What is the formula for desired VT?
VT(current) x PaCO2 (current)/ PaCO2 (desired)
What wave form is this?
Changes in airway resistance and
compliance do not change the
What wave form is this?
increased airway resistance,
because airway turbulence
What wave form is this?
The flow never decreases more
What wave form is this?
turbulence to flow in the
beginning of inspiration,
What wave form is this?
Volume wave
What does this wave form indicate?
Air trapping because the tracing
did not go back to baseline.
What type of wave form is this?
Pressure waveform
What does this waveform indicate?
Obstruction
What does this waveform show?
Pressure with an assisted breath
What type of wave form is this?
Flow wave form with air trapping
how soon will VAP occur?
Within the first two weeks of mechanical
ventilation
What is the mortality rate for VAP?
5 to 40%
What are some common pathogens responsible
Escherichia coli
for VAP?
Serratia marccesans
What are the symptoms for VAP?
- Increased white blood cell count
(.11,000/mL)
For VAP how do you position the patient?
Semi-Fowler (30-45 degrees)
What are some antibiotics used to treat VAP?
Tobramycin
Cefepime
