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Fundamental Critical Care Support > Chapter 5: Mechanical Ventilation > Flashcards

Chapter 5: Mechanical Ventilation Flashcards

1
Q

7 advantages of Noninvasive Positive Pressure Ventilation

A
  1. reduced need for sedation
  2. preservation of airway predictive ventilation
  3. Avoidance of upper airway trauma
  4. decreased incidence of nosocomial PNA and sinusitis
  5. improved comfort
  6. shorter length of stay in ICU and Hospital
  7. improved survival
    (p63)
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2
Q

8 disadvantages of Noninvasive Positive Pressure Ventilation

A
  1. Claustrophobia
  2. increased workload for RT, nurse, physician
  3. pressure lesions
  4. unprotected airway
  5. can’t do deep suctioning
  6. gastric distension
  7. upper extremity edema , axillary vein thrombosis, tympanic membrane dysfunction
  8. Delayed intubation
    (p63)
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3
Q

In what patient type is NPPV best utilized

A

Alert, cooperative, and expected to improve (p64)

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4
Q

Causes of Hypoxemic Respiratory Failure likely to respond to NPPV

A

Cardiogenic Pulmonary Edema WITHOUT hemodynamic instability
Mild to moderte PJP
Respiratory failure in immunocompromised patients
(p65)

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5
Q

Causes of Hypercapnicn Respiratory Failure likely to respond to NPPV

A

Acute COPD exacerbation
Acute Asthma exacerbation
Respiratory failure in CF patients
(p 65)

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6
Q

IPAP greater than ____ can lead to gastric dissension

A

20

p(65)

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7
Q

Contraindications to NPPV (11)

A 
Cardiac or respiratory arrest
hemodynamic instability
MI or arrhythmia 
Noncooperative
inability to protect airway
high aspiration risk
active upper gi bleed
sever hypoxemia
severe encephalopathy
facial truma
significant agitation
(p66)
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8
Q

How long to wait for improvement before switching from NPPV to invasive

A

no improvement in 1-2 hours or when therapeutic goals have not been met at 4-6 hours (p66)

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9
Q

Avoid inspiratory pressures greater than ____ mm H2O to avoid gastric dissension

A

20

p66

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10
Q

A ___ ____ breath aka ____ _____ ensures the delivery of a preset tidal volume (unless peak pressure) is exceeded

A

Volume-cycle or volume assist

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11
Q

With volume assist/cycle what does worsening airway resistance due to peak inspiratory pressure

A

increases

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12
Q

A ____ ____ or ___ _____ ____ breath applies a constant pressure for a preset time.

A

time cycled, pressure assist control

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13
Q

What does an increase in resistance alter in time cycled/pressure assist control do?

A

changes tital volume

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14
Q

How does Flow cycle/ pressure support breath work

A

The patient imitates every breath and the ventilator delivers support with a preset pressure value. Patient sets rate and tidal volume. breaths are terminated when the flow rate decreases to a predetermined percentage of initial peak flow.

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15
Q

Assist control breaths can be delivered with either ___ or ____

A

volume cycle or time cycled breaths

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16
Q

Pressure support ventilation provides a preset level of ____

A

inspiratory pressure, to help overcome disease process.

17
Q

What type of breaths in PSV

A

flow cycled

18
Q

in PSV the patient controls the ___ and exerts sting influence on ____

A

RR, duration of inspiration

19
Q

Synchronized Intermittent Mandatory Ventilation can deliver what kinds of breaths

A

volume or time cycled

20
Q

In SIMV when no effort is detected _____

A

the ventilator delivers the preset Vt at preset time elapsed rate

21
Q

AC Ventilation Advantages and Disadvantages

A

Advantages: Patient can increase ventilatory support, reduced work of breathing compared with spontaneous breathing
Disadvantages: excessive inspiratory pressures

22
Q

AC volume ventilation Advantages and Disadvantages

A

Advantages: Guarantee delivery of set Vt (unless peak pressure is exceeded)
Disadvantages: excessive inspiratory pressures

23
Q

ac pressure ventilation Advantages and Disadvantages

A

Advantages: Limitation of peak inspiratory pressures, variable flow rates, accommodates to patients demaNDS
Disadvantages: Vt Increase or decrease with lung resistance/compliance changes

24
Q

Pressure support ventilation Advantages and Disadvantages

A

Advantages:
comfort, improved patient/ventilator interaction, decreased work of breathing
Disadvantages: apnea alarm may not trigger backup ventilation mode. Variable patient tolerance

25
Q

synchronized intermittent mandatory ventilation Advantages and Disadvantages

A

Advantages: less interference with normal cardiovascular function
Disadvantages: increased work of breathing compared to AC

26
Q

controlled mechanical ventilation Advantages and Disadvantages

A

Advantages: rests respiratory muscles completly
Disadvantages: Requires sedatives/neuromuscular blockade, adverse hemodynamic effects

27
Q

Most common mechanical ventilation type used

A

AC

28
Q

What variables influence peak inspiratory flow

A

flow rate. diameter of tube, secretions, bronchial diameter

29
Q

What should inspiratory plateau pressure be kept at

A

<30 mm H20

30
Q

What prophylactic measures should be taken when a patient is mechanically ventilated

A

PPI or H2 blocker- gastric stress ulcers
DVT prophylaxis- mechanical or pharm
elevate head of bed to 30 degrees , oral hygiene, daily evals to stop mechanical vent to stop PNA

31
Q

normal amounts if PEEP applied

A

8-15 cm H2O

32
Q

Mechanical ventilation goals in ARDS

A

PaO2 55-80
PPlat <30
Vt 4-6 ml/kg PBW
pH > 7.15 is acceptable

33
Q

What vent settings to start with ARDS

A

AC with Vt of 8ml/kg PBW

  • decrease by 1 ml/kg over next 4 hours until Vt is 4-6 ml/kh
  • if Pplat is >30 decrease Vt by 1 ml/kg until Vt is 4 or arterial pH reaches 7.15
  • If using Vt 4 ml/kg and Pplat is <25 Vt can be increased by `ml/kg until Pplat is 25cm H2O or Vt is 6ml/kg
  • If Pplat of <30 has been achieved with Vt >6 ml/kg and lower Vt is clinically problematic it is acceptable to maintain high Vt
34
Q

Initiation of PEEP in ARDS starting point

A

5 CM H20 and titrate up 2-3 cm
full recruitment effect may not be apparent for several hours
monitor BP, HR and Pao2 while on PEEP
Optimal Peep settings are typically 8-15 cm H20

35
Q

First consideration when hypotension occurs immediately after ignition of mechanical ventilation

A

tension pneumothorax

36
Q

Why are patients with obstructive lung disease prone to auto PEEP

A

need for prolonged expiratory phase

Fundamental Critical Care Support (13 decks)

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