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RT-131A > Chapter 5 - Selecting Ventilator and Mode > Flashcards

Chapter 5 - Selecting Ventilator and Mode Flashcards

1
Q

What are the percentages of patients connected to the ventilator?
ETT vs. Trach

A

ETT: 75%

Trach: 25%

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2
Q

What are 3 methods of Noninvasive Support?

A
  • NPV
  • CPAP
  • NPPV
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3
Q

What is CPAP used for?

A
  • Improve Oxygenation
  • OSA
  • Tx of COPD Exacerbation
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4
Q

Describe what Full Ventilatory Support is

A

Ventilator provides all the energy of ventilation

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5
Q

What are the Ventilator settings for Full Ventilatory Support?

A
  • Normal Vt
  • Normal RR
  • Adequate alveolar ventilation
  • AC/VC or AC/PC
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6
Q

Describe what Partial Ventilatory Support is

A

Ventilator provides some of the energy, but pt. must actively participate in WOB

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7
Q

What are the ventilator settings for Partial Vent Support?

A
  • RR is 6 or less
  • Vt is set for mandatory breaths, patient generated on spontaneous
  • Pt needs to work to maintain normal or adequate alveolar ventilation
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8
Q

What is Partial Ventilatory Support not ideal for?

A

Pts with high WOB or muscle fatigue

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9
Q

What are modes determined by?

A
  • Type of Breath
  • Targeted Control variable
  • Timing of Breath delivery
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10
Q

What are Mandatory Breaths?

A

Vent controls timing, Vt, or Both

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11
Q

What are Spontaneous breaths?

A
  • Pt controls timing and Vt

- Affected by pt demand and lung characteristics

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12
Q

What are Assisted Breaths?

A
  • Pt receives some support from vent
  • When pressure on inspiration is higher than baseline (Pressure Support)
  • Helps pt overcome some WOB
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13
Q

What occurs when Targeting Volume as the Control Variable?

A
  • Guarantees Vt
  • Maintains a minimum MV
  • Volumes are unaffected by changes in lung characteristics and patient effort.
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14
Q

What are Hazards of Targeting Volume as the Control Variable?

A

Increased Peak Airway Pressures due to Increased Resistance and Decreased Compliance

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15
Q

What are Disadvantages of Targeting Volume as the Control Variable?

A
  • Flow may be fixed on some ventilators
  • Sensitivity may be set incorrectly
  • Either of these can lead to Patient-vent. Dyssynchrony
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16
Q

What settings are allowed in Targeting Volume as the Control Variable?

A

-Vt, RR, I-Flow Rate, Flow Pattern

17
Q

What are Advantages of Targeting Pressure as the Control Variable?

A
  • Reduced risk of overdistention due to pressure control
  • Descending flow pattern
  • Pts I-Flow demands met with variable flow rates
  • Reduction in WOB
18
Q

What are Disadvantages of Targeting Pressure as the Control Variable?

A

-Variable Vt and MV

19
Q

What occurs with Targeting Pressure as the Control Variable?

A
  • Preset pressure target without guaranteed Vt
  • Pressure is not affected by changes in lung characteristics
  • Vol. WILL be affected by changes in lung characteristics
20
Q

What occurs in CMV?

A
  • All breaths are mandatory
  • Ventilator(Controlled) or Patient(Assist/Control) triggered
  • Set Rate ate Vt or Pressure
21
Q

What is considered Controlled Ventilation?

A
  • If pt does not trigger
  • If pt is “locked out” from taking an extra breath
  • If pt is medically prevented from assisting ventilation
22
Q

What factors can trigger a breath with a fully sedated patient?

A

A Hiccup and Cardiac contraction

23
Q

What occurs in Assist/Controlled Ventlation?

A
  • Pt is triggering breaths over set rate
  • Pt receives the preset vol or pressure when triggered
  • Pt can become hyperventilated with excessive triggering
  • May require increased lvls of sedation to reduce over triggering
24
Q

What occurs in Volume-Targeted CMV?

A
  • Set RR and Vt
  • Not all work is done by vent unless settings are appropriate
  • Pt can do up to 50% of WOB if flow rate is inadequate
  • Flow must be set high so that pressure rise is immediate with the beginning of inspiration
25
Q

What occurs in Pressure-Targeted CMV?

A
  • Set RR and I-Pressure
  • Improves WOB as pressure is immediate and variable to pts need
  • Decelerating flow pattern helps gas distribution
  • Vol is NOT guaranteed
26
Q

What occurs in IMV?

A
  • Delivers a set vol or pressure at set time intervals
  • Allows pt to breath spontaneously btwn mandatory breaths
  • Breath stacking occurs if pt was taking a spont breath at same time of a mandatory breath
27
Q

What occurs in SIMV?

A
  • Corrected breath stacking by placing mandatory breaths within a “time window”
  • Mandatory breaths that are bent triggered by time interval or pt triggered by effort within a time window
  • Pt takes spont breaths btwn mandatory breaths
  • Spont breaths may be on CPAP or PS
  • Used for weaning
28
Q

What occurs in Spontaneous Modes?

A
  • Spont breating
  • CPAP
  • PS
29
Q

What occurs in Spontaeous Breathing?

A
  • No suppot from vent
  • Pt breaths through the circuit - T-piece
  • Vent can monitor RR, Vt, MV, and alarm
  • SBT (Spontaneous Breathing Trial)
30
Q

What is a Disadvantage of Spontaneous Breathing?

A

Pt might have high WOB

31
Q

What occurs in CPAP?

A
  • Pt breaths spontaneously through the circuit
  • Vent offers PEEP to prevent loss of FRC
  • Helps improve oxygenation by preventing atelectasis
  • Allows close monitoring of pts resp status
32
Q

What occurs in PS?

A
  • Pt Triggered, Pressure Limited, Flow Cycled
  • Spont mode where breaths are assisted
  • Pt starts from baseline pressure and is given a preset pressure boost on inspiration
  • Vt is dependent on Pt Effort, Compliance and Resistance, and Preset Pressure Gradient
  • Leaks and Sudden pressure spikes
  • Useful in overcoming resistance of ETT
33
Q

What occurs in BiPap

A
  • Noninvasive BiLevel Support
  • Pt triggers all breaths and rate can be set (Lowest is 4)
  • Compensation for leaks-Estimated Vt and MV
  • Prevents complications of intubation
  • Pt and Therapist Dependent
34
Q

What are the common modes of Closed Loop Ventilation?

A

Dual Control: Vol Delivered Every Breath

Dual Control Pressure Ventilation with Vt Target

35
Q

What occurs in Dual Control: Vol Delivered Every Breath?

A
  • Pt triggered, Pressure and Vol Targeted, Flow Cycled
  • Vent monitors Vt and adjusts flow to meet minimum Vt
  • Pt must be able to trigger breath and maintain adequate alveolar ventilation
  • Breath terminated when flow reaches certain lvl, as long as Vt delivered
36
Q

What Occurs in Dual Control Pressure Ventilation with Vt Target?

A
  • Auto-Flow or PRVC
    • Vent adjusts pressure breath by breath to reach desired Vt
    • Adjust up or down depending on pt needs
    • Allows for lower peak airway pressures as compliance improves
    • Not ideal for pts with marked dyssynchrony
  • Volume Support (VS)
    • Similar to PS but pressure adjusts to deliver Vt target
37
Q

What are the less frequently used Closed Loop Modes of Ventilation?

A

MMV
APRV
PAV

38
Q

What occurs in MMV?

A

Mandatory Minute Ventilation

  • PS mode with a Low MV threshold
  • Reverts to VC if pt does not maintain MV
  • Vent only monitors the vol over one min but cannot tell how it was achieved

RT-131A (13 decks)

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