COVID and Mechanical Ventilation Flashcards
What is FiO2? What is normal room air?
fraction of inspired O2
normal room air is 20-21%
What is tidal volume?
normal amount of air ventilated at rest
What is PEEP?
positive end expiratory pressure - pressure at the end of exhalation that keeps alveoli from collapsing to allow for gas exchange
What is purpose of BiPAP (bilevel positive airway pressure)
Purpose is to decrease the effort for the patient to exhale
What is the purpose of CPAP (continuous positive airway pressure)?
Purpose is to keep airways from collapsing during inhalation and exhalation
What are contraindications for PT for BiPAP and CPAP?
no contraindications but still need to check medical status which may determine if they are fit for PT
What is volume control?
preset tidal volume delivered at a set respiratory rate
- used when pt has no spontaneous breathing
What is pressure control?
predetermined amount of pressure at a set rate
- ventilator determines inspiratory time
- pt has no spontaneous breathing
What is assist control?
- delivers a specific amount of tidal volume
- patient or ventilator can trigger when breaths are taken
What is Pressure regulated volume control (PRVC)?
combines pressure and volume controlled ventilation
- preset tidal volume is delivered at set rate, but w/ lowest possible pressure
What is SIMV (synchronous intermittent mandatory ventilation)?
used to assist patients who have some, but not sufficient breathing
- delivers certain number of breaths in coordination w/ respiratory effort of patient
- used for weaning and does have increased work of breathing
What is pressure support ventilation?
- small amount of pressure occurs on inspiration
- Patient initiates all breaths
What is volume support?
- tidal volume and PEEP are set
- patient initiates breathing
- ventilatory support in proportion to patient’s inspiratory effort and target volume
What should be documented in note based on telemetry?
vent mode
RR
FiO2
PEEP
What are red alarms for mechanical vent?
- high pressure
- circuit disconnected
- apnea
What are yellow alarms for mechanical vents?
- low tidal volume
- high respiratory rate
- low minute ventilation
- low inspiratory pressure
5 major factors to consider during weaning off mechanical vent?
- respiratory demand and ability of neuromuscular system to cope w/ O2 demand
- oxygenation
- CV performance
- Psychological factors
- adequate rest and nutrition
weaning off mechanical vent signs of distress
- tachypnea > 30 breaths/min
- decreased pH < 7.25-7.30 w/ increased PaCO2
- paradoxical breathing patterns
- HR change > 20 bpm\
- BP change > 20 mmHg
- agitation, panic, diaphoresis, cyanosis, angina, or arrhythmias
What are contraindications for a patient on a mechanical vent?
- comatose, unresponsive, does not follow commands
- severe agitation/combativeness
- PEEP > 10cm H20 or FiO2 > 0.6 (60%)
- uncontrolled active bleeding
What can prolonged vent support lead to?
- skin breakdown
- joint contractures
- deconditioning
Acute care activities for patient on mechanical vent
- AROM
- Resistive therapeutic exercises
- Aerobic activities
- bed mobility
- reaching activities w/ emphasis on trunk rotation
- head and neck therapeutic exercise and positioning - extensors
- diaphragmatic breathing
What amount of O2 can someone safely go with?
6 liters or less
What is a trach collar?
collar w/ blue tubes
- nasal cannula for trach
- allows patient to breathe on their own but they have a trach
What is a passy muir valve?
purple valve that allows someone w/ a trach to speak
What is used to increase arterial O2, improve lung compliance for a patient on pressure control?
PEEP
What is used if patient is on high level of respiratory support?
Assist control
- patient has some breathes but is very minimal
What helps prevent barotrauma?
pressure regulated volume control (PRVC)
