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Principles I* > E3- Anesthesia Ventilators > Flashcards

E3- Anesthesia Ventilators Flashcards

1
Q

A ventilator is an automatic device that will provide what two things to the patient?

A
  • Patient ventilation
  • Patient oxygenation
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2
Q

On the anesthesia workstation, ventilators essentially replace what component?

A
  • The green reservoir bag
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3
Q

What ventilation was available from old ventilator models?

A
  • Only offered volume-controlled ventilation
  • No PEEP
  • Couldn’t provide high enough PIP
  • Only controlled mandatory ventilation
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4
Q

Barotrauma is an injury that results from ______

A
  • Injury resulting from high airway pressures
  • Limit PIP to avoid this
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5
Q

Compliance

A
  • Ratio of a change in volume to a change in pressure
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6
Q
  • decrease in compliance causes decrease in ________ bc volume used to expand system (volume controlled)
  • newer vents alter volume delivered to compensate for ____________________ (pressure controlled)
A
  • Vt
  • system compliance
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7
Q

Work of Breathing

A

o Energy expended by the patient/ventilator to move gas in + out of lungs.

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8
Q

Exhaust Valve

A

Valve that opens to allow driving gas to exit the bellows housing during inhalation

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9
Q

What is Fresh Gas Compensation?

A
  • a way to prevent FGF from affecting tidal volume
  • by measuring tidal volume and adjusting the volume of gas delivered by the ventilar.
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10
Q

The time during which lungs are held inflated at a fixed volume and pressure.

A
  • Inspiratory pause time
  • inspiratory platuea

Increase intrathroacic P –> dec preload –> dec CO !!

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11
Q

I:E ratio

A
  • Ratio of the inspiratory phase time to the expiratory phase time
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12
Q

Normal I:E Ratio

A
  • 1:2
  • We spend more time expiring

intrathoracic p > dec preload > dec CO – decrease I:E to 1:1 to help CO

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13
Q

Inverse ratio ventilation

A
  • Inspiratory phase time is longer than the expiratory phase time
  • 2:1
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14
Q

The sum of all tidal volumes in one minute

A
  • Minute volume
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15
Q

Peak Pressure

A
  • The maximum pressure during the inspiratory phase time
  • PIP
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16
Q

Spill Valve

A
  • The valve in the ventilator that allows excess gases to be sent to scavenging system during exhalation
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17
Q

The energy that the patient/ventilator expends to move gas in and out of the lungs.

A
  • Work of breathing
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18
Q

%%%

Factors that affect delivered tidal volume.

A
  • Fresh gas flow
  • Compliance
  • Leak
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19
Q

On older vents, as FGF increases, what happens to tidal volume?
* what do newer vents do to excess FGF?

A
  • Tidal volume increase
  • diverted during inspiration
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20
Q

How do newer vents compensate for system compliance?

A
  • New vents will alter the volume delivered to compensate for system compliance (pressure control)
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21
Q

2 compliance factors affecting ventilation

A

o System – bent tube, step on circuit
o patient – asthma, COPD, Trendelenburg, supine, laparoscopy CO2 insufflation

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22
Q

How does a leak affect delivered tidal volume?

A
  • Leaks around ETT or LMA
  • will cause a decrease tidal volume that can’t be compensated by the ventilator
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23
Q

Components to the bellows ventilator.

A
  • Driving gas supply + FGF
  • Controls
  • Alarms
  • Pressure-limiting mechanism
  • Bellows (accordion-like device)
  • Housing
  • Exhaust Valve
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24
Q

Components of Bellows Ventilators

What does the driving gas + FGF do to the bellows?
What is another name for this?

A
  • The driving gas is the gas external to the bellows that cause them to collapse.
  • FGF is internal the bellows + delivered to pt
  • Double Circuit
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25
Q

Components of Bellows Ventilators

FGF is oxygen, air or mix + in the bellows it is equal to?
If oxygen using, what is flow from flowmeters + Vm from FGF?

A
  • Vm
  • flow control from flowmeters (1-2 L/min) + Vm from FGF (4-5 L/min)
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26
Q

Components of Bellows Ventilators

What are the two required alarms on the ventilator?

A
  • Low-pressure alarm
  • High-pressure alarm
  • high, medium, + low priorities
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27
Q

Components of Bellows Ventilators

What is the most common cause of low-pressure ventilator alarms?

A
  • Disconnection of a circuit
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28
Q

Components of Bellows Ventilators

What are examples of high-pressure ventilator alarms?

A
  • Kinking of the ETT
  • Occlusion of mask
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29
Q

Components of Bellows Ventilators

What is the pressure limiting mechanism?
What is a good set point for the pressure limit of the inspiratory pressure?

A
  • Limits inspiratory pressure
  • 10 cmH2O above average inspiratory pressure with desired Vt
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30
Q

Components of Bellows Ventilators

What is the housing of the anesthesia machine?

A
  • Clear plastic cylinder
  • Allows movement of bellows to be observed
  • Has scale on side for rough estimation of tidal volume
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31
Q

%%%

What is the function of the exhaust valve?

A
  • Communicates with the housing and allows driving gas to be vented to the atmosphere on exhalation
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32
Q

The bellows is _______ driven

A

pneumatically

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33
Q

What are the two kinds of bellows?

Which one is safer?

How are they named?

A
  • Ascending Bellows (standing) safer
  • Descending Bellows (hanging)
  • named on what they’re doing during exhalation
34
Q

Why are ascending bellows considered safer?

A
  • disconnection in circuit,&raquo_space; bellows will fail to rise on exhalation&raquo_space; trigger CRNA to know something is wrong.
  • For descending bellows = continue to descend even if disconnection d/t gravity
35
Q

What are the 3 bellows problems?
What do they lead to?

A
  • Improper seating of bellows inside housing&raquo_space; inadequate ventilation
  • Hole&raquo_space; alveolar hyperinflation / barotrauma
  • Scavenging system closed&raquo_space; waste gases vented to room
36
Q

Hole in bellows :: if driving gas is O2 vs. air

A
  • if driving gas is O2 - increase FiO2
  • if air - dcrease FiO2
37
Q

What are the components of Piston Ventilators?

A
  • mechanically driven motor (plunger of syringe)
  • no driving gas - single circuit
  • use less gas
38
Q

PIston ventilators don’t alter ______ based on compliance.

A

Vt

39
Q

Piston ventilator 4 extras

A

o Very small piston chamber
o Accurate tidal volumes
o Hidden on machine…no visual ventilation
o Very quiet

40
Q

What are 2 piston problems

A
  • refills even with disconnection
  • entrain room air during leaks&raquo_space; dilutes O2/volatiles
41
Q

3 controlled ventilation modes

A
  • volume control
  • pressure control
  • volume guarantee pressure-control
42
Q

What is the most commonly used mode of ventilation?

A
  • Volume control
43
Q

What is volume control mode of ventilation?

A
  • Preset tidal volume is delivered (fixed parameter)
  • Additional breaths = at machine preset Vt

any RR is always with set Vt - RR 10 + Vt 500 ,, RR 20 + Vt 500

44
Q

Volume control mode can cause excessive ________ pressure.

A
  • inspiratory
45
Q

Volume control mode will have set:

A
  • Set Tidal Volume
  • Set Respiratory Rate
  • Set I:E Ratio
46
Q

%%%%

What conditions would a volume control mode not be beneficial for the patient?

A
  • Conditions with decreased compliance and FRC
  • Obese/Pregnant patients
  • Trendelenburg/Lithotomy procedures
  • Patients with lung pathology
  • Patients that need to be weaned from the vent
47
Q

%%%

How much tidal volume should be delivered to a patient on a ventilator?

A
  • 4-6 mL/kg
48
Q

Describe pressure control ventilation.

A
  • Preset inspiratory pressure is quickly achieved during inspiration.
  • Set PIP, RR, and I:E Ratio
49
Q

Describe tidal volume with pressure control ventilation.

A
  • Tidal volume varies with resistance and compliance

*Insufflation + Trendelenburg&raquo_space; cause low Vt *

50
Q

What will insufflation of the abdomen do to inspiratory pressure?

A
  • Increase inspiratory pressure, which will cause a low tidal volume.
51
Q

What is the good thing about pressure control ventilation?

A
  • This vent setting protects lungs from barotrauma of excess pressure
52
Q

What is the bad thing about pressure control ventilation?

A
  • The pressure delivered in this mode might not develop enough tidal volume for the patient.
  • Increase risk for atelectasis
  • cause hypoventilation
53
Q

What are ways to deliver more tidal volume in pressure control ventilation mode to patients with low lung compliance?

A
  • Increase PIP
  • Use Inverse I:E ratio, longer inspiration than expiratory time. The body will have time to adapt to increased pressure.
54
Q

Describe Volume Guarantee Pressure-Control.

A
  • Maintain Tidal Volume by adjusting PIP over several breaths.
  • Prevent sudden Tidal Volume changes d/t compliance
  • Lost insufflation - *change in compliance when case finishing up *
55
Q

What is Assist Control Ventilation?

A
  • Predetermined negative pressure will trigger breath
  • Breath is preset tidal volume

set paramter 8 RR + 600 Vt — pt triggers 10 RR @ 600 ea

56
Q

What is Intermittent Mandatory Ventilation (IMV)?

A
  • Mandatory ventilator breath is set - RR is set
  • Additional native breaths at** variable tidal volume**
  • Allows breath stacking
57
Q

What is SIMV?

A
  • Synchronizes ventilatory-driven breaths with spontaneous breaths
  • makes a waiting time before the next breath + pt has to exhale - no stacking
  • Provides backup to weaning ventilator
  • Best for weaning
58
Q

What is Pressure Support?

A

*** PIP + inspiratory time **set
* Vt equates to the native effort
* Need apnea alarm

59
Q
  • standard machines have variable amts of __________ substances
    What are ways to use a ventilator during an MRI?
A

FERROMAGNETIC

  • MRI compatible machines
  • Anesthesia machine kept outside in hallway
  • Machine bolted to wall
  • Aluminum tanks or pipeline gas supply
60
Q

General Hazards: What 4 can cause ventilation failure?

A
  • Disconnection from power supply
  • Extremely high FGF
  • Fluid in electronic circuitry
  • Leaking bellows housing

FIX = Bag the pt

61
Q

General Hazards: How can there be a loss of breathing system gas?

A
  • Failure to occlude spill valve
  • Leak in the system

Need to do daily anesthesia machine check

62
Q

General Hazards: What 4 can cause incorrect ventilator settings?

A
  • Inadvertent bumping
  • Not adjusted for new case
  • Not adjusted for position/pressure changes
  • Ventilator turned off for xrays (cholangiogram)
63
Q

3 Advantages of a ventilator

A
  • Allows anesthesia provider to devote energy to other tasks (free hands)
  • Decreases fatigue
  • Produces more regular rate, rhythm, and Vt
64
Q

6 Disadvantages of a ventilator

A
  • Loss of “feel” (reservoir bag)
  • Older versions may not have all the desired modes
  • Components are hard to clean or fix
  • Lack user-friendliness
  • Noisy or too quiet
  • May require high-flow driving gases…expensive
65
Q

What is the trace gas concentration?

A
  • Concentration of a gas far below that needed for anesthesia or detected by smell
66
Q

Trace concentration units

A
  • PPM (parts per million)
67
Q

100% of gas is how many PPM?

A

1,000,000, PPM

68
Q

1% of gas is how many PPM?

A

10,000 ppm

69
Q

Higher levels of trace gas concentration are seen in… 3

A
  • Pediatric anesthesia
  • Dental surgery
  • Poorly vented PACU’s
70
Q

Chart from NIOSH 1977 - maximums of how much ppm allowed
1. halogenated agent alone?
1. nitrous oxide?
1. combination - halogenated?
1. combination - nitrou oxide?
1. Dental facilitites (nitrous oxide alone)?

A
  1. 2
  2. 25
  3. 0.5
  4. 25
  5. 50
71
Q

6 causes for operating room contamination

A
  • failutre to turn off vaporizer
  • poor fitting mask
  • flushing circuit into room
  • spilling when fill vaporizer
  • uncuffed ETT
  • scavenging system leaks
72
Q

For years what did old studies conclude about trace gas exposure?

A
  • Spontaneous abortions
  • Spontaneous abortion in spouses
  • Infertility
  • Birth defects
  • Impaired performance
  • Cancer/mortality
  • Liver disease
  • Cardiac disease

These negative side effects of gas exposure has been mitigated with the scavenger system

73
Q

Scavenging system function.

A
  • Removes the collection of gases from equipment used to administer anesthesia or exhaled by the patient.
  • removal of these gases outside the work environment
74
Q

Describe the passive scavenging system.

A
  • attached to room ventilation system
  • Entire volume is exhausted to the atmosphere.
  • Disposal tubing from the anesthesia machine is attached to the exhaust grilland removed with room air.

Very economic – uncommon :(

75
Q

Describe the active scavenging system.

A
  • Attached to central vacuum system
  • Must be able to provide high volume (30L/min)
  • Need plenty of suction outlets and close to anesthesia machine

COMMON

76
Q

5 Ways to alter work practices + not contaminate the OR

A
  • mask fit
  • turn off gas flow durign intubation
  • 100% wash out at end of case
  • prevent liquid spills
  • plase anesthesia machine close to exhaust grill - passive system
77
Q

7 causes of hypoxic inspired gas mixture

A
    • Incorrect gas in pipeline
    • Incorrectly installed outlets
    • Oxygen tubing or hoses attached to incorrect flow meter
    • Incorrect cylinder attached to yoke
    • Incorrect cylinder…..around world O2 is green, white, blue, and black
    • Flow control malfunction
    • Leak in oxygen flow meter
78
Q

How can the ventilator cause hypercapnia? 4

A
  • Hypoventilation
  • Absorbent failure (exhaustion)
  • Excessive dead space
  • Defect coaxial system - mapleson D
79
Q

How does an anesthetic agent overdose over with the anesthesia machine? 5

A
  • Tipped vaporizer - lots of liquid
  • Vaporizer accidentally on
  • Incorrect agent in vaporizer
  • Interlock system failure
  • Overfilled vaporizer
80
Q

How does Hypoventilation occur on the ventilator?

A
  • Insufficient gas : swithc from pipeline to cylinder
  • Obstruction
  • Leaks
  • Main machine power off
  • Breathing system leaks (disconnections)
81
Q

What are 6 ways to prevent inadvertent exposure to volatiles?

MH , severe nv pts

A
  • Change breathing system hoses and bag
  • Change fresh gas supply hose
  • Change absorbent
  • Use very high oxygen flows to flush the machine
  • Remove vaporizers
  • Use an axillary flowmeter for supplemental oxygen
82
Q

2 Causes of blocked inspiratory + expiratory paths?

A
  1. mask wrapping
  2. absorbent wrapping

Principles I* (20 decks)

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