Early Mobilization of Critically Ill

Question 1

What are Fibrotic Lung characteristics?

Answer 1

Enlarged/damaged bronchioles
Distorted alveoli
Honeycomb clustered cystic air spaces
Fibrosis between alveoli resulting in decreased gas exchange
Slow blood flow; blood shunting possibly leading to hypoxia

Question 2

Characteristics of Hemodynamic Stability

Answer 2

MAP: >65
Pulmonary pressures: 2-8 (central), 10-20 (pulm artery)
Mixed venous oxy sat: 60-80%
Pulm vascular resistance

Question 3

Respiratory Stability Characteristics

Answer 3

Stability of saturation/oxygen therapy over 8 hours
Respiratory reserve ratio (pO2/FiO2): >300
SpO2 >90%

Question 4

Respiratory acidosis ABGs

Answer 4

Low pH 45

Compensate with metabolic alkalosis (HCO3 > 26)

Question 5

Respiratory alkalosis ABGs

Answer 5

High pH >7.45

Low PCO2

Question 6

Metabolic acidosis ABGs

Answer 6

Low pH

Question 7

Metabolic alkalosis ABGs

Answer 7

High pH >7.45
High HCO3 >26

Compensate with respiratory acidosis (PCO2> 45)

Question 8

Fraction of inspired O2 comparison with oxygen therapy volume

Answer 8

1L= 24%
2L=28%
3L=32%
4L=36%
(increase by 4% each L)

Question 9

Respiratory Reserve Ratio value interpretations

Answer 9

Shows arterial blood oxygen- PaO2/FiO2

476: normal healthy
>300: sufficient for mobilization

Question 10

What are the 9 steps of oxygen transport?

Answer 10

1. FiO2
2. Airway
3. Lung/chest wall- alveolar ventilation
4. Diffusion of O2 via alveolar PA
5. Perfusion of lungs- gravity helps
6. Myocardial function- preload, afterload, and contractility
7. Peripheral circulation
8. Tissue extraction and oxygenation
9. Return desaturated blood/CO2 to lungs

Question 11

What is the MRC Sum Score?

Answer 11

Strength assessment for critically ill- UE and LE
-wrist extension, biceps, abduc, quad, DF, hip flexion

Grades 0-5; total out of 60 points bilaterally

Question 12

Breathing Strategies for Restrictive lung pathologies

Answer 12

Treat underlying cause:

• atelectisis (hypoventilation), secretion (pneumonia), chest wall expansion (mechanical deficit)
• with interstitial lung diseases like fibrosis getting air IN is the problem

Fast shallow breaths= better expansion and air in alveoli
(slow and deep increase work due to decreased compliance)

Sitting is best position due to diaphragm mechanical advantage!