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RTH 132 Hannah > Effects of Positive Pressure Ventilation > Flashcards

Effects of Positive Pressure Ventilation Flashcards

1
Q

What must you have when using positive pressure ventilation?

A

A closed system

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2
Q

PPV increases __ and decreases __

A

MAP; CMO

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3
Q

What does ventilation impede?

A

Venous return

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4
Q

What enhances venous return?

A

Spontaneous breathing

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5
Q

When you create negative interthoracic pressure, you ___ the diaphragm

A

Pull down

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6
Q

MAP is always equal to what?

A

Greatest surface area

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7
Q

High volumes or PEEP overdistend the alveoli and squeeze pulmonary vessels, ____ PVR and cardiac work

A

Increasing

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8
Q

PVR is most increased by what?

A

MAP

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9
Q

Increased PVR ___ RV afterload

A

Increases

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10
Q

Normal can overcome PVR by doing what to RV contraction?

A

Increasing

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11
Q

Abnormal can’t overcome and RVSV ___

A

Drops

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12
Q

What does RVSV stand for?

A

Right ventricle stroke volume (amount objected per beat)

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13
Q

___ of RV can also force the intraventricular septum shift to the left

A

Dilation

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14
Q

What does PVR stand for?

A

Pulmonary vascular resistance

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15
Q

Dilation of RV is often with PEEP __ than 15 cmH20

A

greater

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16
Q

Dilation of RV causes LVSV to ___

A

Decrease

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17
Q

___ endocardial (coronary) blood flow is a cardiovascular consideration

A

Decreased

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18
Q

PPV reduces venous return and CMO, which can decreased ____

A

Coronary perfusion

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19
Q

What can contribute to myocardial dysfunction?

A

Ischemia

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20
Q

M aortic DP - LVEDP equals what?

A

CorArtPP

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21
Q

Patients who have ___tension have a ___ venous return

A

Hypotension; decreased

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22
Q

Patients who have ___ tension have an ___ venous return to the left ventricle

A

Hypertension; increased

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23
Q

An increase in intrapulmonary shunt can cause ___ blood flow and ventilation to most gravity dependent areas of the lung is ___

A

Increased; decreased

24
Q

An increase blood flow can increase to ___%

A

10%

25
Q

How do you calculate oxygen delivery?

A

CaO2 x CMO

26
Q

PPV results in __ V/Q mismatch and hypoxemia, which in turn ___ O2 content and ___ O2 delivery

A

High; decreases; decreased

27
Q

Normal people rarely have a ___ in compensation

A

Decrease

28
Q

A decreased in stroke volume is compensated by ____ and increase is ____, as well as shunts away from the kidneys and lower extremeties

A

Tachycardia; SVR

29
Q

Effectiveness of ____ depends upon integrity of neuroreflexes

A

Compensation

30
Q

What can vascular effects be blocked by?

A
  • Spingal/general anesthesia
  • Spinal chord transection
  • Polyneuritis
31
Q

___ levels of PEEP make situation worse when trying to compensate

A

Increased

32
Q

What happens when you impede venous return?

A

Lower stroke volume

33
Q

When you apply PEEP to ____, you greatly increase surface area, which makes the situation worse

A

MAP

34
Q

Patients with stiff lungs, like ___, are ___ likely to experience hemodynamic changes because ___ pressure is transmitted to the pleural space

A

ARDS; less; less

35
Q

Who are at most risk for cardiovascular considerations of PPV?

A

People with compliant lungs and stiff chest walls

36
Q

In patients with high ____, much of pressure is lost to the poorly conductive airways and less actually reaches the ____ level

A

Airway resistance; alveolar

37
Q

What should you lower to reduce cardiovascular changes?

A

MAP

38
Q

What 6 things play a role in cardiovascular changes?

A
  • PIP
  • Inspiratory flow
  • MAP
  • PEEP
  • I:E ratio
  • Inflation hold
39
Q

What should you alter on the vent to reduce PPV complications?

A
  • Reduce MAP

- High inspiratory flow to increase PIP

40
Q

PIP stands for what?

A

Peak inspiratory pressure

41
Q

What are three points about high flow?

A
  • More pressure lost to patient circuit
  • More pressure will be needed overcome Raw
  • Uneven ventilation occurs with high flows
42
Q

What needs to increase when flow goes down?

A

PRAMP

43
Q

What creates the flow?

A

Pressure gradient

44
Q

What is the goal of PPV when it comes to cardiovascular considerations?

A

Flow not too high to cause problems but not too low to cause an increase WOB

45
Q

An I:E ratio of 1:1 may lead to ____ and ___ mean airway pressure

A

Air trapping; increase

46
Q

When is an inflation hold used?

A

Diagnostically ONLY

47
Q

What does PEEP always increase?

A

MAP

48
Q

What may not always decrease CMO?

A

Stiff lungs

49
Q

Holding breath greatly increases what?

A

Airway pressure

50
Q

High peak PIP does not always reflect what?

A

Mean airway pressure

51
Q

If a patient has auto-PEEP, will vent calculations of MAP be accurate?

A

Not always

52
Q

What should you do to see if you have auto-PEEP?

A

Expiratory hold

53
Q

What mode can reduce mean airway pressure by allowing a spontaneous breath?

A

SIMV

54
Q

What is auto-PEEP?

A

When you allow alveoli to equal out with pressure at the airway

55
Q

What are the main cardiovascular considerations when it comes to PPV?

A
  • Dilation of RV
  • Increased PVR, RAW, pulmonary shunt
  • Decreased oxygen delivery, endocardial (coronary) blood flow
  • Blood pressure changes
  • Effectiveness of compensation
  • Duration and magnitude of PPV

RTH 132 Hannah (12 decks)

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