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MODES OF VENT > Effects of PPV > Flashcards

Effects of PPV Flashcards

1
Q

PPV has cardiac considerations include

A

The amount of PPV we use

The patients lung condition

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2
Q

What does PPV do to MAP

A

Increases

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3
Q

What does PPV do to CMO

A

Decreases

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4
Q

Why does PPV decrease CMO?

A

The impedance of Venous Return

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5
Q

How does PEEP affect MAP?

A

Increases

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6
Q

How does PPV affect Pulmonary Vascular Resistance?

A

Increases

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7
Q

High volumes or PEEP does what to alveoli and pulmonary vessels?

A

Over distend alveoli

Squeeze pulmonary vessels

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8
Q

What is PVR most increased by?

A

Mean Airway Pressure (MAP)

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9
Q

T/F Pulmonary vascular resistance is increased by PIP?

A

False

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10
Q

How does PVR affect Right Ventricular Afterload

A

Increases

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11
Q

Normal people can over come PVR how?

A

Increasing Right Ventricular Contractions

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12
Q

People with abnormal hearts can not compensate from PVR and then what happens?

A

Right Ventricular Stroke Volume drops

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13
Q

Dilation of right ventricle can cause what to happen?

A

Force the intraventracular septum to shift left

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14
Q

What PEEP levels can cause the Intraventricular septum to shift left?

A

> 15 cmh20

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15
Q

What else can cause the Intraventricular septum to shift left?

A

decreased blood volume

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16
Q

If the intraventricular septum is shifted left, what is that going to do to the Left Ventricle Stroke Volume

A

Decrease it

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17
Q

PPV -> ___________-> compress pulmonary vessels -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> high v/q mismatch -> hypoxemia -> decreased o2 content -> reduced o2 delivery

A

Increase intrathoracic pressure

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18
Q

-> Increase intrathoracic pressure -> compress pulmonary vessels -> Reduce stroke volume -> ____________-> high v/q mismatch -> hypoxemia -> decreased o2 content -> reduced o2 delivery

A

reduce cardiac and pulmonary blood flow

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19
Q

-> Increase intrathoracic pressure -> compress pulmonary vessels -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> high v/q mismatch -> hypoxemia -> _________ -> __________

A

decreased o2 content

reduced o2 delivery

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20
Q

-> Increase intrathoracic pressure -> _________ -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> high v/q mismatch -> hypoxemia -> decreased o2 content -> reduced o2 delivery

A

compress pulmonary vessels

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21
Q

-> Increase intrathoracic pressure -> compress pulmonary vessels -> Reduce stroke volume -> reduce cardiac and pulmonary blood flow -> _______ -> _______ -> decreased o2 content -> reduced o2 delivery

A

high v/q mismatch

hypoxemia

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22
Q

T/F PPV can cause a decrease in intrapulmonary shunting?

A

False.

Can cause an INCREASE in intrapulmonary shunting

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23
Q

T/F ventilation is gravity independent

A

FALSE

Ventilation is gravity dependent

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24
Q

Ventilation is gravity dependent and areas of lung are ______, where as blood flow is _______

A

decreased, increased.

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25
Q

Intrapulmonary shunting can increase how much with ppv?

A

10%

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26
Q

PPV does what to Endocardial (coronary) blood flow

A

Decreases

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27
Q

PPV reduces Venous return and _______

A

Cardiac Minute Output

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28
Q

PPV reduces _____ _____ and Cardiac Minute Output

A

venous return

29
Q

PPV reduces venous return and CMO and this will cause what to decrease?

A

Coronary Perfusion

30
Q

What else can contribute to myocardial dysfuntion?

A

Ischemia

31
Q

Compensation in Normal People:

Rarely have a decrease in CMO. The decrease in
stroke volume is compensated for by
_______ and increase in systemic vascular resistance

A

tachycardia

32
Q

Compensation in Normal People:

Rarely have a decrease in CMO. The decrease in
stroke volume is compensated for by

A

tachycardia and increase in systemic vascular resistance

33
Q

Compensation in normal people

Since most people do not have a decrease in Cardiac Minute Output. The decrease in stroke volume is compensated for by tachycardia and SVR. Also shunts blood away from where?

A

from the kidneys and other lower extremities

34
Q

Why would a patient be hypotensive?

A

Impeded venous return

35
Q

hypotension is rare due to

A

Compensation

36
Q

BP

Increase’s in?

A

Heart Rate
Systemic Vasoconstriction
Shunt blood away from kidneys and other ext.

37
Q

Effectiveness of compensation depends upon

integrity of

A

neuroreflexes.

38
Q

Pts who are hypertensive increase venous

return to which ventricle

A

Left ventricle

39
Q

Pts who are hypertensive increase venous

return to the left ventricle. This is because

A

pulmonary vessel compression is minimal in

HTN.

40
Q

Vascular effects can be blocked by

I) pulmonary hypotension 
II) spinal/general anesthesia
III) spinal chord transection 
IV) polyneuritis
V) increased venous return
A

II, III, IV

41
Q

High Airway Resistance

In pts with high Raw much of the pressure is
lost to the

A

poorly conductive airways and

less actually reaches the alveolar level.

42
Q

Which Patient is less likely to experience hemodynamic changes because less pressure is transmitted to the pleural space?

A)  ARF type II
B)  ARF type I
C) ARDS
D) COPD
E) Patients with compliant lungs and stiff chest wall
A

ARDS

Pts with stiff lungs (ARDS) , are less likely to
experience hemodynamic changes because
less pressure is transmitted to pleural space.

43
Q

Which Patient is more likely to experience hemodynamic changes because less pressure is transmitted to the pleural space?

A)  ARF type II
B)  ARF type I
C) ARDS
D) COPD
E)  Patients with compliant lungs and stiff chest wall
A

People with compliant lungs and stiff chest

walls are most are risk.

44
Q

Effects of lung/ compliance and Raw:

Pts with stiff lungs (ARDS) , are less likely to
experience ___________ changes because
less pressure is transmitted to pleural space.
People with compliant lungs and stiff chest
walls are most are risk.

A

hemodynamic

45
Q

Effects of lung/ compliance and Raw:

Pts with stiff lungs (ARDS) , are less likely to
experience hemodynamic changes because
_______ ______ is transmitted to _____ ______.
People with compliant lungs and stiff chest
walls are most are risk.

A

less pressure; pleural space

46
Q

Systemic hypotension rarely occurs in normal individuals receiving positive-pressure ventilation due to

A

compensatory mechanisms.

47
Q

Beneficial or Harmful effects of Left Ventricular

dysfunction

A

Beneficial

48
Q

Duration and Magnitude of PPV

Lower _____ to reduce cardiovascular
changes.

PIP, MAP, inspiratory flow, I:E ratio,
inflation hold and PEEP play a role.

A

MAP

49
Q

Duration and Magnitude of PPV

Lower MAP to reduce cardiovascular
changes.

What else play a role.

I) PIP
II)  MAP 
III) inspiratory flow
IV)  I:E ratio
V) RR
VI) inflation hold
VII) FIO2
 VIII) PEEP
A

I, II, III, IV, VI, VIII

50
Q

Three Points About High Flow

A

More pressure lost to pt circuit

More pressure will be needed to
overcome Raw

Uneven ventilation occurs with high
flows

51
Q

Altering vent to reduce PPV complications

What would you reduce?

A

MAP

52
Q

Altering vent to reduce PPV complications

MAP increases ____ which leads to (increased/decreased) o2

A

FRC

Increases

53
Q

Altering vent to reduce PPV complications

High Insp flow tend to increase ?

A

PIP

54
Q

Altering vent to reduce PPV complications

High insp flows tend to increase PIP, but shorten ?

A

Inspiration

55
Q

Altering vent to reduce PPV complications

high insp flows tend to increase PIP, but shorten inspiration which can lower

A

MAP

56
Q

What occurs with high flow?

A

Uneven Ventilation

57
Q

What is the goal with flow?

A

Flow not too high to cause problems

Flow not too low to cause ^ WOB.

58
Q

When would you use an INSP hold?

A

Diagnostically only

59
Q

What I:E Ratio do you typically want

A

1 : 2 to 1 :4

60
Q

What can happen if you have an I:E ratio of 1:1?

A

Air trapping

Increase in MAP

61
Q

PEEP = Stiff lungs may not always decrease

A

CMO

62
Q

What will PEEP always do to MAP

A

Increase it

63
Q

T/F High Peak PIP does always reflect Paw

MAP

A

FALSE

High Peak PIP does NOT always reflect Paw
MAP

64
Q

Vent calculations of MAP may not always

be accurate if pt has

A

auto-PEEP

65
Q

Vent calculations of MAP may not always

be accurate if pt has auto-PEEP. This is why inflation hold is only used for

A

plat pressure

66
Q

What mode can reduce Paw by allowing

spontaneous breathing.

A

SIMV

67
Q

PPV can help pts with

A

LV dysfunction

68
Q

PEEP may Increase PaO2 and improve ____ _____ dysfunction is due to ______

A

cardiac perfusion ; hypoxemia

69
Q

Decreased venous return may

A

Improve Stroke Volume

MODES OF VENT (4 decks)

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