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Artificial Airways_Ventilation > Establishing Need for Mech Vent Pilbeam 4 > Flashcards

Establishing Need for Mech Vent Pilbeam 4 Flashcards

includes Critical values!

1
Q

What are the PHYSIOLOGICAL objectives of mechanical ventilation

A
  1. Support or manipulate pulmonary gas exchange (alveolar ventilation/CO2 levels and alveolar oxygenation (CaO2 x cardiac output)
    2 Increase lung volume (prevent/treat atelectasis w/PEEP and restore/maintain FRC)
  2. Reduce work of breathing
  3. Minimize cardiac impairment
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2
Q

What are the CLINICAL objectives of mechanical ventilation?

A

Reverse acute respiratory failure
Reverse respiratory distress
Reverse hypoxemia
Prevent/reverse atelectasis and maintain FRC
Reverse respiratory muscle fatigue
Permit sedation, paralysis or both (ie surgery)
Reduce systemic or myocardial oxygen consumption
Minimize associated complications and reduce mortality

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3
Q

Recognizing the patient in distress- what should you assess?

A
  1. Level of consciousness and sensorium
  2. Appearance: evidence of cyanosis, color, diaphoresis?
  3. Vital signs: RR, HR, BP, temp, SaO2
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4
Q

Sudden onset dyspnea- signs and symptoms

A

anxious, eyes wide open, (panic) nostril flare, furrowed brow, diaphoretic, flushed or ashen, use of accessory breathing muscles, paradoxical breathing, abnormal breath sounds, tachycardia, arrhythmias, hypotension; patient complants of SOB

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5
Q

What is the definition of acute respiratory failure (ARF)

A

any condition (rapid onset) where respiratory activity is inadequate to maintain 02 uptake and CO2 clearance

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6
Q

A patient is considered to be in ARF status when their ABG results are what?
(pH, PaCO2, PaO2)

A

ph < 7.25
PaCO2 > 50
PaO2 < 60

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7
Q

List the 2 types of ARF

A

Type I hypoxic respiratory failure

Type II hypercapnic respiratory failure

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8
Q

Type I is also called _____ _______ accompanied by hypercapnia

A

pump failure

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9
Q

Type II is also called lung failure accompanied by hypoxemia or ________ failure.

A

ventilatory failure

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10
Q

What are the 4 causes of hypoxemic respiratory failure?

A

1 V/Q mismatch (relative shunt)
2 diffusion defects
3 right to left shunting (severe shunt)
4 alveolar hypoventilation
5 inadequate inspired O2 (high altitude, CO poisoning, aging and related increased dead space)
Yes there are 5 causes but Denise always says “the 4 major”

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11
Q

What is the ventilatory pump?

A

the respiratory muscles, thoracic cage, and nerves that are controlled by respiratory centers in the brainstem

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12
Q

What 3 types of disorders can lead to ventilatory pump failure?

A

1 Central nervous system disorders
2 Neuromuscular disorders
3 Disorders that increase the work of breathing

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13
Q

What are early signs and symptoms of hypoxia?

A

tachycardia and tachypnea

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14
Q

Does severe shunting respond to O2?

A

NO

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15
Q

Severe hypercapnia eventually leads to CO2 narcosis, _______ _______, coma and death

A

cerebral depression

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16
Q

Severe hypercapnia eventually leads to _____ _____ , cerebral depression, coma and death

A

CO2 narcosis (reduction of the hypoxic drive/ respiratory effort)

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17
Q

What is the differential diagnosis for CHRONIC hypercapnic respiratory failure and ACUTE hypercapnic respiratory failure?

A

The severity of the change in pH.
In ACUTE hypercapnic RF, pH decreases 0.08 for every 10 mmHg increase in PaCO2. In CHRONIC hypercapnic RF, pH decreases 0.03 for every 10 mmHg increase in PaCO2

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18
Q

In chronic hypercapnia, ph decreases _____ for every _____ mmHg increase in PaCO2

A

0.03 for every 10 mmHg

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19
Q

In acute hypercapnia, ph decreases _____ for every _____ mmHg increase in PaCO2

A

0.08 for every 10 mmHg

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20
Q

What is congenital central hypoventilation syndrome (CCHS) (aka primary alveolar hypoventilation aka Ondine’s curse)?

A

Congenital or developed sleep disorder wherein patient’s suffer from respiratory arrest during sleep and involving an inborn failure of autonomic control of breathing due to congenital defect or developed due to severe neurological trauma to the brainstem

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21
Q

Elevation of PaCO2 levels lead to a(n) _________ in cerebral blood flow caused by ___________.

A

increase - caused by dilation of cerebral blood vessels

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22
Q

List some of the causes of decreased respiratory drive (as found in ARF- hypercapnic, CNS related)

A

depressant drugs, head trauma, sleep disorders, acid/base abnormalities, inappropriate O2 therapy, hypothydroidism

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23
Q

List some of the causes of increased respiratory drive (as found in ARF- hypercapnic, CNS related)

A

increased metabolic rate, metabolic acidosis, anxiety associated with dyspnea

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24
Q

What happens when a person’s PaCO2 rises above 70 mmHg?

A

PaCO2 greater than 70 has a CNS depressant effect reducing respiratory drive and ventilation

25
Q

T/F Hypoxia normally acts as a respiratory stimulant

A

true

26
Q

Normally the work of breathing consumes __ to ___ % of total oxygen consumption

A

1 to 4%

27
Q

What are two (physiological) causes of increased work of breathing?

A

increased deadspace (as in COPD/ emphysema) and increased airway resistance (as in chronic bronchitis or asthma)

28
Q

Should mechanical ventilation be used to control ICP in patients with brain injury?

A

clinical evidence says no- brain injury by itself is not an indication for intubation and CMV

29
Q

What are the normal and the critical values for dead space to tidal volume ratio? (Vd/Vt)?

A

normal values are 30 to to 40% (0.3 to 0.4)

critical value is a ratio greater than 60^ (0.6)

30
Q

What are the normal and critical values for PaO2 (indicating the need for O2 therapy or PEEP/CPAP)

A

Normal tension is 80-100

Values less than 70 (on FIO2 above 60) require intervention

31
Q

What are the normal and critical values for P(A-a)? [arterial to alveolar difference]

A

Normal values are 3 to 30

Critical values are >450 on O2

32
Q

What are the normal and critical values for the ratio of arterial to alveolar PO2 (PaO2/PAO2)

A

Normal is 75% (or 0.75)

Critical value is less than 15% (0.15)

33
Q

Whar are the normal and critical values for the PaO2/FIO2 (P/F ratio)

A

Normal is 475

Critical value is below 200

34
Q

MIP (maximum inspiratory pressure) and vital capacity (VC) are test results performed to assess what?

A

respiratory muscle strength of patients (generally performed on those with neuromuscular disorders)

35
Q

Should mechanical ventilation be used for patient’s with flail chest?

A

Only when it is associated with imminent respiratory failure

36
Q

What are the normal and critical values for MIP, mean inspiratory pressure (aka NIF, negative inspiratory force)?

A

Normal adult range is -100 to -50

Critical value is -20 to 0

37
Q

What are the normal and critical values for MEP (maximum expiratory pressure)

A

Normal is 100 cmH20

Critical value is <40

38
Q

What are the normal and critical values for tidal volume (Vt) in mL/kg

A

Normal is 5-8 mL/kg

Critical value is less than 5

39
Q

What are the normal and critical values for VC (vital capacity) in mL/kg

A

Normal is 65-75

Critical value is <10-15 mL/kg

40
Q

What are the normal and critical values for respiratory frequency (breaths per minute)

A

Normal is 12 to 20

Critical value is greater than 35 b/m

41
Q

What are the normal and critical values for forced expired volume at 1 second (FEV1) in mL/kg

A

Normal is 50-60

Critical value is less than 10 ml/kg

42
Q

What are the normal and critical values for peak expiratory flow rate (PEFR) in L/min

A

Normal is 350 to 600

Critical value is 75 to 100 L/min

43
Q

Measurement of MIP must begin as closely as possible to the patient’s _______ ________

A

residual volume (from maximal exhalation)

44
Q

A MIP of -20 will generate a tidal volume large enough for the patient to _________

A

produce a good cough

45
Q

What is the definition of vital capacity?

A

the volume of air that can be maximally exhaled following a maximum inspiration

46
Q

What is the formula used to obtain a male patient’s ideal body weight?

A

Men: 106 + (6 x ht in inches - 60)

47
Q

What is the formula used to obtain a female patient’s ideal body weight?

A

Female: 100 + (5 x ht in inches -60)

48
Q

An elevated PaCO2 would suggest that _______ is increased relative to tidal volume

A

dead space

49
Q

How do you calculate arterial oxygen content? (what is the formula)

A

CaO2= [(Hb x 1.34) x SaO2] + (PaO2 x 0.003)

50
Q

To treat arterial hypoxemia caused by hyperventilation you should _____.

A

increase alveolar ventilation

51
Q

To treat arterial hypoxemia caused by low V/Q ratio, you should _____.

A

use PEEP or CPAP

52
Q

The PaO2/PAO2 is expressed in a percentage. What does this number mean? (what is it telling you?)

A

what percentage of the oxygen available in the alveoli is diffusing into the pulmonary capillaries

53
Q

According to Pilbeams on room air the normal ranges for P/F ratios should be:

A

350-450. The lower the number, the more severe the problem.

54
Q

List the 4 standard criteria for instituting Mechanical Ventilation

A

1 Apnea or absence of breathing
2 Acute ventilatory failure
3 Impending ventilatory failure
4 Refractory hypoxemic respiratory failure with increased work of breathing or an ineffective breathing pattern

55
Q

T/F No single value for PaO2, PaCO2 or pH indicates a need for invasive ventilation

A

TRUE

56
Q

Non invasive positive pressure ventilation (NIV) is the treatment of choice for acute on chronic respiratory failure unless ________ is also a factor.

A

cardiovascular instability

57
Q

What are the indications for using NIV?

A

at least 2 of the following:

  • Resp rate greater than 25 b/m
  • Moderate to severe acidosis (pH 7.25 to 7.30; PaCO2 45 to 60
  • Moderate to severe dyspnea with use of accessory muscles and paradoxical breathing
58
Q

What are the absolute contraindications for NIV?

A

respiratory arrest, cardiac arrest, non-respiratory organ failure (encephalopathy, GI bleeding or surgery, hemodynamic instability (with or w/out unstable cardia angina), upper airway obstruction, inability to protect the airway and/or high risk of aspiration, inability to clear secretions, facial or head trauma/surgery

59
Q

What are the relative contraindications for NIV

A

cardiovascular instability; uncooperative patient (impaired mental status, hypersomnolence); copious or viscous secretions, fixed nasopharyngeal abnormalities, extreme obesity

Artificial Airways_Ventilation (6 decks)

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