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Critical Care > Ex 1: Resp Failure: Ventilators/Pressure and Alarms > Flashcards

Ex 1: Resp Failure: Ventilators/Pressure and Alarms Flashcards

1
Q

Indications for Ventilation

Hypoxia values?

A

PaO2 ≤ 60 mm Hg on FiO2 > 0.5

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2
Q

Indications for Ventilation

Hypercapnea values?

A

PCO2 ≥ 50 mm Hg with pH ≤ 7.25

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3
Q

Indications for Ventilation

Progressive deterioration signs?

A

Increasing RR
Decreasing VT
Increase in WOB

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4
Q

Positive Pressure Ventilation

What is it?

A

Movement of gases into lungs through positive pressure

Opposite of normal respirations

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5
Q

Endotracheal Intubation

preferred route

A

Orotracheal

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6
Q

Endotracheal Intubation

Used to:

A

Maintain an airway
Remove secretions
Prevent aspiration
Provide mechanical ventilation

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7
Q

Assessment of Ventilation

End-tidal CO2 (ETCO2)
is use for what?

A

trending

  • Must compare with ABGs
  • Values tend to be 2 to 5 mm Hg less than PaCO2
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8
Q

Ventilator Settings

FiO2 is?

A

fraction of inspired oxygen (FiO2) is
- the amount we’re giving

( the concentration of oxygen in the gas mixture)

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9
Q

Ventilator Settings

Tidal Volume (VT)

A

amount of air that moves in or out of the lungs with each respiratory cyc

approximately 500 ml per inspiration

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10
Q

Ventilator Settings

Positive end-expiratory pressure (PEEP)

normal range and function?

A

5-20 cm H2O

Increases FRC to improve oxygenation
Reduces Cardiac Output

( functional residual capacity (FRC) is the volume in the lungs at the end of passive expiration)

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11
Q

Auto-PEEP

What is it?

A

Spontaneous development of PEEP

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12
Q

Auto-PEEP

caused by

A

gas trapping

  • Insufficient expiratory time
  • Incomplete exhalation
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13
Q

Auto-PEEP

signs of Incomplete exhalation from gas trapping?

A

Rapid RR
Airflow obstruction
Inverse I:E ventilation

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14
Q

Auto-PEEP

How is it assessed?

A

Assess by 2-sec pause (hold) maneuver

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15
Q

Ventilator Modes

ACV

A

Assist-Control Ventilation

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16
Q

SIMV

A

Synchronized Intermittant Mandatory Ventilation

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17
Q

PSV:

A

Pressure Support Ventilation

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18
Q

PC-IRV:

A

Pressure Control Inverse Ratio Ventilation

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19
Q

(APRV)/CPAP

A

Airway pressure-release ventilation

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20
Q

Volume Ventilation

How is it different than pressure vent

A

The VT delivered by the ventilator is constant

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21
Q

Volume Ventilation

What are the types

A

Volume assist/control (VAC)

Synchronized intermittent mandatory ventilation (SIMV)

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22
Q

Pressure Ventilation

How is it different than volume?

A

Ventilator set to allow airflow until preset pressure is reached

PIP can be better controlled

23
Q

Pressure Ventilation

What are the risks

A

hypoventilation and respiratory acidosis

24
Q

Pressure Ventilation

What are the types

A

CPAP, pressure support (PSV),
pressure A/C, inverse-ratio ventilation,
airway pressure release (APRV)

25
Q

Volume Assist/Control Ventilation ACV)

Key functions and when is it useful?

A
  • *Preset number of breaths at preset VT**
  • Patient may trigger additional breaths
  • VT does not vary
  • Ventilator performs most of the WOB

Useful in normal respiratory drive but weak or unable to exert WOB

26
Q

Volume Assist/Control Ventilation ACV)

What are the risks?

A

hyperventilation and respiratory alkalosis

27
Q

SIMV : Synchronized Intermittent Mandatory Ventilation

Key functions?

A
  • Ensures predetermined number and tidal volumes of breaths each minute
  • Additional breaths by the patient are allowed and not assisted by the machine

Prevents patient from fighting the ventilator
(Ventilator assisted breaths are synchronized into the patient’s own respiratory cycle)

28
Q

Pressure Support (PS)

key function?
How does it assist and what does it decrease?

A

Pressure support augments the patient’s spontaneous respirations by delivering positive pressure during the effort.

Patient’s spontaneous effort is assisted by preset amount of positive pressure
- 6 to 12 cm H2O

Decreases WOB with spontaneous breaths

29
Q

Pressure Control Ventilation

What does it do?

A

Delivers set tidal volume either initiated by patient or ventilator

  • Combines pressure and volume control
    (Pressure is adjusted by the ventilator breath to breath , responding to compliance and resistance)
30
Q

Airway Pressure Release

What does it do?

A

Allows for spontaneous breaths
(Preset CPAP during inspiration and expiration)

**Used for Alveolar recruitment and decreased deep sedative/paralytic use

31
Q

High-Frequency Oscillatory Ventilation (HFOV)

Key function

A

Delivers low tidal volume at very fast rate (300-420 bpm)

used to treat refractory respiratory failure.

32
Q

High-Frequency Oscillatory Ventilation (HFOV)

When is it used?

A

Used in patients with noncompliant lungs (such as ARDS) who remain hypoxemic despite conventional and advanced ventilation

33
Q

High-Frequency Oscillatory Ventilation (HFOV)

What may be indicated?

A

Sedation and paralysis

34
Q

Noninvasive Positive-Pressure Ventilation (NPPV)

What is it?

A

Delivery of positive-pressure ventilation (PPV) without artificial airway

35
Q

Noninvasive Positive-Pressure Ventilation (NPPV)

Key function?

A

Reduces complications associated with MV
- May prevent the need for intubation and its associated complications.

(Minute ventilation is the volume of gas inhaled or exhaled from a person’s lungs per minute.)

36
Q

Noninvasive Positive-Pressure Ventilation (NPPV)

When is it useful?

A

Used in conjunction with portable ventilator

COPD
Heart failure
Palliative care

37
Q

Noninvasive Positive-Pressure Ventilation (NPPV)

Examples?

A

Examples
Nasal CPAP
BiPAP

38
Q

Noninvasive Positive-Pressure Ventilation (NPPV)

Requirements?

A

Tight seal of mask
Intact respiratory drive
Able to protect airway

39
Q

Alarms and Nursing Interventions

Troubleshooting?
3

A

Never shut alarms off; silence only

Always assess patient and equipment

Call for Help

40
Q

Types of Alarms

High pressure indicates?

A

Secretions
Kinks/Dislodgement
Vent Asynchrony
Resistance

41
Q

Types of Alarms

Low pressure indicates?

A

Vent disconnect
Extubation
Cuff Leak

42
Q

Alarms and Nursing Interventions

When troubleshooting always be prepared to?
2

A

Prepare to manually ventilate patient

Prepare to change/replace equipment

43
Q

Types of Alarms

Apnea indicates?

A

Resp Arrest
Oversedation
Extubation

44
Q

Types of Alarms

High VT or RR indicates?

A

Pain/Agitation

Metobolic Changes

45
Q

Types of Alarms

Low VT or minute ventilation indicates?

A

Extubation/Cuff Leak

Insufficient gas flow

46
Q

Nursing Considerations

What can cause ETT Out of Position?

A

Tube can dislodge into right mainstem or esophagus during movement and repositioning.

47
Q

Nursing Considerations

How to prevent unlplanned Extubation?

A

Nurse must protect airway to prevent unplanned extubation

Securing the tube is important

Important to assess bilateral breath sounds regularly.

48
Q

Nursing Considerations

How to prevent damage to Oral or Mucous Membranes?

A

Carefully monitor patient’s skin for breakdown from both tape and commercial devices.

49
Q

Nursing Considerations

How to prevent Laryngeal/Tracheal Injury?

A

Prevent excess head movement

Routine monitoring of ETT cuff pressure
Keep no higher than 25 to 30 cm H2O

50
Q

Weaning Patients from Ventilator

Readiness conditions to wean?

  • what must be adequate?
  • what must be resolved?
  • absent of what factors
A
  • Hemodynamic stability; adequate cardiac output
  • Adequate respiratory muscle strength
  • Adequate oxygenation without a high FiO2 and/or high PEEP

Underlying cause for mechanical ventilation resolved

Absence of factors that impair weaning
Mental readiness
Minimal need for medicines that cause respiratory depression

51
Q

Weaning Patients from Ventilator

Which devices use a Weaning trial or spontaneous breathing trial (SBT)?

A
  • Synchronized intermittent mechanical ventilation
  • Pressure support
  • T-piece trials
  • CPAP
52
Q

Stop the Weaning Process

What are the resp conditions?

*not tolerating the weaning process

A 
Respiratory rate > 35 or < 8 breaths/min
Low spontaneous VT < 5 mL/kg
Labored respirations
Use of accessory muscles
Abnormal breathing pattern
Low oxygen saturation < 90%
53
Q

Stop the Weaning Process

What are the cardiovascular conditions?

*not tolerating the weaning process

A 
HR or BP changes > 20% from baseline
Dysrhythmias (e.g., PVCs)
ST-segment elevation
Blood pressure changes more than 20% from baseline
Diaphoresis
54
Q

Stop the Weaning Process

What are the neurologic conditions?

*not tolerating the weaning process

A

Decreased level of consciousness
Anxiety/agitation
Subjective discomfort

Critical Care (8 decks)

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