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Mechanical Ventilation > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

ventilation def

A

the movement of gas into and out of the lungs

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2
Q

what does adequate spontaneous ventilation require

A

sufficient Vt, RR, and minute volume to support O2 and CO2 removal, while maintaining acid-base balance

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3
Q

Single best clinical index of ventilation

A

PaCO2

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4
Q

Hypoventilation, hyperventilation, normal values

A

Normal 35-45 mmHg
Hypoventilation > 45 mmHg
Hyperventilation < 35 mmHg

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5
Q

anatomic deadspace def (and normal)

A

vol of gas in conducting airways down to terminal bronchioles
Normal 1mL/ lb IBW (~150mL)

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6
Q

alveolar deadspace (and normal)

A

alveoli that are ventilated w/o perfusion
Normal 0

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7
Q

what diseases increase alveolar deadspace

A

deadspace diseases; emphysema and PE

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8
Q

physiologic deadspace def (and normal)

A

total fxnal DS volume that consists of the alveolar and anatomic DS
VDphys = VDanat + VDalv
Normal phys DS = anat DS
Phys DS > anat DS with DS disease (ex emphysema and PE)

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9
Q

mechanical DS def

A

volume of rebreathed gas d/t mechanical device (ex ventilator tubing)

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10
Q

alveolar ventilation def (and normal)

A

vol of gas reaching alveoli that are ventilated AND perfused per min
Normal 4-5Lpm

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11
Q

most common reason for initiating mechanical ventilatory support

A

acute respiratory failure

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12
Q

what is ventilatory capacity affected by

A

respiratory drive, lung function, ventilatory workload, and ventilatory muscle strength

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13
Q

ventilatory requirements are determined by

A

oxygenation status, CO2 production, lung function, circulatory balance, acid base production

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14
Q

causes of ARF

A
  • PNA
  • ARDS
  • Trauma
  • Sepsis
  • Post op respiratory failure
  • COPD exacerbation
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15
Q

early manifestations of ARF

A
  • Tachycardia
  • Tachypnea
  • Diaphoresis
  • Anxiety
  • Respiratory distress
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16
Q

signs of ARF

A
  • Decreased resp drive
  • Accessory muscle use
  • Intercostal retractions
  • Chest wall & diaphragmatic asynchrony
  • Decreased chest wall excursion
  • Apnea
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17
Q

goals for mechanical ventilatory support

A
  • Provide adequate alveolar ventilation
  • Ensure adequate tissue oxygenation
  • Restore & maintain acid-basis balance
  • Decrease WOB
  • Normalize alveolar ventilation & PaCO2
  • Correct respiratory & metabolic acidosis
  • Reverse hypoxemia
  • Relieve respiratory distress
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18
Q

indications for mechanical ventilation

A

apnea, acute vent failure, impending vent failure, refractory hypoxemia,

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19
Q

what do you do if a peds pt is apneic

A

check for foreign body aspiration

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20
Q

causes of apnea

A

cardiac arrest, MI, trauma, shock, OD, spinal cord injuries, neuro disease, general anesthesia, paralytics

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21
Q

acute vent failure def

A

sudden increase in PaCO2 w a decrease in pH

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22
Q

what pH indicates mech vent needed

A

pH < 7.25

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23
Q

chronic vent fail def

A

increase in PaCO2 but pH normal d/t metabolic compensation

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24
Q

impending vent failure def

A

vent failure likely to occur in immediate future

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25
Q

what does IVF often lead to

A

elective intubation/ventilation

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26
Q

what do you try before elective intubation

A

HHF/HFNC for 30-120 mins

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27
Q

wdyd for a COPD pt w IVF and pH > 7.25

A

BiPAP trial

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28
Q

how to dx refractory hypoxemia

A

FiO2 increase > 10% & PaO2 increase < 5 mmHg

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29
Q

P/F ratio def

A

PaO2/FiO2 - measure the effectiveness of O2 transfer across the lung

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30
Q

P/F ratio classifications

A
  • Mild ARDS: P/F 200-300 mmHg (while on PEEP 5)
  • Mod ARDS: P/F 100-200 mmHg (while on PEEP 5)
  • Severe ARDS: P/F < 100 mmHg (while on PEEP 5)
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31
Q

why do ARDS pts have severe oxygenation problems

A

increased intrapulmonary right to left shunt

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32
Q

full ventilatory support def

A

provides 100% of pt’s vent needs

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33
Q

full vent support is available through

A

VC and PC

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34
Q

types of full vent support

A

AC/VC, AC/PC, SIMV/VC, SIMV/PC

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35
Q

how does a ventilator (on full support) minimize amt of pt effort

A

by delivering adequate Vt, RR, and minute volume

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36
Q

can spont breathing pts trigger vent in CMV

A

YES; if pt goes apneic, vent will deliver set breath

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37
Q

partial vent support def

A

Requires pt to continue to spont breathe to maintain adequate alveolar ventilation but provides enough support required to maintain good PaCO2

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38
Q

what is partial vent support available through

A

SIMV

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39
Q

what rate requires pt to breathe on SIMV

A

RR < 8-10bpm

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40
Q

VC-CMV

A

all mandatory breaths, pt/time triggered, volume/time cycled

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41
Q

what does the clinician set in VC-CMV

A

desired Vt, minimum RR, insp peak flow, insp flow waveform, trigger sensitivity

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42
Q

advantages of VC-CMV

A

i. Constant Vt (even when compliance/Raw changes)
ii. Guaranteed minimum ventilation delivered (d/t set RR and Vt)
iii. Provides full vent support

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43
Q

disadvantages of VC-CMV

A

i. Unsafe PIPs may occur (d/t reduced compliance or increased Raw)
ii. Unsafe Pplat may occur (d/t inappropriate Vt or reduced compliance)
iii.Improper trigger sensitivity or inadequate flow rates may increase WOB

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44
Q

PC-CMV

A

all mandatory breaths, pt/time triggered, time cycled

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45
Q

what does the clinician set in PC-CMV

A

insp pressure, RR, I-time (or insp % time), insp rise time/ramp, trigger sensitivity

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46
Q

advantages of PC-CMV

A

i. Constant insp pressure
ii. Desired Vt can be achieved by adjusting PIP or I-time

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47
Q

disadvantages of PC-CMV

A

i. Vt varies d/t changes in pt effort, system compliance, or Raw
ii. Increased PEEP w/o increased PIP = decrease ∆P and Vt
iii. Increased PIP and Pplat may cause barotrauma or VILI

48
Q

VC-SIMV

A

Breaths can be mandatory, time/pt triggered, volume/time cycled
PS normally added, insp pressure support pt triggered, pressure limited, flow cycled

49
Q

what does the clinician set in VC-SIMV

A

Vt, min RR, peak flow, trigger sensitivity for mandatory breaths
(PS and tube compensation for spont breaths)

50
Q

advantages of VC-SIMV

A
  1. reduced mean airway pressures (may maintain CO & BP)
  2. Maintenance of ventilatory muscle activity, strength and coordination
  3. Reduced need for sedation or paralytics
51
Q

disadvantages of VC-SIMV

A
  1. Increased WOB associated with ETT/trach tubes during spont breathing
  2. Spont breathing with high ventilatory workloads may cause ventilatory muscle fatigue and dysfxn
52
Q

PC-SIMV

A

Breaths mandatory/spont, pt/time triggered, pressure limited, time cycled

53
Q

what does the clinician set in PC-SIMV

A

pressure control level, min RR, I-time, trigger sensitivity for mandatory breaths
(PS and tube compensation for spont breaths)

54
Q

advantages of PC-SIMV

A
  1. Constant PIP
  2. Desired Vt can be achieved by adjusting pressure control level (∆P=PIP-PEEP), or I-time
55
Q

disadvantages of PC-SIMV

A
  1. High mean airway pressures may reduce venous return and CO
  2. Too rapid rise times may cause pressure spike in insp
  3. Vt varies d/t changes in effort, compliance, resistance
56
Q

PS-CSV aka

A

PS-CPAP

57
Q

PS-CPAP

A

PS provided with each breath
- Variable Vt, RR, flow, I-time

58
Q

what does the clinician set in PS-CPAP

A

trigger sensitivity, pressure support, I-time, and flow termination

59
Q

CPAP def

A

continuous positive airway pressure; spont breathing at constant elevated pressure during insp and exp

60
Q

advantages of PS-CPAP

A
  1. May improve pt-ventilatory synchrony and pt comfort
  2. As PS increases, spont Vt increases and WOB decreases
  3. May increase lung SA for gas exchange, improve oxygenation, prevent alveolar collapse/atelectasis
  4. Often used for SBTs
61
Q

disadvantages of PS-CPAP

A
  1. CPAP increases mean airway pressure, mean intrathoracic pressure, and FRC
62
Q

initial Vt

A

6-8mL/kg IBW; must be adjusted to maintain Pplat < 28-30 cmH2O

63
Q

initial RR

A

12-16bpm

64
Q

normal min vent

A

5-10Lpm

65
Q

IBW equation

A

Male 50 + 2.3(ht - 60)
Female 45.5 + 2.3 (ht-60)

66
Q

initial PC

A

12-15 cmH2O above PEEP

67
Q

initial PS

A

12-15 cmH2O above PEEP

68
Q

what pressure should PIP remain

A

< 40 cmH2O

69
Q

RR should remain below

A

25 bpm

70
Q

Pplat should remain below

A

28-30 cmH2O

71
Q

pressure trigger initial

A

-0.5 to -1.5

72
Q

flow trigger initial

A

1-2 Lpm below baseline

73
Q

what does PEEP/CPAP do

A

restores FRC, improves and maintains lung volumes, and improves oxygenation

74
Q

temp for inspired gas

A

35 +/- 2C

75
Q

positive pt-vent interaction

A

results in adequate oxygenation/ventilation, decreases WOB and promotes pt comfort

76
Q

poor pt-vent interaction

A

asynchrony, increase WOB, pt discomfort, poor oxygenation/ventilation

77
Q

what trigger is more comfortable for pts

A

flow trigger

78
Q

trigger work

A

portion of WOB performed by pt to trigger vent

79
Q

what can increase trigger work

A

inappropriate trigger sensitivity, autoPEEP

80
Q

missed triggering

A

pt insp effort does not trigger vent

81
Q

missed triggering causes

A

autoPEEP

82
Q

trigger delay

A

pt tries to initiate breath but vent delays in giving it

83
Q

double triggering

A

pt receives 2 consecutive breaths from vent before exp

84
Q

double triggering is d/t

A

pts breathing longer than vent I-time

85
Q

double trigger tx

A

increase I-time

86
Q

auto triggering

A

vent initiates insp w/o corresponding pt effort d/t inappropriate vent trigger sensitivity settings

87
Q

what causes autotriggering

A

triggers are too sensitive; cuff leak; system leak; water in system

88
Q

reverse triggering

A

time triggered vent breath stimulates diaphragm -> diaphragm contracts -> triggers next vent breath

89
Q

reverse trigger tx

A

reduce sedation

90
Q

PaO2 normal and clin goal

A

normal 95
clin goal 60-99

91
Q

SaO2 norm and clin goal

A

normal 97
clin goal 90-99

92
Q

Hb norm and clin goal

A

norm men 15
norm women 12-15
clin goal >8

93
Q

CaO2 norm and clin goal

A

norm 19.8
clin goal >16

94
Q

CO norm and clin goal

A

norm 5
clin goal varies d/t pt size

95
Q

SV norm and clin goal

A

norm 70
clin goal 60-80

96
Q

HR norm and clin goal

A

norm 80-100
clin goal 80-100

97
Q

BP norm and clin goal

A

norm 120/80
clin goal within norm range

98
Q

MAP norm

A

90

99
Q

LIP

A

overcoming distending pressure to open alveoli; level at which compliance improves

100
Q

PEEP & LIP

A

PEEP set 2 cmH2O above LIP

101
Q

UIP

A

lung overdistension begins

102
Q

30 for 30

A

PEEP 30 for 30 secs

103
Q

40 for 40

A

PEEP 40 for 40 secs

104
Q

3 chambers of chest tube collection system

A

collection chamber, water seal chamber, suction chamber

105
Q

collection chamber

A

Drainage from chest flows into collection chamber; made of transparent material w calibration markings to allow for observation of drainage fluid

106
Q

water seal chamber

A

filled with sterile water 2 cm in depth

107
Q

how is the water seal chamber a one way valve

A

allows gas to exit from pleural space via chest tube on exhalation while preventing air from entering pleural cavity on inhalation

108
Q

what does bubbling mean in the water seal chamber

A

there is an air leak

109
Q

does increasing the suction source increase chest tube suction

A

no, only increases airflow and noise

110
Q

where should the chest tube be positioned

A

below the pt’s chest; normally on floor

111
Q

RSBI

A

rapid shallow breathing index; > 30bpm with Vt <300mL are associated with need for mech vent

112
Q

RSBI equation

A

RSBI = f/Vt (L)

113
Q

RSBI classification

A

< 105 = adequate spont breathing, high chance of successful liberation

> 105 = inadequate spont breathing, failure of vent wean

114
Q

dynamic compliance equation

A

Cdyn = Vt / (PIP - PEEP)

115
Q

static compliance equation

A

Cstat = Vt / (Pplat - PEEP)

Mechanical Ventilation (1 decks)

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