Exam 3 Flashcards
CMV can either be ___________________ triggered.
Time or patient triggered
CMV can either be ___________________ targeted.
Volume or pressure targeted
What does PEEP help improve?
Oxygenation (Increased PaO2), Keeps alveoli open
What does widening of the PV loop mean?
Decreased compliance
We automatically intubate when __________ is present.
Apnea
Indications for MV
- Refractory hypoxemia
- Inadequate alveolar ventilation
- Inadequate muscle strength
- Increased WOB
What increases airway resistance?
- ET tube size
- Secretions
Increased compliance in P-V loop means _________.
Decreased airflow resistance
What does dynamic compliance deal with?
Airflow resistance
If the loop is shifting toward the P-axis, towards increased PIP what is happening to compliance as airway pressure gets higher?
Decreased compliance - Lungs become less compliant
Head trauma patients may need to be intubated to monitor _____________.
ICPs
If the patients need to be intubated for a short amount of time, what mode would you use?
SIMV
What is SIMV used for?
- Weaning
- Do some of the breathing on their own
- Prevent breath stacking
A high tidal volumes increases what?
PIP
PIP should always be less than _______
30
Increased PIP may be due to what?
Secretions
Pressure control setting is used to control what?
Pressure and allows patient to chose their own volume
What is the requirement for using CPAP?
Patient must be spontaneously breathing
What are CPAP parameters?
- Pressure Support Ventilation
- PEEP
- FiO2
What is the difference between SIMV and IMV?
They both are able to take breaths in-between mandatory breaths
IMV can cause breath stacking, SIMV cannot
Sometimes patients with high ICPs will get put into an alkalotic state (high RR), because…..
It reduces ICPs because it restricts blood vessels
If pressure triggered, what is starting the breath?
Pressure
What does CPAP stand for?
Continuous Positive Airway Pressure
What does SIMV stand for?
Synchronized Intermittent Mandatory Ventilation
What does CMV stand for?
Continuous Mandatory Ventilation
What does IMV stand for?
Intermittent Mandatory Ventilation
What does PEEP stand for?
Positive End-Expiratory Pressure
What does Pmean stand for?
Mean Airway Pressure
What does PIP stand for?
Peak Inspiratory Pressure
What is the cycle variable used as?
Used to end expiration
In I:E times, what does I stand for?
Inspiratory time
In I:E times, what does E stand for?
Expiratory time
What does TCT stand for?
Total cycle time
What is the initial tidal volume range for the ventilator?
6-8 mL/kg
What is the initial respiratory rate range on the ventilator?
10 to 20 breaths/min
What is the initial PEEP setting on the ventilator?
5 cmH2O
What is the IBW for females?
105+5 (Height - 60) divided by 2.2
What is the IBW for males?
106+6 (Height - 60) divided by 2.2
What ventilator parameter would you expect if your patient is coughing? How can the therapist fix that problem?
The PIP would be increased; the RT can suction the patient
With ARDS patients, are we more worried about ventilation or oxygenation?
Oxygenation
What are some reasons the low-pressure alarm would be sounding on the ventilator?
- Patient disconnection
- Leaks in the system
When would a patient benefit from a lower tidal volume?
When the patient has ARDS or restrictive disease
Name 3 trigger variables.
- Flow
- Time
- Patient
Name 4 cycle variables.
- Volume
- Time
- Flow
- Pressure
Which acid-base imbalance cannot be fixed by a vent?
Metabolic acidosis
To wean a patient off the vent, which setting would you start manipulating FIRST?
FiO2
What does an increased VE mean?
Increased WOB is present
What does a decreased VE mean?
Patient not breathing efficiently enough
What is the minute ventilation equation?
Tidal volume x Respiratory rate
A VE above _______ is a cause for concern.
10 L/min
What is the normal range for minute ventilation?
5 to 6 L/min
What is the RR range for ARDS patients?
15-25 breaths/min
What is the tidal volume range for ARDS patients?
4-6 mL
What does a low-pressure alarm indicate?
Patient disconnection or leak in the breathing circuit
What does a high-pressure alarm indicate?
Kinks in the tubing, retained secretions and coughing, decrease in compliance
Why do we as RRTs like the assist control mode?
- Allows patient to participate in WOB
- Gives assistance to decrease the patient’s WOB
- We set the rate and tidal volume but the patient can do more if they want to
What is a disadvantage of assist control mode?
It gives set breaths which can cause breath stacking.
What would the PEEP look like on an ARDS patient?
It would be higher; 10 or greater. It depends on the patient
What would be the initial vent settings on a patient you know nothing about?
VT: 6-8 mL/kg
RR: 10-20 breaths/min
PEEP: 5
What are some things to remember when putting an ARDS patient on the ventilator?
- Small tidal volume
- High RR
- High FiO2
- High PEEP
What is the minute ventilation equation?
Vt x f (frequency)
What ventilator mode would we put a post-surgical patient on?
SIMV
What mode should we switch a patient on whenever we are weaning? What must the patient be doing?
- CPAP mode
- Must be spontaneously breathing
What are the initial vent setting for CPAP mode?
- Pressure support: 5
- PEEP: 5
- FiO2: Less than 40
We need a lower FiO2 when weaning patients to get them closer to the normal room air FiO2 of 21%
If we’re weaning a patient and their tidal volumes are too low, what can we do to make the tidal volume higher?
Increase pressure support
What is the RSBI equation?
RR divided by VT
What is the normal P1.0 range?
0 to -2
What are two noninvasive positive pressure modes?
- CPAP
- BiPAP
What is the difference between IPAP and EPAP called?
Pressure support
What is VAP and what are some ways to prevent it?
Ventilator-acquired pneumonia
Ways to prevent it:
- Closed in-line suctioning
- Oral care
- Head of the bed 30 degrees
- Handwashing
- Changing filters regularly
What are some sources of VAP?
- Poor hand hygiene
- Not changing equipment regularly
What ABG values indicate respiratory failure?
- CO2 greater than 50
- pH less than 7.3
High pressure alarms are set about _____ above PIP.
10 cmH2O
Low pressure alarms are usually set about _________ below PIP.
5-10 cmH2O
What are audible alarm systems designed for?
To alert the clinician of potential dangers related to the patient-ventilator interaction.
What is the highest accepted maximum for an apnea period?
20 seconds
When a ventilator malfunction occurs, what must the clinician do first?
Ensure that the patient is receiving ventilation.
When in doubt, the practitioner should disconnect patient from ventilator, begin manual bag resuscitation, silence alarms and call for help.
A deep breath that occurs regularly as part of a normal breathing pattern.
Sigh
Ventilator checks are generally performed how often?
Every 4 hours
Cuff pressures should not exceed ________.
20-25 mmHg.
Why is it important to frequently reposition a patient’s endotracheal tube?
To prevent pressure injuries to the gums, mouth, lips, or nose that can occur as a result of the constant pressure of the tube.
Manual ventilation must be performed cautiously to avoid things like:
- Inappropriate patterns of ventilation
- Excessive pressures
- Barotrauma
Explain the phrase “fighting the ventilator”
It describes an individual who is apparently doing well while receiving mechanical ventilation but suddenly develops acute respiratory distress.
This is particularly challenging for most clinicians because the patient is not able to verbalize his or her discomfort.
The sudden onset of dyspnea can be identified by _________.
Observing the physical signs of distress.
What are some of the common causes of sudden respiratory distress in patients receiving mechanical ventilation?
- Artificial airway problems
- Bronchospasm
- Secretions
- Pulmonary edema
- Pulmonary embolus
- Dynamic hyperinflation
- Abnormal respiratory drive
- Alteration in body posture
- Drug-induced posture
- Abdominal distention
- Pneumothorax
- Anxiety
What are the most common patient-related problems encountered during mechanical ventilation?
It involves the placement and patency of the artificial airway, the presence of a pneumothorax, bronchospasm and excessive secretions.
What are some clinical benefits of NIV?
- Reduces the need for endotracheal intubation
- Reduces incidence of ventilator-associated pneumonia
- Shortens stay in the ICU
- Shortens hospital stay
- Reduces mortality
- Preserves physiological airway defenses
- Improves patient comfort
- Reduces need for sedation
When can mechanical ventilation be discontinued?
When the need for mechanical ventilation has been resolved.
About _____% of patients requiring temporary mechanical ventilation do not require a gradual withdrawal process and can be disconnected with a few hours or days of initial support.
80
The term _______ is frequently used to describe the gradual reduction of ventilatory support from a patient whose condition is improving.
Weaning
What was ATC designed for?
Specifically to reduce WOB associated with increased ET resistance.
The level of PSV used during IMV typically ranges from _____.
5-10 cmH2O
Successful weaning is more likely if the RSBI is less than _____.
105 (Norma range: 60-105)
Patient who tolerate an SBT of ______ minutes should promptly be considered for ventilator discontinuation.
30-120
Patient who tolerate an SBT of ______ minutes should promptly be considered for ventilator discontinuation.
30-120
