Exam 3 Flashcards
1 hertz=
60 breaths
Less than 1 kg infant tube size is?
2.5 mm
1-2 kg sized infant is fitted with an ?
3.0 mm sized tube
2-4 kg infant is sized with an ?
3.5 mm endotube
5 settings for newborns for HFOV
Paw Power Frequency I:E Bias flow
5 tips for suctioning
•Use a closed-system suctioning •hyperoxygenate prior to suctioning **not with preemies** •pass the catheter frequently •keep attempts short •pass the catheter a predetermined distance
A 1 year old child is selected for a ___ sized endotube ?
4.0 mm
A preemie by age is selected for an ___ sized endotube?
2.5 mm
A term baby by age is selected for a ___ sized endotube ?
3.0 mm
Anatomical considerations in the neonate
•cricoid ring is narrower than the glottis •larynx is more anterior •larynx is more cephalic •tongue is large and bulky •epiglottis is long and stiff
Cannula and masks for peds
Lower flows than adult values are appropriate due to lower inspiratory flow rates and smaller tidal volumes
Concerns with HFNC?
•increased time needed for RT support •increase delay to start oral feeding •increase length of stay in hospital •increase incidence of ROP and BPD
Define HFJV
High frequency jet ventilation •needs a special adaptor or ETT and Two vents
Depth of insertion by age for a 1 year old?
12 cm
Depth of insertion by age for a 2 year old?
14 cm
Depth of insertion by age for a 6 month ?
10 cm
Depth of insertion by age for a newborn?
9 cm
Depth of insertion by age for a preemie?
8 cm
Depth of insertion by age for any tube for a nasal tube?
Add 3 cm to the age depth
Depth of insertion by weight for a 2kg?
8 cm
Depth of insertion by weight for a 1kg ?
7 cm
Depth of insertion by weight for a 3 kg?
9 cm
Depth of insertion by weight for a 4 kg?
10 cm
Drug dosage self -limiting
It is appropriate to use “adult drug doses for children
During Pressure control; what determines Flow?
By machine
During Pressure control; what determines Te?
Ti and F
During Pressure control; what determines Ve?
F and Vt
During Pressure control; what determines Vt?
PiP-peep and cst
Five phases of ROP
•Bilateral vasoconstriction and obliteration of the retinal capillaries •neovascularization •vessel fibrosis •retinal hemorrhage •retinal detachment
Flow-inflating bags
Mapleson system
Frequency-important note (HFOV)
Decrease the frequency will increase volume and decrease PaCO2
Goals of tent therapy
•oxygen delivery •humidity control •environmental temperature control •isolated environment •drug therapy
Greater than 4 kg infant is sized with ?
4.0 mm endotube
Hazards of MV
•Infection •ETT and mechanical problems •Pulmonary oxygen toxicity •cardiac problems •increase ICP • auto peep, over inflation, pneumothorax •ventilator induced lung injury
Hazards of oxygen therapy
Hearing loss,n2 washout *FIO2*, Pulmonary oxygen toxicity *PAO2*, and Retinopathy of prematurity *PaO2*
How to initiate cpap?
•determine need •place on 5-6 cm h2O and appropriate fio2 •flow rate at 6-8 L/min • re-evaluate •cpap may be increased to 8 cm h2O •if minimal improvement, consider MV
How to place an endotube for an infant ?
•Solid black line on ETT is vocal cord marker •tip of the ETT should be at 1 cm above the carina •use of miller blade for 0-1 (for new borns)
How to prevent ROP ?
Delay birth, keep pao2 50-80, (sats 95%) ; use a short course of O2 therapy
How would you define a HFV ventilator?
Delivers more than 150 breaths per minute Oxygenation is controlled by MAP and Fi02
In HFJV what determines VT and CO2?
PIP
In HFOV what is directly influencing PaCO2?
Frequency is directly influencing PaCO2
Indications for HFJV?
•Pulmonary Interstitial Emphysema •severe pulmonary air leak •diaphragmatic hernia •meconium aspiration •surfactant replacement •support of pts. With bronchopulmonary dysplasia •large and persistent bronchopleural fistula
MDI with mask
Ages less than 5 years of age
Neonatal considerations
•Low-flow flow meters •use of a blender •non- heated humidifiers may be used to humidity the gas
Notes for CPT
•May result in hypoxemia in some infants •t-burg may cause intracranial bleed in preemies •may use rubber adapters, masks, electric toothbrush and vibrators to preform therapy
Oxygen hood therapy (oxyhood)
•Maintains controlled environment of temperature, humidity and oxygen. •warmed, humidity oxygen should be delivered at a flow >7 L/min •constantly monitor temperature and fio2 •may use with or without an isolette
Reasons for Retinopathy of prematurity
•unknown factors •increase PaO2, don’t increase for suction..keep 83%-93% •duration of exposure to increase PaO2 •maturity at 36 weeks gestation
Ribavirin (virazole)
•An antiviral agent •used to treat RSV infections •administered as an aerosol using SPAG •is teratogenic
Weight formula for insertion depth
(Weight in kg + 6)
What are the complications of HFJV?
Atelectasis Hypotension Over-inflation Air trapping Apnea
What are the complications of suctioning ?
•muscosal trauma •atelectasis •hypoxemia •arrhythmia/ hypotension •contamination/infection •bronchospasm • increased icp
What are the downsides of incubator therapy?
•difficult to regulate oxygen concentration •must monitor temperature •nursing care is hindered
What are the flows are used in a high flow nasal cannula ?
Flows from 2-6 L/m are used
What are the goals of CPAP?
•improve PaO2 while decreasing FIO2 •stabilize alveoli •alveolar recruitment •increase FRC, surface area •improve V/Q matching •decrease shunt and WOB •stimulate surfactant production
What are the indications for artificial airways
•Bypass upper airway obstruction •provide mechanical ventilation •provide auction •prevent aspiration
What are the ranges for sight?
Poor eyesight to total blindness
What are the straight tubes?
Mcgill and Murphy
What can a HFNC replace?
HFNC can be used to tug heated humidity instead of cpap or as a next step in weaning from oxygen
What causes respiratory failure?
•CNS •Cardiac •metabolic •pulmonary •misc
What do self inflating bags have?
•40 cm H2O with an override •40 +/- 10 cm h2O for child pressures •40 +/- 5 cm h2O for infant pressures
What does HFJV offer over conventional outcomes?
HFJV does not offer additional benefits over conventional in reducing mortality rate or incidence of BPD
What does HFOV mean?
High frequency oscillation ventilation
What does MMAD stand for?
Mass median aerodynamic diameter
What does NTE stand for?
Neutral thermal environment
What is HFOV?
High frequency oscillation ventilation
What is HFV?
High Frequency Ventilation Use of high rates and very small VTs
What is TCPLV?
Time cycled pressure limited ventilation •pressure targeted •pc-ac
What is TCVLV?
Time cycled volume limited ventilation •volume targeted •VC-AC
What is the common rate for HFOV?
600-900 b/min (10-15 hertz)
What is the formula for tube by age?
(Age + 16)/4 for 1-16 years
What is the suctioning pressure of a Adult?
100-150 mm hg
What is the suctioning pressure of a child?
100-120 mm hg
What is the suctioning pressuring of a neonate?
60-100 mm hg
What setting most influential to PaCO2?
F VT (if in VC-AC) Change in pressure;pip-peep (in PC-AC)
What setting most influential to PaO2 during MV?
FiO2 and peep Also v/q matching adjusts in the lung
What should we do to confirm insertion depth?
Verify with chest x ray!
When auto flow is off what determines PiP?
Peep,vt, flow, raw and cst
When auto flow is off what determines Te?
Ti and F
When auto flow is off what determines Ti?
VT and flow
When auto flow is off what determines VE?
F and Vt
When do use cpap?
-spontaneous breathing patients -paO2 <50 mm hg on high fio2
