Finals Flashcards
bicarb levels
- changes slowly
- Either excrete or retain bicarb
- begins in 12-24 hr
- completes change in 48-72
spontaneous
chest wall moves out, negative pressure is created, alveoli lengthen and widen, gas flows in
Heart rate range
60-100 beats
what does ERS stand for?
European Respiratory Society Task Force on standarization of Fuction testing
what does CMV mean?
Controlled mandatory ventilation
Goals of mechanical ventilation
- improve alveolar ventilation
- decrease PaCO2
- Increase PaO2
- improve distribution of ventilation
- aid the failing heart
IC=
IRV + VT
what does CPAP mean?
Continuous Positive Airway Pressure
what is a normal frequency for the ventilator?
8-16 /min
When RV is greater than 130%
Air trapping
severe ARDS
<100
normal valves for static compliance
60-100 cm per cm H2O
PA02-PaO2
10-15 mmhg
values widen as FIO2 increases
Gas diffusion tests are reported at
STPD
V̇e=
Vt • f
Formula for dynamic compliance
VT/PiP-PEEP
formula for static compliance
Vt/Pplat-peep
%sat=
95-100%
what does RV stand for?
Residual volume
pH range
7.35-7.45
what is the purpose of pulmonary function testing?
- chest wall disease
- Neuromuscular disease
- Disability and rehabilition
- pre/post surgury
- disease progression
indications for mechanical ventilation
- apnea
- acute ventilatory failure
- impending acute ventilatory failure
- pulmonary abnomalities
- secondary abnormalities leading to ineffective ventilation
- severe oxygenation deficit
- post operatively
complications of PEEP/CPAP
- barotrauma
- Pneumothorax
- decreased venous return
- decreased cardiac output
- decrease PaO2
What happens when mechanical deadspace increases?
- VA is decreased
- CO2 is increased
- pH is decreased
what is assist control for?
- Providing full ventilatory support
- Patients with stable respiratory drive can trigger mechanical breaths
- decrease the patient’s work of breathing
if FEV1/FVC is less than 70% it is obstruction, If FEV1 is greater than or equal to 80%
Mild obstruction
what does MMV stand for?
Mandatory minute ventilation
Qualifications for home therapy (non-exceptions)
- SaO2 less than or equal to 88%
- PaO2 must be less than or equal to 55 mmhg on RA
Restrictive Lung Disease
- Pulmonary Fibrosis
- Sarcoidosis
- Pneumoconiosis
Blood pressure range
90/60-120/80 mmhg
formula for total O2 contant with Hgb
[1.34(Hgb)(sat)]
Time for withhold of a Methlxanthines
12 Hours
Asthma and obesity
increases DLCO
increased PaO2
Decrease DLCO
what does ERV stand for?
Expiratory Reserve Volume
DL/VA <40%
severe diffusion defect
4th and 5th generation
- Microproccessor
- Volume and pressure control
- Various ventilator modes
- Pressure targeted ventilation and adaptive support ventilation
- Closed loop
- Waveforms
Respiratory rate range
12-20
Third generation ventilator
- pressure control and volume control ventilation
- Microprocessor
- First use of APRV
formula for total O2 contant with amount dissolved in plasma
(.003 • PaO2)
Bicarb range
22-26 Meq/L
what is the purpose of therapeutic PEEP? and what is the classification number of therapeutic peep?
>5 cmH2O, treat atelectasis or hypoxia. For patients with increased FIO2 demand and increasing atelectasis
Tlo setting of APRV
.5-.8 seconds
what affects pulse oximetry?
- circulation
- Nail polish
- movement
- lighting
causes of respiratory Alkalosis
- central nervous system stimulation
- Hypoxemia
- Pulmonary Emboli
- Mechanical ventilation
- Pulmonary disorder
what is the concentrations in the gas diffusion test?
- __
- __
- __
- __
- 21% O2
- 0.3% CO
- 10% helium/Methane/Neon
- Balance N2
TLC=
IRV + VT+ERV + RV
in volume controlled ventilation what is constant and what will vary?
Volume constant- Pressure varies
Pressure limitation will cause VT not to be reached
second generation ventilator
- first apperance of patient-triggered inspiration
- Most monitored Vt and RR
PCO2 is…
the best indicator of alveolar ventilation
Peripheral chemoreceptors
responds to drop in PO2
anion Gap normal
8-16 mEq/L
normal valves for dynamic compliance
30-40 ml per cm H2O
what does PC?
pressure control
what does GINA stand for?
Global initiation for asthma
FEV1/FVC is less than 70% than
Obstruction
if FEV1/FVC is less than 70% it is obstruction, If FEV1 is 30-49% than it is
Severe obstruction
what are predictors for Lung volume and capacities?
Height,Gender, and Age
Hazards and complications of positive pressure ventilation
- pulmonary effects
- cardiac effects
- renal effects
- GI problems
- neurologic effects
- metabolic effects
- airway complications
- mechanical complications
what is the Haldane Effect?
Deoxygenation of the blood increases its ability to carry carbon dioxide; this property is the handane effect. Conversely oxygenated blood has a reduced capacity for carbon dioxide.
positive pressure breath
gas/volume is delivered to the patient via airway, alveoli get filled with gas, chest wall is pushed outward
What if TLC is less than 65-79%
mild restrictive
Helium Dilution
- Closed circuit multi-breath helium dilution test
- Normal test time less than or equal to 3 minutes
CVP means
Central venous pressure
DLco decreases in
- Restrictive lung disease
- Alveolitis
- Space Occupying lesions
- Pulmonary interstital edema
- Lung resections
- Radiation Therapy
- Chemotherapy (Bleomycin)
- Cardiac drugs (Amiodarone)
- COPD
Significant bronchodilator is effective when
FEV1 or FVC change of greater or equal to 12% and greater than or equal to 200 ml
what does IRV stand for?
Inspiratory Reserve Volume
Time for withhold of a SABA?
4 Hours
First generation ventilator
only had volume-controlled ventilation
what is the concerns when performing a PFT?
- dizziness
- fainting
- extreme dyspnea
- recent stroke
- recent MI
- Recent opthalmic
- recent pneumothorax
Decrease Hb Level
Decreases DLCO
What does FRC stand for?
Functional Residual capacity
Time for withhold of a SACA
4 hours
ECG means
electrocardiogram
P/F ratio normal
> 300
DL/VA 60-79 %
mild diffusion defect
Swan-Ganz does
It is done to monitor the heart’s function and blood flow
what is the use for CMV?
- 100% ventilation support
- no respiratory center control
- paralyzed and sedated
- seizure activity that would interrupt MV
causes of hyperventilation
- Psychogenic- Anxiety
- CNS disturbances-tumor
- Metabolic disturbances-fever, exercise
- Drugs
- Pulmonary diseases- low pO2
PCO2 levels can change rapidly
within minutes
varies with changes in venilation
in pressure controlled ventilation what is constant? what will vary?
Pressure is constant and volume will vary
what does ATS stand for?
American Thoracic Society
Time for withhold of a cromolyn sodium
8-12 hours
causes of increased CO2 production
- Exercise
- Fever
- Stress
- Severe burns
- Sepsis
V̇A=
VA • f
Gas diffusion test indications
- Lung transplant candidacy
- Disability
- Medication that may cause pulmonary toxicity (amiodarone, Bleomycin)
- Follow course of disease (decreased DLCO is associated with lung cancer)
VC=
IRV + VT + ERV
DL/VA equal to or lesser than
normal diffusion
indications of APRV
- patient with refractory hypoxemia
- when conventional ventilation is not sufficient
Time for withhold of a Slow-release methylxanthines
24 Hours
Thi setting of APRV
4-6 seconds
if all values are normal and if FEF25-75 is less than 80
Early small airway disease
what does VC mean?
Volume control
A-Line means
Arterial line
mild ARDS
200-300
Goals of PEEP/CPAP
- increase FRC
- Improve stability of alveoli and small airways
- Decrease Shunt
- improve PaO2
increase capillary blood volume
increase DLCO
What if TLC is less than 80%
Restrictive lung disease
Time for withhold of a LACA
24 hours
what is physiologic peep?
2-5 cmH2O
moderate ARDS
100-200
PaCO2 range
35-45 mmhg
what are obstructive lung diseases?
- Asthma
- Emphysema
- Bronchitis
- Bronchiectasis
- Cystic Fibrosis
if FEV1/FVC is less than 70% it is obstruction, If FEV1 is less than 30%
Very Severe Obstruction
what is SIMV?
- synchronized with patient’s own breathing attempts
- Can only trigger during a trigger window
- no breaths during trigger window= machine triggered mandatory breaths
what does A/C mean?
assist control
Negative pressure ventilation concept
extra-thoracic pressure applied to thorax
what does SIMV mean?
Synchronized intermittent mandatory ventilation
FRC=
ERV+RV
what is Choride shift?
the movement of CL- into the RBC as result of HCO3 molecules moving into the plasma to create ionic balance
Time for withhold of a inhaled steroids
do not stop medication
what does VC stand for?
Vital capacity
what if TLC is greater than 120%
Hyperinflation
what is normal starting tidal volume for ventilator?
6-8 ml/kg per IBW
Central chemoreceptor
- Respiratory Centers- medulla of brain stem
- respond to PH of CSF
what does APRV stand for?
Airway pressure release ventilation
Increase COhb level
Decreases DLCO
DL/VA 40-59%
moderate diffusion defect
Temperature range
36.1-37.2 c
Body position
supine increases DLCO
what is normal range for ICP?
5-15 mmhg
what does TLC stand for?
Total lung capacity
Base Excess=
-2/+2 Meq/L
less than a 80% on FVC will qualify as a
Restrictive Pattern (unless obstruction is present)
What is IC stand for?
Inspiratory Capacity
increase in temperature
decrease in pH
increase in PCO2
Increase in PO2
Capacity Gas diffusion
A-C Membrane
Ventilation
Movement of air in & out of the lungs
indications for PEEP/ CPAP
- low PaO2 with high FIO2
- Treat atelectasis and ARDS
in mmv what is patient going to get?
guarantees that the patient always recieve set minute ventilation
causes of metabolic alkalosis
loss of H+
- vomiting, NG tube
- diuretics
- steroids
Exogenous
- administration of bicarb
Electrolyte imbalance
- potassium depletion
- chloride depletion
PA02 formula
[(760-47) • FIO2] - (1.25 • PaCO2)
what percentage of patients use medium masks?
85%
increasing pressure on a bird mark 7
increases tidal volume and increases inspiratory time
what does PEEP mean?
Positive End Expiratory Pressure
Keypoints about PSV
- The higher the set pressure support= the more support the patient is receiving
- The lower the set pressure support= more effort required from the patient
- Back up ventilation must be set appropriately
- F, VT, Ti, Te, and Inspiratory flow is choosen by the patient
increasing flow rate will cause
tidal volume to decrease and inspiratory time to decrease
in RBC (90%)
HCO3 (64%)
how to mmhg into kPa?
divide by 7.5
Normal range for a/A
.75-1
what if the TLC is 50-64%
moderate restriction
V̇D=
VD • f
DLCO (adjusted) <80%
reduced diffusion
causes of metaboloc acidosis
increased formation of acids
- diabetic ketoacidosis
- Lactic Acidosis
- Renal failure
Loss of HCO3
- diarrhea
- renal tubelar acidosis
Exogenous
- aspirin, alcohol ingestion
- hyper-alimentation
- diamox
- ammonium chloride; ethylene glycol ingestion
Altitude
Increases DLCO
Time for withhold of a LABA?
12 hours
if FEV1/FVC is less than 70% it is obstruction, If FEV1 is 50%-79% than it is
Moderate obstruction
decrease in temperature
- increase in pH
- decrease in PCO2
- decrease in PO2
Nitrogen washout is
open circuit multi-breath nitrogen washout
Time for withhold of a leukotriene modifier
24 hours
normal range for CCP?
70-80 mmhg
increase PaCO2
Increases DLCO
causes of hypoventilation
- lung diseases- COPD
- CNS trauma
- Muscle paralysis
- Obesity
- Drug Induced
How to turn Kpa into mmhg?
multiple by 7.5
TLC is less than 50%
Severe Restriction
normal range for combined O2 content
16-23 ml O2/dL blood
PaO2=
80-100 mmhg
what does Vt stand for?
Tidal Volume
what does TEE stand for?
trans-esophageal echocardiography
Respiration
Exchange of gases (O2 & CO2) at A-C membrane and tissue level
MAP formula is
SBP+2(DBP)/3
what if FRC is greater than 120%
Air trapping
Mechanical ventilation definition
The act of breathing partially or totally for a patient by an automatic device connected to the patient’s airway
normal value of Raw
0.6-2.4 cmH2O
