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1internyearprep > ICU - Marino > Flashcards

ICU - Marino Flashcards

1
Q

Volume Control, preselect

A

TV

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2
Q

Volume Control, pressure

A

peak pressure in proximal airways > peak pressure in alevoli

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3
Q

Volume Control Advantages

A
  • Constant TV which allows for pressure adjustments to offset increased resistance or decreased compliance
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4
Q

Volume Control Disadvantages

A
  • pressure at end of inspiration are higher (?risk of lung injury)
  • duration of inspiration is short, inspiratory flow rate can be inadequate which can lead to pt discomfort
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5
Q

Pressure Control, preselect

A

pressure, do so with decelaerating inspiratory flow that allows high flow at onset of lung inflation

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6
Q

Pressure control, pressures

A

end inspiratory airway pressure = peak alveolar presure

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7
Q

Pressure Control Advantages

A

control peak alveolar pressure (30cmH20)

Patient comfort due to high initial flow rates

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8
Q

Pressure Control Disadvantages

A

decrease in alveolar volume when resistance increases or compliance decreases (concern in ARF)

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9
Q

PRVC

A

constant tidal volume but limits end inspiratory airway pressure
selecting lowest pressure needed to deliver tidal volume

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10
Q

Assist Control ventilation, mode

A

can be PC or VC

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11
Q

Assist Control triggers

A

negative pressure or flow rate

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12
Q

Negative Pressure as Trigger

A

generate 2-3cmh20 however this is double the pressure during quiet breathing
1/3 of efforts fail to trigger ventilator

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13
Q

Flow Rate as Inspriation Trigger

A

rates of 1-10L/min required

possible issue is auto-triggers from system leaks

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14
Q

Assist Control Concerns

A

Respiratory cycle and decreasing exhalation

rapid breathing

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15
Q

Respiratory Cycle, IE ratio should be

A

1:2

prevent dynamic hyperinflation or intrinsic PEEP

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16
Q

IMV

A

allow spontaneous breathing between ventilator breathes

can be VC or PC

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17
Q

IMV major indication

A

rapid breathing with incomplete exhalation

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18
Q

why is spontaneous breathing good?

A

promotes alveolar emptying and reduces the risk of trapping/intrinsic PEEP

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19
Q

when not to use IMV

A

respiratory muscle weakness

left heart failure

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20
Q

IMV Disadvantages

A 
increased WOB
decrease CO (esp in pts with LVdysfxn)
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21
Q

IMV, increased WOB

A

due to resistance in ventilator circuit

pressure-support can help overcome

22
Q

pressure support

A

allows pt to terminate the lung inflation

23
Q

PEEP at 5-10

A

helps prevent collapse of distal airways

24
Q

PEEP at 20-30

A

can reopen distal airspaces = alveolar recruitment

25
Q

what can happen with alveolar recruitment if not significant volume of recruitable lung?

A

alveolar distention, increases risk of ventilator-induced lung injury

26
Q

how to measure if there is recruitable lung

A

lung compliance

pa/fio2 ratio

27
Q

increased PCO2

A

resp acidosis

28
Q

decreased PCO2

A

resp alkalosis

29
Q

increased HCO3

A

metabolic alkalosis

30
Q

decreased HCO3

A

metabolic acidosis

31
Q

Metabolic Acidosis, secondary response

A

increase minute ventilation (TV x RR) –> decrease in PCO2

32
Q

how long do secondary respiratory responses take

A

can being in 30min-2h, can take 12-24 hrs to be complete

33
Q

Metabolic Acidosis and using PaCO2 to infer secondary disorder

A

paco2 > 23, resp acidosis

paco2 less than 23, resp alk

34
Q

Step “1” of Acid/Base: looking at PaCo2 and PH

A

if both abnormal, comparing directional change

if only one is abnormal, condition is mixed (directional change of paco2 or pH identifies primary disorder)

35
Q

Primary Resp disorders, how to tell if acute

A

normal or near-normal HCO3

36
Q

chronic resp acidosis and HCO3

A

if lower, incomplete renal response

if higher, secondary metabolic alkalosis

37
Q

chronic resp alkalosis and HCO3

A

if higher, incomplete renal response

If lower, secondary metabolic acidosis

38
Q

AG

A

NA - Cl + HCO3

39
Q

AG range

A

3-11 (7 plus/minus 4)

40
Q

AG with albumin

A

AG + 2.5 x (4.5-albumin)

41
Q

Evevated AG occurs when

A

accumulation of fixed or nonvolatile acids

42
Q

Normal AG occurs when

A

primary loss of bicarb

43
Q

Delta Ratio

A

AG-12 / 24 - HCO3

44
Q

Delta Ratio, how to interpret

A

1 = HG metabolic acidosis only
less than 1 = second acidosis
more than 1 = metabolic alkalosis

45
Q

Causes of High Anion Gap Acidosis

A

Methanol/Metformin, Uremia, DKA/Starvation/Alcohol Ketosis, Paraldehyde, Isonizaid or Iron, Lactic Acidosis, ethylene glycol, rhabdo, salicilaytes

46
Q

Causes of Normal Gap Acidosis

A

Hyperalimentation, Acetalozamide, RTA, Diarrhea, Ureterosigmoid fistula, pancreatic fistula

47
Q

ARDS defintion

A

acute onset, bilateral infiltrates on xray, pao2/fio2 less than 300mmhg
no evidence of left heart failure
presence of predisposing condition

48
Q

ARDS: old criteria vs berlin criteria

A

pao2/fio2 changed
ALI eliminated
no wedge pressure measurement

49
Q

volutrauma

A

excess inflation of distal airspaces

ventilator-induced injury

50
Q

barotrauma

A

associated with escape of air from lungs

51
Q

biotrauma

A

during conventional high volume mechanical ventilation, proinflamm cytokines can appear in lungs and systemic circulation despite no structural differences in lungs

52
Q

atelectrauma

A

collapse of small airways at end expiration

1internyearprep (9 decks)

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