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Vent Support > Improving Oxygenation > Flashcards

Improving Oxygenation Flashcards

1
Q

Types of sigh technique

A

Check camera roll

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2
Q

Causes of anaemic hypoxia

A

Blood can’t carry oxygen:
Abnormal Hgb
CO poisoning
Low RBC

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3
Q

How do you treat anemic hypoxia

A

Blood products
Hyperbaric therapy

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4
Q

What causes circulatory hypoxia

A

Poor blood flow
Can be regional or widespread

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5
Q

How do you treat circulatory hypoxia

A

Pharmacologic intervention

Med to increase ventricular contraction or decrease vascular resistance

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6
Q

What causes histotoxic hypoxia

A

Oxygen is in the system, but unable to carry the O2

Ex: cyanide poisoning

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7
Q

How do you treat histotoxic hypoxia

A

Administer a cyanide kit

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8
Q

What causes cytopathic hypoxia

A

Diminished production of ATP despite normal or better PO2 near mitochondria

Ex: sepsis link

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9
Q

Treatment for cytopathic hypoxia

A

Oxygen therapy

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10
Q

Formula for desired FiO2

A

Desired PaO2 x known FiO2/ Known PaO2

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11
Q

What do we shoot for if the patient isn’t oxygen great and has highest FiO2

A

60 mmHg
90%

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12
Q

Complication of oxygen toxicity

A

Mild tracheobronchitis

Absorption atelectasis

Alveolar damage indistinguishable from ARDS

X-Ray:

Bilateral, peripheral, asymmetrical consolidation with bronchogram

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13
Q

What increases MAP

A

Increase:

PIP
PEEP
Ti

Change to decelerating flow

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14
Q

How do you increase PIP in a volume mode

A

Increase:
PEEP
Ti

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15
Q

By what increments should you increase PC to increase PIP

A

2 cmH2O

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16
Q

Indications for CPAP and PEEP

A

Bilateral infiltrates (CXR)

<60 mmHg and >50%

P/F <300 (ARDS)

Refractory hypoxemia (<10 increase per 20% increase)

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17
Q

Is there PEEP on noninvasive ventilation

A

No. There is EPAP

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18
Q

Application for CPAP

A

CPAP Mask

CPAP Nasal

ETT or tracheostomy

Flow and threshold resistors

Spontaneous w/ freestanding system and MV

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19
Q

How is PEEP increase with infants

A

2-3cmH2O

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20
Q

Low PEEP Strategy: 30%

A

5

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21
Q

Low PEEP Strategy: 40%

A

5-8

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22
Q

Low PEEP Strategy: 50%

A

8-10

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23
Q

Low PEEP Strategy: 60%

A

10

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24
Q

Low PEEP Strategy: 70%

25
Q

Low PEEP Strategy: 80%

26
Q

Low PEEP Strategy: 90%

27
Q

Low PEEP Strategy: 100%

28
Q

High PEEP Strategy: 30%

29
Q

High PEEP Strategy: 40%

30
Q

High PEEP Strategy: 50%

31
Q

High PEEP Strategy: 60%

32
Q

High PEEP Strategy: 70%

33
Q

High PEEP Strategy: 80%

34
Q

High PEEP Strategy: 90%

35
Q

High PEEP Strategy: 100%

36
Q

How do you find optimal PEEP on PC

A

Keep delta P constant (15-25cmH2O)

Asses increase in VT

37
Q

Contraindications for PEEP

A

Hypovolemia

Untreated PTX

Intracranial Pressure

Hyperinflation

Pulmonary effects of PEEP

Transmission of AW pressure to pleural

38
Q

What do you decrease PEEP in increments of

39
Q

When do you wean PEEP

A

FiO2 less than 40%

Hemodynamic stable

Non septic

Improved lung condition

40
Q

What less talked about uses for PEEP

A

CHF

Postoperative atelectasis and hypoxemia

Sleep apnea

Cystic fibrosis

Aw suction

41
Q

Types of lung recruitment maneuvers

A

Sustained inflation

PC-CMV w/ high PEEP

PC-CMV w/ increasing PEEP

Recruitment and decremental PEEP

Sigh technique

42
Q

How do you preform PCV lung recruitment maneuver

A

PIP 35-50cmH2O

Ti 1-2

PEEP 20-30cmH2O

Applied for 1-3 minutes

43
Q

Physical benefits of prone position

A

Changes position of heart

Changes regional diaphragm motion

Pleural pressure more uniformly distributed, which improves recruitment

45
Q

Technique for prone position

A

Sedation
Labor intensive
Extubation
Loss of vascular & catheter
Head turn
Cushion and compression of Abs
Arm positioning

46
Q

What do kinetic beds do

A

Turn patients
Side to side 45-60 degrees

47
Q

Rationale for turning prone patients frequently

A

Prevent pulmonary complications (atelectasis and hypoxemia)

48
Q

Body positioning complications

A

Pt. Agitation
Worsening dyspnea
Hypoxia
Cardiac arrhythmia
Increased ICP
Difficulty examining patient

49
Q

Patient position for a unilateral lung disease

A

Independent lung ventilation

Good lung down

50
Q

Steps to wean FiO2 with a P/F of: >300 (100%)

A

20
20
10 (>95)
10 (>90)
ABG (consider 5)

51
Q

Steps to wean FiO2 with a P/F of: 200-300 (100%)

A

20
20
10 (>95)
10
ABG

52
Q

Steps to wean FiO2 with a P/F of: 150-199 (99-100%)

A

20
20 (>90)
ABG

53
Q

Steps to wean FiO2 with a P/F of: 100-149 (96-100%)

A

20 (>90)
ABG

54
Q

Steps to wean FiO2 with a P/F of: <100 (<96-100)

A

Consider PEEP

55
Q

Complication for lung recruitment maneuver

A

Hypotension
Hypoxemia
Barotrauma

56
Q

Hazards of recruitment maneuver

A

Decrease venous return to thorax

Drop CO

Hypotension

Uneven blood pressure and/or flow to lungs

Variability amongst Pt.

Variability of chest wall compliance

57
Q

Who gets proned

A

P/F <150 w/ > or equal 60% and greater of equal to 5 PEEP

Severe ARDS

Refractory hypoxemia

P/F equal or < 100 and PaO2 = or < 60 100% not responding to other means

59
Q

How long should you wait in between each wean

A

10-30 minutes

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