Initial Ventilator Settings Flashcards
What are the types of ventilators and modes?
- Intubated vs mask
- ICU or home setting
- Brief or long term
What are the goals of ventilators and modes?
- Airway management
- Ventilation
- Oxygenation disturbance
What three things to consider for ventilation?
- Invasive vs non-invasive
- Volume vs pressure
- Full vs partial support
What three ways is non-invasive ventilation accomplished?
- NPV
- CPAP
- NPPV
What two ways may require the use of a face/nasal mask?
CPAP and NPPV
What are the general findings of negative pressure ventilators?
- NO AIRWAY!
- patient can talk, eat and drink
- avoid complications of PPV
- most often used in home - long term
- negative pressure across chest wall
In negative pressure ventilators, compliance and resistance must be ___
Stable
What kind of ventilation is good for patients who need night ventilation?
Negative pressure
What is negative pressure ventilation good for?
- Neuromuscular
- Kyphoscoliosis
- Chest wall deformity
- Spinal cord injuries
- Central control
- COPD at night
What must patients have for negative pressure ventilation?
- Airway protection
- Ability to swallow
- Normal compliance and resistance
What are the disadvantages of NPV?
- Patient access difficult
- May cause tank shock
- Not much control
- No spontaneous breathing
- Hot and noisy
- Not good for acute exacerbation of COPD
- No OSA - may exaggerate airway closure
How do you set a negative pressure ventilator?
- Set 5-10 below patient’s rate
- Increase negative pressure until patient can’t talk
- Max pressure of 35 can be achieved
- Use spirometer to measure volume
What things should you do when adjusting negative pressure ventilators?
- Adjust volume by increasing pressure or itime
- Ask patient how he feels
- Draw ABG to assess
What are the hazards of an iron lung?
- Abdominal pooling
- Large and cumbersome
- Nursing care difficult -IV
- Still used today
What is the chest curiass?
- Applies negative pressure to thorax
- Eliminates abdominal pooling
- Difficult to maintain a seal
What is a body wrap?
- Also called a pneumowrap, raincoat or poncho
- Made of nylon
- Not as efficient but popular because easy to use
What are the indications for NPPV?
- Patients with acute-on-chronic RF who require short term ventilation
- Terminally ill patients
- Patients who tolerate nasal/ask for long term
- Patients with ARF
What are the contraindications for NPPV?
- DNR orders
- Inability to clear secretions
- Inability to fit a mask
- Resp arrest - need for intubation
- Severe acidosis
- Shock Bp <90 mmHg
- Uncontrolled arrhythmias
- Uncooperative patient
- Upper airway obstruction/trauma
What is CPAP?
Keeps alveoli open and increases a PFT factor
When is CPAP used?
- Oxygenation
- Obstructive sleep apnea
- COPD with increase in WOB (be careful with COPD!)
When is NPPV for chronic RF used?
- Chest wall deformities
- Neuromuscular disorders
- Central alveolar hypoventilation
- COPD
- Cystic fibrosis
- Bronchiectasis
When is NPPV for acute RF used?
- COPD
- ARDS
- Pneumonia
- Asthma
- CF
- AIDS
- Heart failure
What are the advantages of NPPV?
- Avoids airway complication
- Flexibility in initiating and removing support
- Preserves airway defense
- Reduces need invasive monitoring
What are the disadvantages of NPPV?
- Cannot be used if aspiration risk
- Cannot be used for excessive secretions
- Cannot be used loss of protective airway reflexes
- Cannot be used in upper airway obstruction
- May not work ARF with oxygen deficit
- Causes gastric distension, skin press sores, facial pain, dry nose, eye irritation, poor sleep and discomfort