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RT, Mechanical Ventilation (III Semestre) > Initiation of Mech. Vent. > Flashcards

Initiation of Mech. Vent. Flashcards

1
Q

Indication for Initiation of Mechanical Ventilation:

Reason why we need to put a patient on mechanical ventilation

A
  • Acute Ventilatory failure.
  • Acute Oxygenation Failure
  • Impending Respiratory Failure
  • Prophylactic Ventilatory Support
  • Apnea.
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2
Q

What does it mean Acute Respiratory Failure?

A

Mean unable to remove PaCO2 normally.

  • PH <7.25*
  • PaCO2 > 50 mm Hg*
  • COPD patients
  • Head trauma patient
  • Drug over dose patients
  • Chest trauma patients ( all these condiction are common on ER and it will take the patient to ARF)
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3
Q

When you assess an Acute Ventilatory failure Patient, what you expect to see?

A

Rapid Shallow Breathing Index

  • RSBI = RR/VT *
  • Normal value is < 100*
  • Abnormal value: RR40/0.25ml = 160 (>100) (*The faster is the breathing, the lower the volume will get)
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4
Q

Tecnically when we consider Hypoxemia?

A

When PaO2 decreases < 60 mm Hg

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5
Q

P/F ratio is used to:

A

Calculate the worsenesses of Hypoxemia, the lower the ratio is the worse the Hypoxemia will be.

Example: 100 PaO2 at 0.21 %

100/0.21 = 476 (>200 is normal)

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6
Q

What is P/F ratio?

A

PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure to fractional inspired oxygen. It is a widely used clinical indicator of hypoxaemia.

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7
Q

What impending Respiratory Falirure?

A
  • A gradual ↑ of PaCO2
  • ↑ WOB to mantain normal gas exchange.
  • Progressive Acidosis and Hypoventilation, PH <7.35, PaCO2 >50 mm Hg
  • Progressive Hypoxemia <60 mmHg
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8
Q

Assessment Parameters Suggesting IRF?

(IRF= Impending Respiratory Failure)

A
  • VT : <3-5 mL/Kg IBW
  • RR : >25/min
  • VE : >10 L/min
  • VC : <15 mL/Kg IBW
  • MIP : >-25 cm H2O
  • PaCO2 trend: ↑ to >50 mm hg
  • PaO2 trend: ↓ to <60 mm Hg
  • VS : ↑RR, ↑HR, ↑BP, ↓ SpO2
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9
Q

VT of <3-5 mL/Kg IBW, this numers suggest what?

A

Impending Respiratory failure

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10
Q

RR has to be more than what number in orden to be Impending Respiratory Failure?

A

>25 breaths per minute, if the patient continues to breath like that por a long period of time eventually will get into RF.

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11
Q

VE >10 L/m and VC of <15 mL/Kg IBW, What indicate on patient assessment parameters?

A

Impemding Respiratory Failure

(Patient must be connected to a ventilator)

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12
Q

How PaCO2 and PaO2 trend has to be for a patient to go on Respiratory Failure?

A
  • PaCO2 ↑ >50 mmHg
  • PaO2 ↓ <60 mmHg
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13
Q

In a patient that is getting into RF, RR will:

a. Decrease

b. Increase

c. No change will occurs

A

b. Increase

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14
Q

In a patient that is getting into respiratory failure HR will be:

  1. Normal
  2. Decreased
  3. Increased
A

3. Increased

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15
Q

How BP will be on a patient that is getting into RF?

A

Increased

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16
Q

SaO2 on a patient that in getting into respiratory failure will be:

17
Q

What happened to a patient that can not take the minimun Vital Capacity (<15ml/Kg IBW)?

A

Tecnicaly this patient can’t take deep breaths, He won’t be able to cough, going into RF eventually.

18
Q

Indication for Prophylactic (prevention) Ventilatory Support

A
  • Reduce Risk of Pulmonary Complication
  • Reduce Hypoxemia of mejor body organs
  • Reduce Cardiopulmonary Stress
19
Q
  • Prolong Shock
  • Head Injury
  • Smoke Inhalation
  • Hypoxic Brain
  • Hypoxia of the heart muscles

What would you do if a patient shows up one or some of these signs?

A

Ventilate the Patient to prevent RF.

20
Q

What is the absolute Mechanical Ventilation Contraindication and why?

A

Tension Pneumothorax, because of the positive pressure of the ventilator create Barotrauma.

21
Q

Contraindications for Mechanical Ventilation.

A
  • Tension Pneumothorax
  • Patient informed consent
  • Medical Futility
  • Reduction of the patient pain and suffering.
22
Q

What do we need to select for the initial Ventilatory Setting?

A
  1. Mode (S/T, AC, Assist)
  2. VT or PIP/TI
  3. RR
  4. FiO2
  5. PEEP
  6. I:E ratio
  7. Flow Pattern (Square, accelarating, desalarating)
23
Q

Before select the mode, what the Therapist need to have in consideration regarding to the patient?

A

If the patient need Full Ventilatory Support (FVS) or Partial Ventilatory Support (PVS)

24
Q

What modes are include on FVS?

A
  1. A/C (VC or PC)
  2. SIMV (VC or PC)
25
Q

Once the patient is on Ventilator, how long the therapist should wait to do and ABG test?

A

30 minutes

26
Q

The initial FiO2 setting should be betwen?

A

50% - 100%

27
Q

On the ventilator setting, what would you ajust to correct low PaO2?

A

↑ PEEP or ↑ FiO2

Note: 40% & 10 cm H2O is better than 60% & 5 cm H2O. This mean that is better to raise the PEEP than the FiO2

28
Q

Volutrauma is:

A

Overstretching of the lung caused by to much volume

29
Q

Hazards & complications of mechanical ventilation:

A
  • Barotrauma
  • Volutrauma
  • ↓ Cardiac out put
  • Multiple lung failure
  • Operator error
  • Ventilator associated pneumonia
30
Q

If a patient comes to ER with PH <7.25 and PaCO2 >50mm Hg, what would you say about this patient?

A

This patient in on Respiratory failure, must be ventilated

31
Q

If a patient is breathing 40 time per minute, with a tidal volume of 0.25L, what is his or her Rapid shallow breathing index (RSBI) and what would you do, and why?

A

40/0.25= 160 → RSBI

This patient have to be mechanically ventilated before gets into RF. Why, because it will not last too much breathing 40/min (It will get tired)

32
Q

What will happent to TI, TE, and I:E ratio when we ↑ Flow?

A
  • TI will ↓
  • TE will ↑
  • I:E ratio will ↓
33
Q

If we decrease Flow, is what direction TI, TE, and I:E ratio will move?

A
  • TI will ↑
  • TE will ↓
  • I:E ratio will ↑
34
Q

When we increase VT: TI, TE, and I:E ratio will move up or down?

A
  • TI will ↑
  • TE will ↓
  • I:E ratio will ↑
35
Q

↓ VT will cause TI, TE, and I:E ratio to move in what direction?

A
  • TI will ↓
  • TE will ↑
  • I:E ratio will ↓

RT, Mechanical Ventilation (III Semestre) (7 decks)

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