Invasive and non-invasive mechanical ventilation Flashcards
what are the indications for mechanical ventilation?
airway protection ARDS shock acute neuromuscular dz respiratory or cardiac arrest acutely elevated intracranial pressure tachypnea / bradypnea respiratory acidosis
what does positive pressure ventilation do?
generates a mechanically induced change in transpulmonary pressure within the airways
what is the downside of positive pressure ventilation?
supine positioning changes the distribution of inspired gases - delivered primarily to anterior portions of lung
what are the 3 Ts that define volume and pressure targeted breaths?
target
trigger
termination
spontaneous breaths are targeted solely by what parameter?
pressure
what is the airway pressure in volume targeted breaths?
variable
the tidal volume in pressure targeted breaths is determined by what factor?
inspiratory pressure
inspiratory time
who determines the flow in pressure targeted breaths?
patient
what mode is used when the operator wants to minimize patient work of breathing?
assist
what are the two major disadvantages of assisted mode ventilation?
high minute ventilation and respiratory alkalosis
dynamic hyperinflation
what are the two types of assist modes?
pressure
volume
what is used to determine if a patient is ready to be taken off ventilation?
spontaneous
what are ways to improve oxygenation?
increase FiO2
adjust airway pressure
what are two methods to adjust airway pressure?
PEEP
increased inspiratory time
what are the drawbacks to increased airway pressure (PEEP)?
- increased dead space from overdistending functional alveoli
- decreasing venous return, CO, and oxygen delivery from increased intrathoracic pressure
- VALI from overstretching alveoli
- barotrauma leading to alveolar rupture, air leak
what ventilation parameter determines pCO2?
minute ventilation
equation: minute ventilation
TV x RR
what is the tidal volume for anyone without ARDS?
6-8 cc / kg predicted body weight
why is it important to keep tidal volumes low during ventilation?
tidal volumes can injure the lung (overdistension)
what are the indications for noninvasive mechanical ventilation?
acute exacerbation COPD acute cardiogenic pulmonary edema neuromuscular failure pneumonia - immunocompromised time? asthma? other respiratory failure?
what are contraindications to noninvasive mechanical ventilation?
comatose secretions bleeding vomiting ARDS hemodynamic instability inability to wear mask
high flow nasal cannula oxygen is mainly used for what indication?
hypoxic respiratory failure
what is ECMO? what does it provide?
use of cardiopulmonary bypass circuit for prolonged but temporary life support
provides mechanism for gas exchange and/or cardiac support allowing for recovery
