L15: Ventilatory Support Techniques (Shih)

Question 1

Bellow with hole will deliver iso + air to patient, and patient will get light***

Answer 1

Bellow might still work!

-check for leak by filling with water

Question 2

Ascending bellow better than descending bellow***

Answer 2

Stops going up and down if connection to patient lost

Question 3

Compliance = ***

Answer 3

Change in lung volume/change in lung pressure

C = change V/change P

Question 4

Easy to over-ventilate patients with low compliance.

Answer 4

:)

Question 5

PEEP causes decreased CO***

Answer 5

Alveoli always partially inflated, so extra air resists bloodflow and decreases CO.

-can give fluids, dobutamine, norepi, etc. to help heart while you help lungs with PEEP

Question 6

Recruitment manuever

Answer 6

Series of increasing PEEP to open up more alveoli

Question 7

Causes of hypoxia. Which can be fixed with ventilation?

Answer 7

• low FiO2
• hypoventilation
• shunt
• V/Q mismatch
• diffusion impairment

All fixable except diffusion impairment

Question 8

See perfusion pic

Answer 8

:)

Question 9

Patients with dead space tend to get better with oxygen supplementation

Answer 9

:)

Question 10

Disease like aspiration pneumonia decreases compliance***

Answer 10

:)

Question 11

Type 2 ventilatory distress

Answer 11

Brain/neck origin

60-80% chance coming off ventilator, since lungs intact and normal

Question 12

Type 1 ventilatory distress

Answer 12

Primary lung problem (ie. Pneumonia)

-30-40% chance coming off ventilator

Question 13

Complications of ventilatory support***

Answer 13

• Oxygen toxicity (atelectasis, low surfactant, free radicals)
• thromboembolism
• pneumothorax
• acute lung injury
• ARDS

Question 14

Prevention of ARDS***

Answer 14

• low volume, high frequency ventilation
• high PEEP
• HFO
• “Hypovolemia”
• neuromuscular blockers with sedation (ie. High dose propofol)

Question 15

ARDS

Answer 15

(Acute Resp. Distress Syndrome)

• 80% mortality in vet med
• pulmonary edema
• high alveolar permeability
• collapsed alveoli
• inflammatory cells –> lung inflammation –> cytokine release –> massive sepsis

Question 16

Thromboembolism –> ET CO2 and chest sounds***

Answer 16

ET CO2 low

Chest sounds ok

Question 17

Pneumothorax –> ET CO2 and chest sounds***

Answer 17

ET CO2 high?

Chest sounds decreased

Question 18

Acute lung injury –> ET CO2 and chest sounds***

Answer 18

ET CO2 variable

Chest sounds increased

Question 19

Disadvantages of ventilators like those up in anesthesia

Answer 19

• deliver constant FiO2 (100% O2), which can cause neuropathies and lung/eye damage longterm
• No PEEP
• No humidity
• Constant ventilatory mechanism