Lecture 29: ICU Flashcards
what is ICU liberation
aim = to liberate pts from harmful effects of ICU stay
comprehensive “bundle” for interdisciplinary team
decreases likelihood of hospital death w/ 7 days ICU admission by 68%
reduces delirium by 25-50%
decreases ICU readmissions by half
describe A-F of ICU bundle
A = assess, prevent, manage pain
B = both spontaneous awake trials (SATs) and spontaneous breathing trials (SBTs)
C = choice of anesthesia and sedation
D = delirium assessment, prevention, and management
E = early mobility and exercise
F = family engagement and empowerment
describe early mobility in ICU
safe and feasible for adults and kids
decreases/prevents delirium
improves functional outcomes
cost effective
may look different than typical acute care PT eval
requires interdisciplinary team
*need right pt, right time, right therapist
barriers to ICU rehab
pt “too sick”
pt too sedated
medical equipment limits mobility
limited or under qualified staffing
prioritization of ICU pts for follow up intervention along continuum of care
ICU med staff with limited knowledge regarding what rehab services can offer pts
describe the stoplight system
grades various clinical considerations and what is considered safe in bed and out of bed activities
Green = low risk of adverse event; proceed as usual according to ICU protocols
yellow = potential risk of adverse event; risk may be outweighed by benefit of mobilization; clarify precautions/contraindications prior to mobilization
red = significant potential risk; active mobilization should not occur unless specifically authorized by treating ICU specialist in consult with senior PT and senior nursing staff
indications for mechanical vent
acute respiratory failure (hypoxemia vs hypercapnic respiratory failure)
compromised lung function (PNA, COVID, CF, pleural effusions, aspiration)
breathing difficulties (rib fxs, neurological insults, phrenic nn injury)
inability to maintain airway (trauma, severe AMS, ETOH/substance abuse, airway swelling)
what is a Passy-Muir Valve (PMV)
external speaking valve that creates a closed pressure system for the creation of sounds by vocal cords
RR for MV setting
normal = 10-16
may be adjusted depending on goal
Tidal volume use with MV
volume of air moved in and out of lungs with normal breathing
normal = 4-8 ml/kg body weight
may be adjusted depending on goals
fraction inspired O2 (FiO2) with MV
atmospheric = 21%
can go up to 100% with MV
positive end expiratory pressure (PEEP) for MV
amount of pressure at end of expiration that keeps alveoli open to allow for gas exchange and prevents collapse
atmospheric = 3-5 cmH2O
can go up as high as 20 cmH2O depending on goal of MV
minute volume (MV or ME) on mechanical vent
total amount of air moved in and out of lungs in 1 min
rate x volume (RRxTV = MV)
average 4-6 L/min
what is pressure support on a MV
pressure delivered by vent to overcome airway resistance and open airways
spontaneous weaning mode
pre-set pressure given during inhale only
ranges from 5-30 cmH2O
higher number = more work vent is doing, and pt can generate inhale easier
assisted vs spontaneous MV modes
assisted
- vent starts and stops breath, does most of work
- provides pre set parameters set by MD/RT
- non-wearing modes
spontaneous
- pt starts and stops breath, does all or some of work
- vent will provide volume or pressure only AFTER the pt initiates their own breath
- weaning modes
what is assisted control with a vent
non weaning modes of MV
can provide full vent support bt doesn’t have to depending on situation (used if pt is unconscious’s edited, etc and cant generate own breath)
pt can generate inhalation and triggers the vent to provide a pre set pressure or volume
if pt doesn’t generate a breathe, the vent will provide a breath based on pre set parameters
provides ability to keep pts work of breathing very low
pts can tolerate increased demands if medically stable and working with PT since the vent can provide so much more support
