Lecture 32 - Mechanical Ventilation and Support of Failing Lung Flashcards
Clinicians set 3 parameters for Bilevel Positive Airway Pressure (BiPAP): 1. ______ PAP 2. ______ PAP 3. ______ Minute ventilation (RR x TV) is dependent on patient effort for RR. TV is determined by the difference between ____ and ____, combined with the resistance of the airways and compliance of the lung parenchyma.
- Inspiratory Positive Airway Pressure (IPAP) 2. Expiratory PAP (EPAP) 3. FiO2 The difference between IPAP and EPAP
Indications for BiPAP (remember this is not intubation) are _______ exacerbation, CHF exacerbation, less so for ______ exacerbation, and mild ______ (especially in immunocompromised patients).
COPD exacerbation CHF exacerbation less so for Asthma mild ARDS (especially immunocompromised patients)
Contraindications for BiPAP include cardiac or _______ arrest (remember BiPAP relies on the patient to take their own breaths), _____ trauma (should make sense that you don’t want to put a mask on these patients), and basically anything that might make a mask not suitable.
Respiratory arrest Facial trauma
When a patient is placed on a ventialtor, the clinicians can determine only the ______ Minute ventilation, _____, and PEEP (Positive End Expiratory Pressure). The patient controls Airway resistance, Compliance, and _____ Minute Ventilation (they can breath as much as they want to).
Minimum Minute Ventilation (remember this is RR x TV) FiO2 Maximum Minute Ventilation
RR controls how long the patients have for _______. The slower the RR, the LONGER patients have for ______. With that in mind, which patients would benefit from lower RR? Which patients might benefit from higher RR?
Expiration Expiration Patients with obstructive pulmonary diseases would benefit from longer expiration (so lower RR). Patients with acidosis, or the need to eliminate CO2 would benefit from higher RR.
In Volume Control Ventilation, clinicians set the volume that will be delivered, and they set the duration for the respiratory cycle (so flow is constant over this time until the volume has been delivered). Then what is Pressure in the lungs dependent on?
Pressure is dependent on the compliance of the Patient’s lungs.
During Mechanical Ventilation, TV is usually set using the patient’s Ideal ___ ___ (it allows clinicians to estimate how large the patient’s lungs should be ideally).
Ideal Body Weight (IBW)
Peak Airway Pressure is measured directly by the ventilator machine (Normal value is < ____ cm H2O) –> Peak Airway Pressure gives an idea about the _____ and _____ of the patient’s lungs. How is Plateau Airway Pressure measured? What value should it always be below? Keep in mind it tells you about the Compliance of the patient’s lungs.
Normal < 30 cm H2O Resistance and Compliance Plateau Airway Pressure is measured by pausing flow at the end of inspiration –> so it measures pressure WITHOUT flow. It should always be below 30 cm H2O.
If there is a large difference between Peak Airway Pressure and Plateau Airway Pressure (> ____ cm H2O), it indicates a issue with _______ –> so the problem is with the tubing of the ventilator. If there is a small difference between the two pressures, the issue is the ______ of the patient’s lung.
> 5cm H2O Resistance (so issue with the tubing of the vent) Compliance
What is PEEP, and how does it help patients on vents?
PEEP = Positive End Expiratory Pressure. It allows the patient’s alveoli to remain slightly expanded at end expiration –> facilitates better gas exchange and decreases alveolar damage.
Follow ABCDEF to avoid doing more harm than good with Mechanical Ventilation of Patients. What does the acronym stand for?
A = Awakening the patient every day from sedation B = Breath –> give the patient a spontaneous breathing trial every day to see if they can come off the vent. C = Coordination among the medical team between awakening and breathing (basically monitoring) D = Delirium should be assessed every day E = Early mobility (even while ventilated F = Family –> engage patient’s family at bedside.
