Management of Mechanical vent.

Question 1

To improve ventilation on a ventilator, what do we ajust?

Answer 1

To improve ventilation on a ventilated patient, we adjust:

1. Adjust V_t

2. Change RR

3. PSV

Question 2

On the ventilator, what is the first thing that we look at it, to veryfy the right ventilation?

Answer 2

Tidal Volume, is the first thing that we look at it, verify if is correct.

Question 3

What do we do to fix PaCO2?

Answer 3

We either change the V_{<strong>t</strong>} or RR or PSV if the patient is on Spontaneous Breathing.

Question 4

The strategy to fix ventilatios is:

a. Fix O₂ first

b. Fix PaCO₂ first

Answer 4

b. Fix PaCO₂ first

Question 5

The disire RR formula is?

Answer 5

RR = KnownPaCO₂ x Known RR / Desire PaCO₂

Question 6

What are the ways to fix Oxygenation?

Answer 6

We either increase PEEP or FiO₂

Question 7

At 60% PaO_^2, Saturation will be?

Answer 7

90%, NBRC hospital does not treat it.

Question 8

The desire FiO2 formula is:

Answer 8

FiO2= Desire PaO2 x Known FiO2 / known PaO2

Question 9

PEEP may be increased untill..?

Answer 9

Interfere with cardiovascular function:

• CO fall out of range (5-8 ml)
• Minimun BP equal or > than 90 mm Hg
• Cardiac Index normal 2.5 - 3.1 L/min/m²

Question 10

Mechanical ventilation can only fix what type of hypoxemia?

Answer 10

Hypoxic Hypoxemia, Mechanical ventilation can only fix O₂ in the blood, not on the Tissue.

Question 11

What do we do to correct Low O₂ in a ventilator setting?

Answer 11

We first increase PEEP, if does not change, then increase FiO₂

Question 12

Does PaO2 >60 mm Hg require Oxygen therapy?

Answer 12

According to NBRC Hospital PaO >60 mm Hg does not require O2 therapy

Question 13

What is the physiological side effect of Positive pressure ventilation?

Answer 13

Low Cardiac Output

Question 14

When we should stop adding PEEP to fix low PaO₂?

Answer 14

• Cardiact OutPut, when this start to decrease bellow normal range (5-8 ml) we should stop adding PEEP?
• Cardiac Index 2.5 - 3.1
• BP > 90

Question 15

Ventilation problem will be fix by adjusting what setting?

Answer 15

Either V_t or RR or PSV

Question 16

Oxygenation problem will be fix by adjusting what setting on the ventilator?

Answer 16

PEEP or FiO₂

_{<span><em>Always try to fix Oxygenation by adjusting PEEP first, if there is not change then try FiO2</em></span>}

Question 17

How we get total rate?

Answer 17

Total rate is the sum of mandatory rate plus spontaneous breath

Example:

• mandatory rate: 12/min*
• Spontaneous breath:20/min*
• Total rate: 32 (12+20)*

Question 18

How we get total Minute ventilation?

Answer 18

By adding: V_E from mandatory breaths plus V_E from Spontaneoun breaths.

Example:

Mandtory breath is 12 x .45L V_T = 5.4 V_E

• Spontaneous breaths is 20 x .45L V_T = 9V_E*
• Total V_E is 14.4 (5.4+9=14.4)*

Question 19

How we fix Hypoxemia in the NBRC hospital?

Answer 19

• If FiO2 is equal or >0.60, Then ↑ PEEP
• If FiO2 is < 0.60, then ↑FiO2