Mechanical Ventilation Flashcards
How does mechanical ventilation differ from regular ventilation?
Positive pressure occurs in the lungs upon inhalation, which normally would be negative pressure. (Positive pressure ventilation).
What are some indicators for mechanical ventilation?
RR >35, PaCO2 >55 with pH <7.2, PaO2 <55 (with supplemental O2), severe SOB and inc WOB, trouble speaking, fatigue, respiratory arrest, cardiovascular complications (shock, HF, dec BP)
What are things that need to be done post-intubation?
Auscultate chest and epigastrium, visualize bilateral chest rise, CXR, CO2 detector, mark tube location at teeth, connect to ventilator
What is AC mode ventilation? When is this mode used? What parameters do we want to monitor?
Set RR, set Vt, patient may take spontaneous breaths above set rate but will receive set Vt. This mode is usually the one patients are initially put on once intubated (paralyzed etc.). Need to monitor peak pressures, RR (if they’re going above set rate),
What to increased peak pressures (>30) indicate?
Worsening lung compliance or obstruction to air flow.
What is the usual Vt range?
6-8 ml/kg
What is SIMV mode ventilation? What is often added to this setting? When might we see this mode being used? What are parameters we would want to monitor?
Set RR (usually lower like 4-10/min) and Vt, patient will receive set tidal volume for all set breaths, but will receive own tidal volume for initiated breaths. Pressure support is often added to patient-initiated breaths to make it easier for pt to breathe in. Weaning mode. Monitor RR, Vt (patients), and peak inspiratory pressure.
What is PCV? When does this mode of ventilation support people best? Why? What are parameters we would want to monitor?
Set pressure, set RR. Patient can initiate additional breaths and receive same pressure. This form of ventilation is best for people who have poor lung compliance or extreme oxygenation issues (pressure ventilation avoids barotrauma to lungs, and you can alter inspiration:expiration time to increase inspiration and support oxygenation). Monitor Vt, RR, MV.
What is PSV? When would this be used? What are parameters we want to monitor?
Set pressure, but no set RR or Vt. Provides a pressure boost to inspiration. Used as a weaning mode. Monitor RR, Vt, MV.
What might be some reasons why a high pressure alarm sounds? What can you do about it?
Secretions, coughing, bronchospasm, kink in tubing, patient biting down on ETT, ++ water in tube, displaced ETT, pneumothorax. Suction patient, auscultate, bronchodilation, check ETT, bite block, sedation, empty water in tubes.
What might be some reasons for a decreased pressure alarm? What can you do about it?
Cuff leak (ETT), leak in circuit. Auscultate trachea, check cuff pressure, check circuit for leaks, tighten connections.
What might be some reasons for a decreased exhaled Vt alarm? What can you do about it?
Cuff leak, leak in circuit, patient is tiring on weaning mode, worsening lung compliance (pressure limit being reached)
What ventilator settings will support ventilation?
Vt, RR, increased pressure (indirectly increases Vt).
What ventilator settings will support oxygenation?
PEEP, FiO2
