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Critical Care 1 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

amount of air in normal breath

A

tidal volume = Vt

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2
Q

Vt

A

tidal volume

amount of air in normal breath

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3
Q

problem of too high Vt

A

tidal volume too high causes Ventilator Induce Lung Injury

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4
Q

cause of Ventilator Induced Lung INjury

A

too high Vt

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5
Q

surface of airway not involved in gas exchange

A

dead space

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6
Q

Fick’s law of Diffusion

A

gas travels from high to low concentration

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7
Q

gas travels from high to low conetration

A

ick’s Law of DIffusion

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8
Q

when do you hear apneuristic posturing

A

decerebrate postuirng

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9
Q

apneuristic breathing

A

depe gasping inspiration with a pause at full inspiration followed by a brief insufficient release

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10
Q

deep gasping inspiration with a pase inspiration followed by brief insufficient relase

A

apneuristic brathing

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11
Q

complete irregular breathing w/irregular pasuses and apnea

A

ataxic

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12
Q

ataxic

A

complete irregular breathing w/irregular pasues and apnea

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13
Q

BIots

A

quick shallow inspiration followed byrgular/iregular apnea

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14
Q

quick shallow inspiration followed by regular/irregular apnea

A

Biot’s

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15
Q

respiration in stroke

A

Biot’s

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16
Q

respiration if pressure on medula r/t herniation

A

Biot’s

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17
Q

cause of BIot’s

A

stroke

pressure on medulla from herniation

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18
Q

Cheyne-STokes

A

progressivelydeeper and faster then decrease to tempoary apnea

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19
Q

progressively deeper and faster then decreased to tempary apnea

A

Cheyne-STokes

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20
Q

when do you see Cheyne Stokes

A

decorticate

cushing’s brainstem herniation

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21
Q

respiration in Cushing’s triad

A

Cheyne-STokes

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22
Q

resp in DKA

A

Kussmaul’s

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23
Q

Kussmau’s Respirations

A

resp in DKA

respiration gradulally becomes deeper, labored, and gasping

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24
Q

respirations deep and labored

A

Kussmauls’

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25
gold standard for oxygenation
SpO2 = pulse ox
26
gold standard for ventilation
capnography = ETCO2
27
inability to diffuse oxygen
hypoxic respiratory failure
28
respiratory failure in ARDS
hypoxic respiratory failure
29
respiratory failure in pneumonia
hypoxic respiratory failure
30
respiratory failure in CHF
hypoxic respiratory failure
31
dx if pO2 below 60
hypoxic respiratory failure
32
definition of hypoxic respiratory failure
pO2 below 60
33
treatment if hypoxic respiratory failure
increase oxygen concentration (FiO2 and PEEP | *treatment assumes that you have adequate tidal volume and rate)
34
how to increase oxygen saturation
increase FiO2 (oxygen concentration) and PEEP
35
increase FiO2 (oxygen concentration) and PEEP
treatment for hypoxic respiratory failure
36
inability to remove CO2
hypERcarbic respiratory failure
37
cause of hypercarbic respiratory failure
damage to pons/upper medulla from stroke or trauma | respiratory acidosis
38
dx hypercarbic respiratory failure
ETCO2 over 45
39
dx if ETCO2 is over 45
hypercarbic respiratory failure
40
treatment of hypercarbic respiratory failure
incrase tidal volume (pPLAT) then rate increasae (double the minute volume (Ve), normal is 4-8L'min
41
what happens if you exceed __ml/kg of ideal body weight for tidal volume settings
over 8ml/kg for tidal volume settings can cause ventilatior associated lung injuries *slowly increase and reassess every 15min
42
ventilator setting for tidal volume
Vt = 4-8ml/kg ideal body weight | volume of air delivered per breath
43
ventilator setting that is the volume of air delivered per breath
Vt = tidal volume 4-8ml/IBW over 8 = ventilator associated lung injury
44
Ve
minute volume how much air is breathed by the pt in one minute F x Vt
45
4-8 ml/kg IBW
Vt = tidal volume
46
F x Vt
calculate Ve = minute volume | how much air breatahed by a pt over 1 minute
47
calculate Ve
minute volume = F x Vt (tidal volume)
48
purpose of PEEP
keep alveoli open so oxygen can diffuse
49
3 ventilator settings that keep alveoli open so oxygen can diffuse
adequate peep increased FRC driving pressure
50
2 ventilator delivery methods
``` volume = preset volume consistent. once tidal volume is delivered, exhalation begins pressure = preset inspiratory pressure. once the pressure is achieved, exhalation begins ```
51
max PIP
35
52
PIP
amount of resistance to overcome the ventilator circuit, appliances/ETT, and the main airway
53
pPlat
measurement of the pressure applied during positive pressure ventilation to the samll airways/alveoli. *represents the static end inspiratory recoil pressure of hte respiratory system, lung, and chest wall respectively
54
when is pPlat measured
during an inspiratory pause while on m. ventilator
55
normal pPlat
under 30
56
values for PIP & pPlat
PIP under 35 | pPlat under 30
57
CMV
controlled mandatory ventilation
58
who needs CMV
controlled mandatory ventilation sedated/apneic/paralyzed all breaths are trigged, limited, cycled by the ventilator pt unable to breathe on own
59
best ventilator mode for sedated
CMV all breaths are triggered/limited by ventilator pt unable to breathe on own
60
best ventilator mode for apneic
CMV ventilator does all work pt can't breathe on own
61
best ventilator mode for paralyzed
CMV | ventilator does all the work
62
ventilator setting that does all the work and the pt has no ability to initiate their own breaths
CMV = controlled mandatory ventilation
63
preferred ventilator mode for respiratory distress
Assist COntrol
64
trigger for breath in Assist Control
either the pt or by elapsed time
65
how does Assist Control work
ventilator suipports every breath whether it is initiated by the pt or the ventilator *full tidal volume (Vt) regardless of respiratory effort or drive
66
anxious pt on Assist Control
can cause breath stacking/auto-PEEP
67
what ventilator setting can cause auto-PEEP
Assit COntrol
68
good ventilator setting for ARDS
AC
69
ventilator setting where the ventilator supports every breath even if pt initiates in order to deliver the full Vt
AC
70
auto-PEEP
aka breath stacking *predisposes to barotrauma/hemodynamic comproimises increases WOB/effort to trigger the ventilator *diminishes the forces generated by the respiratory muscles
71
SIMV
synchronized intermittent mandatory ventilation
72
how does SIMV work
if pt fails to take a rbeath, the ventilator will provide a breath spontaneous breathing by pt in-between assisted breaths at preset intervals
73
ventilator setting where it can sense pt taking a breath and either support it while also allowing pt to take spontaneous breaths in-between preset interval
SIMV
74
best ventilator setting for intact respiratory drive
SIMV
75
candidate for SIMV
someone with an intact ventilation drive | *able to take their own breaths in-between preset intervals
76
how does Pressure Support Ventilation (PSV) work
pressure support makes it easier to overcome the resistance of the ET tube and is often used during weaning b/c it reduces WOB *supports or provides pressure during inspiration to decrease pt's overall WBO
77
what does pt determine in PSV
pressure support ventilation | *tidal volume and rate
78
PSV
pressure support ventilation
79
ventilator setting that provides pressure during inspiration to decrease pt overall work of breathing
PSV = pressure support ventilation
80
what does pt need to be able to do in order to use PSV
consistent ventilatory effort by pt | pt determines Vt, rate (minute volume)
81
what does BiPAP mean
BiPAP refers to a specific manufacturer, not a vent setting
82
pressure alarm if ventilator is dislodged
low pressure
83
pressure alarm if ventilor is obstructed
high pressure
84
pressure alarm if pneumo
high pressure alarm
85
pressure alarm if stacked breaths
high pressure alarm
86
pressure alarm if pt is hypovolemic and on ventilator
low pressure
87
pressure alarm if ARDS
high pressure
88
pt and ventilator are fighting
pt-ventilator dyssynchrony
89
problem patient-ventilator dyssynchrony
PROBLEM: inadequate sedation or pain control | b/c increased oxygen demand & WOB. increased HR/BP/ICP
90
waveform sign if patient-ventilator dyssynchrony
curare cleft
91
curare cleft
waveform sign of patient-ventilator dyssynchrony
92
interventions for patient-ventilator dyssynchrony
``` manage auto-peep adjust rate to pt demand, adjust sensitivity Y minute volume suction analgesia & sedation ```
93
what settings does teh algorithm have you look at if sudden acute respiratory deterioration while on a m. ventilator
``` PIP (decreased/increased/no change) plateau pressure (no change or increqased) ```
94
troubleshooting the ventilator | acute respiratory deterioration and the PIP is decreased
air leak hypoventilation hyperventilation
95
troubleshooting the ventilator | acute respiratory deteroration w/o PIP changes
consider PE
96
troubleshooting the ventilator | acute respiratory deterioration w/PIP increased
next consider if the pPlat is increased or if no change
97
troubleshooting the ventilator | acute respiratory deterioation with increased pPLAT -6
``` abd distension atelectasis pneumo p. edema atelectasis pleural efflusion ```
98
troubleshoot the ventilator | acute respiratory deterioration with no change in pPlat
airway obstruction, bronchospasm, ET tube cuff herniation
99
RASS
Richmond Agitation-Sedation Scale +4 = combative 0= alert and calm -4= deeply sedated
100
tool used to monitor m. vented pt for over/undersedation
``` RASS = Richmond Agitation-Sedation Scale +4 = combative 0= alert and calm -4= deeply sedated ```
101
decreased V/Q
ventilation is not keeping up with perfusion | *resp fail/pneumonia/ARDS, low PaO2, high PaCO2
102
formula for V/Q
alveolar ventilation/CO | = ~.08
103
low V/Q normal V/Q high V/Q
normal V/Q = ~0.8. alveoli are ventilated and perfused low V/Q = shunted. alveoli are perfused but not ventilated high V/Q= deadspace. alveoli are ventilated but not perfused
104
example of low V/Q
shunt perfusion = alveoli are perfused by not vented | ET in mainstem bronchus
105
example of high V/Q
deadspace | alveoli are ventilated but not perfused
106
what is the problem of asthma
breathing out. | respiatory acidosis due to hypercarbic respiratory failure
107
CXR in asthma
flattened disaphragm on CXR. chest cavity is overexpanded due to air trapping
108
shark fin ETCO2
asthma
109
asthma as reflected on ETCO2
shark fin
110
interventions for asthma -ventilator
increase I:E ration to 1:4 (b/c this is an exhalation problem) zero PEEP or under 5
111
I:E setting on ventilator if asthma attak
increase to 1:4 b/c exhalation problem
112
PEEP if on a ventilator & asthma attack
zero to under 5 PEEP
113
rx for asthma attack
``` bronchoD steroid epii magnesium ketamine if sedated ```
114
cutesy names for COPD
blue bloater - chronic bronchitis | pink puffer = emphysema
115
CXR if COPD
flatted diaphragm. chest cavity is expanded from air trappign
116
problem if COPD
problem is breathing out | respiratory acidosis b/c hypercalrbic respriatory failure
117
benefit of increased I:E ratio
more expiratory time increases CO2 clearance but it does carry a risk of atelectasis (increased I only is uncommon but it may be used to increase oxygen at a cost of CO2 clearence)
118
pleural efflusion
fluid in the pleural space | gravitates to the most dependent space
119
CXR of pneumonia
patchy infiltrates | lobular consolidation
120
what happens = hypoxemia & p. HTNin ARDS
diffuse alveolar injury * increased permeability of the alveolar-capillary barrier * influx of fluid into the alveoliar space
121
CXR of ARDS
ground glass appearence patchy infiltrates bilateral diffuse infiltrates
122
ground glass appearence on CXR
ARDS
123
Swan-Ganz findings in ARDS
high PAWP (18-20) b/c the right heart is pumping against incresed resistance in the lung vasculature
124
ARDS treatment
focus on oxygenation -increase PEEP & FiO2 -lower tidal volume (4) increase rate (F)
125
calculate male predicted body wt
50 + 2.3(height in inches - 60)
126
calculate female predicted body wt
45.5 + 2.3(heigh in inches -60)
127
inclusion criteria for ARDS
1. PaO2/FiO2 under 300 2. bilateral infiltrates consistent w/p. edema 3. no clinical evidence of left atrial HTN
128
oxygenation goal for ARDS
minimam PEEP of 5. incremental FiO2/PEEP combos to achieve goal fo PaO2 55-80 & SpO2 88-95%
129
pPlat goal if ARDS
under 30 check pPlat q4hrs or after each change in PEEP/Vt *pPlat over 30 = decrease Vt by 1ml/steps *pPlat under 25 and Vt under 6ml/kg = increase Vt by 1ml/kg until pPlat is over 25 or Vt 6ml/kg *pPlat under 30 and breath stacking, incrae Vt in 1ml/kg increaments to 7 or 8

Critical Care 1 (13 decks)

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