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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
Q

gold standard for oxygenation

A

SpO2 = pulse ox

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26
Q

gold standard for ventilation

A

capnography = ETCO2

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27
Q

inability to diffuse oxygen

A

hypoxic respiratory failure

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28
Q

respiratory failure in ARDS

A

hypoxic respiratory failure

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29
Q

respiratory failure in pneumonia

A

hypoxic respiratory failure

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30
Q

respiratory failure in CHF

A

hypoxic respiratory failure

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31
Q

dx if pO2 below 60

A

hypoxic respiratory failure

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32
Q

definition of hypoxic respiratory failure

A

pO2 below 60

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33
Q

treatment if hypoxic respiratory failure

A

increase oxygen concentration (FiO2 and PEEP

*treatment assumes that you have adequate tidal volume and rate)

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34
Q

how to increase oxygen saturation

A

increase FiO2 (oxygen concentration) and PEEP

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35
Q

increase FiO2 (oxygen concentration) and PEEP

A

treatment for hypoxic respiratory failure

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36
Q

inability to remove CO2

A

hypERcarbic respiratory failure

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37
Q

cause of hypercarbic respiratory failure

A

damage to pons/upper medulla from stroke or trauma

respiratory acidosis

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38
Q

dx hypercarbic respiratory failure

A

ETCO2 over 45

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39
Q

dx if ETCO2 is over 45

A

hypercarbic respiratory failure

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40
Q

treatment of hypercarbic respiratory failure

A

incrase tidal volume (pPLAT)
then rate increasae
(double the minute volume (Ve), normal is 4-8L’min

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41
Q

what happens if you exceed __ml/kg of ideal body weight for tidal volume settings

A

over 8ml/kg for tidal volume settings can cause ventilatior associated lung injuries
*slowly increase and reassess every 15min

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42
Q

ventilator setting for tidal volume

A

Vt = 4-8ml/kg ideal body weight

volume of air delivered per breath

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43
Q

ventilator setting that is the volume of air delivered per breath

A

Vt = tidal volume
4-8ml/IBW
over 8 = ventilator associated lung injury

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44
Q

Ve

A

minute volume
how much air is breathed by the pt in one minute
F x Vt

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45
Q

4-8 ml/kg IBW

A

Vt = tidal volume

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46
Q

F x Vt

A

calculate Ve = minute volume

how much air breatahed by a pt over 1 minute

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47
Q

calculate Ve

A

minute volume = F x Vt (tidal volume)

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48
Q

purpose of PEEP

A

keep alveoli open so oxygen can diffuse

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49
Q

3 ventilator settings that keep alveoli open so oxygen can diffuse

A

adequate peep
increased FRC
driving pressure

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50
Q

2 ventilator delivery methods

A 
volume = preset volume consistent. once tidal volume is delivered, exhalation begins
pressure = preset inspiratory pressure. once the pressure is achieved, exhalation begins
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51
Q

max PIP

A

35

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52
Q

PIP

A

amount of resistance to overcome the ventilator circuit, appliances/ETT, and the main airway

53
Q

pPlat

A

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
Q

when is pPlat measured

A

during an inspiratory pause while on m. ventilator

55
Q

normal pPlat

A

under 30

56
Q

values for PIP & pPlat

A

PIP under 35

pPlat under 30

57
Q

CMV

A

controlled mandatory ventilation

58
Q

who needs CMV

A

controlled mandatory ventilation
sedated/apneic/paralyzed
all breaths are trigged, limited, cycled by the ventilator
pt unable to breathe on own

59
Q

best ventilator mode for sedated

A

CMV
all breaths are triggered/limited by ventilator
pt unable to breathe on own

60
Q

best ventilator mode for apneic

A

CMV
ventilator does all work
pt can’t breathe on own

61
Q

best ventilator mode for paralyzed

A

CMV

ventilator does all the work

62
Q

ventilator setting that does all the work and the pt has no ability to initiate their own breaths

A

CMV = controlled mandatory ventilation

63
Q

preferred ventilator mode for respiratory distress

A

Assist COntrol

64
Q

trigger for breath in Assist Control

A

either the pt or by elapsed time

65
Q

how does Assist Control work

A

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
Q

anxious pt on Assist Control

A

can cause breath stacking/auto-PEEP

67
Q

what ventilator setting can cause auto-PEEP

A

Assit COntrol

68
Q

good ventilator setting for ARDS

A

AC

69
Q

ventilator setting where the ventilator supports every breath even if pt initiates in order to deliver the full Vt

A

AC

70
Q

auto-PEEP

A

aka breath stacking
*predisposes to barotrauma/hemodynamic comproimises
increases WOB/effort to trigger the ventilator
*diminishes the forces generated by the respiratory muscles

71
Q

SIMV

A

synchronized intermittent mandatory ventilation

72
Q

how does SIMV work

A

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
Q

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

A

SIMV

74
Q

best ventilator setting for intact respiratory drive

A

SIMV

75
Q

candidate for SIMV

A

someone with an intact ventilation drive

*able to take their own breaths in-between preset intervals

76
Q

how does Pressure Support Ventilation (PSV) work

A

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
Q

what does pt determine in PSV

A

pressure support ventilation

*tidal volume and rate

78
Q

PSV

A

pressure support ventilation

79
Q

ventilator setting that provides pressure during inspiration to decrease pt overall work of breathing

A

PSV = pressure support ventilation

80
Q

what does pt need to be able to do in order to use PSV

A

consistent ventilatory effort by pt

pt determines Vt, rate (minute volume)

81
Q

what does BiPAP mean

A

BiPAP refers to a specific manufacturer, not a vent setting

82
Q

pressure alarm if ventilator is dislodged

A

low pressure

83
Q

pressure alarm if ventilor is obstructed

A

high pressure

84
Q

pressure alarm if pneumo

A

high pressure alarm

85
Q

pressure alarm if stacked breaths

A

high pressure alarm

86
Q

pressure alarm if pt is hypovolemic and on ventilator

A

low pressure

87
Q

pressure alarm if ARDS

A

high pressure

88
Q

pt and ventilator are fighting

A

pt-ventilator dyssynchrony

89
Q

problem patient-ventilator dyssynchrony

A

PROBLEM: inadequate sedation or pain control

b/c increased oxygen demand & WOB. increased HR/BP/ICP

90
Q

waveform sign if patient-ventilator dyssynchrony

A

curare cleft

91
Q

curare cleft

A

waveform sign of patient-ventilator dyssynchrony

92
Q

interventions for patient-ventilator dyssynchrony

A 
manage auto-peep
adjust rate to pt demand, 
adjust sensitivity Y minute volume
suction
analgesia & sedation
93
Q

what settings does teh algorithm have you look at if sudden acute respiratory deterioration while on a m. ventilator

A 
PIP (decreased/increased/no change)
plateau pressure (no change or increqased)
94
Q

troubleshooting the ventilator

acute respiratory deterioration and the PIP is decreased

A

air leak
hypoventilation
hyperventilation

95
Q

troubleshooting the ventilator

acute respiratory deteroration w/o PIP changes

A

consider PE

96
Q

troubleshooting the ventilator

acute respiratory deterioration w/PIP increased

A

next consider if the pPlat is increased or if no change

97
Q

troubleshooting the ventilator

acute respiratory deterioation with increased pPLAT -6

A 
abd distension
atelectasis
pneumo
p. edema
atelectasis
pleural efflusion
98
Q

troubleshoot the ventilator

acute respiratory deterioration with no change in pPlat

A

airway obstruction, bronchospasm, ET tube cuff herniation

99
Q

RASS

A

Richmond Agitation-Sedation Scale
+4 = combative
0= alert and calm
-4= deeply sedated

100
Q

tool used to monitor m. vented pt for over/undersedation

A 
RASS = Richmond Agitation-Sedation Scale
\+4 = combative
0= alert and calm
-4= deeply sedated
101
Q

decreased V/Q

A

ventilation is not keeping up with perfusion

*resp fail/pneumonia/ARDS, low PaO2, high PaCO2

102
Q

formula for V/Q

A

alveolar ventilation/CO

= ~.08

103
Q

low V/Q
normal V/Q
high V/Q

A

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
Q

example of low V/Q

A

shunt perfusion = alveoli are perfused by not vented

ET in mainstem bronchus

105
Q

example of high V/Q

A

deadspace

alveoli are ventilated but not perfused

106
Q

what is the problem of asthma

A

breathing out.

respiatory acidosis due to hypercarbic respiratory failure

107
Q

CXR in asthma

A

flattened disaphragm on CXR. chest cavity is overexpanded due to air trapping

108
Q

shark fin ETCO2

A

asthma

109
Q

asthma as reflected on ETCO2

A

shark fin

110
Q

interventions for asthma -ventilator

A

increase I:E ration to 1:4 (b/c this is an exhalation problem)
zero PEEP or under 5

111
Q

I:E setting on ventilator if asthma attak

A

increase to 1:4 b/c exhalation problem

112
Q

PEEP if on a ventilator & asthma attack

A

zero to under 5 PEEP

113
Q

rx for asthma attack

A 
bronchoD
steroid
epii
magnesium
ketamine if sedated
114
Q

cutesy names for COPD

A

blue bloater - chronic bronchitis

pink puffer = emphysema

115
Q

CXR if COPD

A

flatted diaphragm. chest cavity is expanded from air trappign

116
Q

problem if COPD

A

problem is breathing out

respiratory acidosis b/c hypercalrbic respriatory failure

117
Q

benefit of increased I:E ratio

A

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
Q

pleural efflusion

A

fluid in the pleural space

gravitates to the most dependent space

119
Q

CXR of pneumonia

A

patchy infiltrates

lobular consolidation

120
Q

what happens = hypoxemia & p. HTNin ARDS

A

diffuse alveolar injury

  • increased permeability of the alveolar-capillary barrier
  • influx of fluid into the alveoliar space
121
Q

CXR of ARDS

A

ground glass appearence
patchy infiltrates
bilateral diffuse infiltrates

122
Q

ground glass appearence on CXR

A

ARDS

123
Q

Swan-Ganz findings in ARDS

A

high PAWP (18-20) b/c the right heart is pumping against incresed resistance in the lung vasculature

124
Q

ARDS treatment

A

focus on oxygenation
-increase PEEP & FiO2
-lower tidal volume (4)
increase rate (F)

125
Q

calculate male predicted body wt

A

50 + 2.3(height in inches - 60)

126
Q

calculate female predicted body wt

A

45.5 + 2.3(heigh in inches -60)

127
Q

inclusion criteria for ARDS

A
  1. PaO2/FiO2 under 300
  2. bilateral infiltrates consistent w/p. edema
  3. no clinical evidence of left atrial HTN
128
Q

oxygenation goal for ARDS

A

minimam PEEP of 5. incremental FiO2/PEEP combos to achieve goal fo PaO2 55-80 & SpO2 88-95%

129
Q

pPlat goal if ARDS

A

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 (14 decks)

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