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Pulmonary > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

early tracheostomy benefits?

A

lower sedation use, trend toward dec mortality. no decrease in risk of PNA or days on MV

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2
Q

mechanism of benefit with HHFNC?

A

higher Fio2, CPAP, turbulent not laminar flow which leads to gas mixing, decrease in anatomic dead space

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3
Q

Pressure Control mode sudden loss of tidal volume with reduced expiratory flow and prolonged expiratory time?

A

airway obstruction

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4
Q

DTF threshold for failure to liberate from MV?

A

<30%

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5
Q

things on vent that will worsen diaphragmatic dysfunction?

A

increased support, increased use of controlled modes

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6
Q

abdominal paradox

A

sign of diaphragmatic weakness within 1 minute of SBT

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7
Q

things that can cause phrenic nerve injruy during CABG?

A

ishcemia to vaso vasorum, direct trauma, cold induced neuropraxia

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8
Q

diaphragm paralysis on sniff test?

A

during forceful inspiration the paralyzed diapharagm will move upward

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9
Q

physiology of SILI?

A

more even distribution of pleural pressure changes to all lung units, harder diaphragm work

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10
Q

SILI can cause these problems?

A

overdistension of damaged lung areas, air trapping from inc RR, resp muscle fatigue of diaphragm, pendeluft

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11
Q

how is. a pressure support breath terminated?

A

flow cycled via a percentage of the peak inspiratory flow

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12
Q

surrogate for transpulmonary pressure in a normal person?

A

plateau pressure

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13
Q

in morbid obesity how does pplat inaccurately predict Tp?

A

low chest wall compliance leading to a high pleural pressure therefore the pplat will overestimate the Tp and underestimate the pressure needed to overcome this higher pleural pressure

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14
Q

how does heliox work?

A

lower density than oxygen making more linear distribution through airways in high resistance situation

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15
Q

when is heliox CI?

A

it is a 70/30 mixture so if patient is requiring high oxygen then should not use

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16
Q

dynamic complicane equation?

A

TV/(peak-PEEP)

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17
Q

static compliance equation?

A

TV/(plateau- PEEP)

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18
Q

increase in peak without rise in plateau?

A

mucus plug

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19
Q

plateau and peak in (mainstem intubation, TPTX, air trapping)

A

inc in plateau and peak

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20
Q

causes of decreased static compliance? inc in both pip and Plat

A

PTX, ARDS, effusion, restrictive disease

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21
Q

causes of decreased dynamic lung compliance? inc PIP without inc plat

A

tube occlusion, bronchial secretions, bronchospasm

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22
Q

most direct measurement of diaphragmatic failure in MV?

A

transdiaphragmatic pressure via nerve stimulation

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23
Q

reintubation can lead to what outcomes?

A

inc change of nosocomial PNa, inc in crude mrotality, inc LOS

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24
Q

disadvantages of Volume AC?

A

worse change for respiratory alkalosis

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25
Q

what will increadse minute ventilation in HFOV?>

A

decrease in the frequency

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26
Q

change in bias flow in HFOV does what?

A

changers oxygenation

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27
Q

PRVC you set what?

A

goal TV

28
Q

in PAV what does the clinician set?

A

percent work of breathing

29
Q

NAVA does what?

A

pressure is proportional to the electrical activity of the diaphragm

30
Q

how do you measure the electrical activity in NAVA?

A

via esophageal probe

31
Q

benefits of NAVA?

A

decreases innefectvie tirggering
decreases overinflation
improves neuro ventilation coupling

32
Q

change O2 in HFOV?

A

change mean airway pressure, I time, and bias flow

33
Q

change ventilation in HFOV?

A

higher frequency lower MV

higher delta pressure higher MV

34
Q

why is there an increased mortality in HFOV?

A

increase mAP, leasding to decrease venous return

35
Q

concave up

A

overdistension, stress index >1, compliance decreases over time

36
Q

concave down

A

underrecruitment, stress index <1, complaicne increase with time

37
Q

TPP at end expiration?

A

PEEP- esophageal pressure at end exp

negative value indicates repetitive collapse

38
Q

TPP at end inspiration?

A

plateau- esophageal pressure at end insp

> 25 indicates overdistension

39
Q

definition of the TPP?

A

pressure to overcome the lung recoil

40
Q

esophageal pressure in obestiy and volume overload?

A

high

41
Q

what is pendelluft?

A

caused by regional variation in ressitance and elastance

41
Q

what is pendelluft?

A

caused by regional variation in ressitance and elastance

42
Q

in pressure control when does plateau equal peak?

A

during zero flow

43
Q

in spontaneously breathing patient, how would you measure autopeep

A

esophageal balloon

44
Q

why would autopeep be underestimated in asthma?

A

not accounting for the closed airways during exhalation

45
Q

a patient with marked respiratory distress spontaneous breathing, why is their TPP high?

A

very negative pleural pressure

46
Q

static compliance equation.

A

VT/(plat-PEEP)

47
Q

dynamic complaince eq

A

VT/(PIP-PEEP)

48
Q

compliance of the chest wall?

A

VT/(change of esophageal pressure)

49
Q

normal complaince of the respiratory system? Value

A

normal value 50-100 ml/cmH2O

50
Q

normal chest wall compliance?

A

80 ml/cmH2O

51
Q

lung compliance equation, normal?

A

VT/change in transpulmonary pressure

200 ml/cmH2O

52
Q

elastance equation?

A

inverse of compliance

1/Crs= 1/compliance chest wall + 1/complaince of lung

53
Q

resistance during inspiration equation?

A

(PIP-plat)/iflow

expiration plat-PEEP/eflow

54
Q

work of breathing equation

A

pressure xvolume

55
Q

how can you deteremine WOB?

A

difference of esophageal pressure at inspiration and expiration

56
Q

hallmark presentation of inadeqaute flow?

A

sucking down on pressure curve

57
Q

pressure curve is concave up?

A

inadeqate flow

58
Q

how to fix inadequate flow?

A

inc flow, change to pressure setting and inc pressure setting

59
Q

positive deflection in pressure curve ending?

A

delayed terimination

60
Q

another clue to delayed termination?

A

prolonged period of zero flow

61
Q

delayed termination fix?

A

shorten the cycle criteria

62
Q

premature termination fix?

A

lengthen cycle criteria

63
Q

difference between PEEP and iPEEP?

A

iPEEP is preferentially distrubtued to airways with obstructiona dn away from poorly compliant alveoli which is not beneficial

64
Q

right mainstem intubation will lead to what?

A

worse compliance

65
Q

high esophageal pressure at end expiration could signify what?

A

instrinsic PEEP

Pulmonary (14 decks)

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