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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
what will increadse minute ventilation in HFOV?>
decrease in the frequency
26
change in bias flow in HFOV does what?
changers oxygenation
27
PRVC you set what?
goal TV
28
in PAV what does the clinician set?
percent work of breathing
29
NAVA does what?
pressure is proportional to the electrical activity of the diaphragm
30
how do you measure the electrical activity in NAVA?
via esophageal probe
31
benefits of NAVA?
decreases innefectvie tirggering decreases overinflation improves neuro ventilation coupling
32
change O2 in HFOV?
change mean airway pressure, I time, and bias flow
33
change ventilation in HFOV?
higher frequency lower MV higher delta pressure higher MV
34
why is there an increased mortality in HFOV?
increase mAP, leasding to decrease venous return
35
concave up
overdistension, stress index >1, compliance decreases over time
36
concave down
underrecruitment, stress index <1, complaicne increase with time
37
TPP at end expiration?
PEEP- esophageal pressure at end exp negative value indicates repetitive collapse
38
TPP at end inspiration?
plateau- esophageal pressure at end insp >25 indicates overdistension
39
definition of the TPP?
pressure to overcome the lung recoil
40
esophageal pressure in obestiy and volume overload?
high
41
what is pendelluft?
caused by regional variation in ressitance and elastance
41
what is pendelluft?
caused by regional variation in ressitance and elastance
42
in pressure control when does plateau equal peak?
during zero flow
43
in spontaneously breathing patient, how would you measure autopeep
esophageal balloon
44
why would autopeep be underestimated in asthma?
not accounting for the closed airways during exhalation
45
a patient with marked respiratory distress spontaneous breathing, why is their TPP high?
very negative pleural pressure
46
static compliance equation.
VT/(plat-PEEP)
47
dynamic complaince eq
VT/(PIP-PEEP)
48
compliance of the chest wall?
VT/(change of esophageal pressure)
49
normal complaince of the respiratory system? Value
normal value 50-100 ml/cmH2O
50
normal chest wall compliance?
80 ml/cmH2O
51
lung compliance equation, normal?
VT/change in transpulmonary pressure 200 ml/cmH2O
52
elastance equation?
inverse of compliance 1/Crs= 1/compliance chest wall + 1/complaince of lung
53
resistance during inspiration equation?
(PIP-plat)/iflow expiration plat-PEEP/eflow
54
work of breathing equation
pressure xvolume
55
how can you deteremine WOB?
difference of esophageal pressure at inspiration and expiration
56
hallmark presentation of inadeqaute flow?
sucking down on pressure curve
57
pressure curve is concave up?
inadeqate flow
58
how to fix inadequate flow?
inc flow, change to pressure setting and inc pressure setting
59
positive deflection in pressure curve ending?
delayed terimination
60
another clue to delayed termination?
prolonged period of zero flow
61
delayed termination fix?
shorten the cycle criteria
62
premature termination fix?
lengthen cycle criteria
63
difference between PEEP and iPEEP?
iPEEP is preferentially distrubtued to airways with obstructiona dn away from poorly compliant alveoli which is not beneficial
64
right mainstem intubation will lead to what?
worse compliance
65
high esophageal pressure at end expiration could signify what?
instrinsic PEEP

Pulmonary (14 decks)

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