Mechanical Ventilation Flashcards
indications for mechanical ventilation X4
apnea or impending loss of airway
acute respiratory failure
severe hypoxia
respiratory muscle fatigue
short term artificial airway
endotracheal tube (ETT)
long term artificial airway
tracheostomy (Trach)
are ETT’s emergent or planned
can be both
are trachs emergent or planned
usually planned
after the ETT is inserted what do you do
confirm placement
how do you confirm ETT placement X6
end tidal CO2
auscultate lungs bilaterally
auscultate epigastrium
chest wall movement
monitor SpO2
CXR
end tidal CO2 detector confirmation
yes = yellow problem = purple
what should you hear in the epigastrium when checking ETT placement
no air sounds
how far above the carina should the end of the ETT be
3-4 in above carina
what should the ETT cuff pressure be
<25 cm H2O
what is the carina
where the lungs branch off to the right and left
what needs to be at the bedside in case of trach emergencies
obturator
how often should you clean the trach stoma
q shift and PRN
how should you clean the trach stoma
sterile saline, dressing change, and change the ties
how often should you change the inner cannula
q shift and PRN
how often should oral care be done with artificial airways
q4
when should inline suctioning be done
q shift and PRN
how long should suctioning last
no more than 10 seconds
how far should you insert the catheter when suctioning
until resistance is met
f/RR
frequency/respiratory rate
FiO2
fraction/percent of inspired oxygen
I:E ratio
inspiratory time compared to expiratory time
normal I:E ratio
1:2
PEEP
positive end-expiratory pressure
normal PEEP
5-10
PIP
peak inspiratory pressure
normal PIP
15-20
Ve
minute ventilation/volume
normal Ve
6-8 L/min
Vt X RR
Vt
tidal volume
normal tidal volume
6-8 mL/kg of ideal body weight
normal tidal volume in COPD/ARDS
4-6 mL/kg ideal body weight
FiO2 on HFNC
delivers O2 from 21%-100%
O2 flow rate on HFNC
up to 60 L/min
is there humidification in HFNC
yes
what are the functions of HFNC
clear physiological dead space of expired air and keeps alveoli open at the end of expiration
HFNC cons X3
limits patient mobility
requires good fit
requires adequate spontaneous RR
what does CPAP provide
a preset pressure provided throughout the inspiratory and expiratory phases of the breath
how does CPAP work
keeps alveoli from collapsing leading to better oxygenation and less work of breathing
CPAP only provides X not X
only provides airway pressure - NOT O2
what must the patient be able to do with CPAP
breath spontaneously and do all of the work (breathing coughing)
2 bipap settings
Inspiratory pressure
expiratory pressure
IPAP assists
ventilation
EPAP assists
oxygenation
is BIPAP or CPAP more specific
BIPAP
vent settings to blow off CO2
increase RR and/or Vt
vent settings to increase PaO2
increase FiO2 and/or PEEP
what does Assist control ventilation do
provides a fixed tidal volume that the vent will deliver at the set time intervals or when the patient initiates a breath
how does ACV Vt change when the patient initiates a breath
remains the same
how does SIMV work
vent does half the work - allows patient to spontaneously breathe without vent assistance
what happens if the pt takes a breath while on SIMV
the patient will only get what they breathe - if they take a breath lower than the tidal volume thats all they will get
what type of patient is SIMV best used on
a weaning method - patient is improving over time
what does PS (pressure support vent) do
decreases work of breathing by boosting the patients own self-initiated breaths
normal PSV settings
5-15
what is PEEp
expiratory pressure setting to apply positive pressure during exhalation
when should you be cautious about peep X3
increased ICP
low CO
hypovolemia
how to treat aspiration, abdominal distentium or ileus distention
insert NG/OG
what is oxygen toxicity
FiO2 >50% for more than 24-48 hours
s/s of oxygen toxicity X5
restlessness
dyspnea
chest discomfort
fatigue
atelectasis
how to reduce barotrauma
PEEP
what is barotrauma
increased airway pressure distends lungs and potentially ruptures alveoli
who is at highest risk for barotrauma
noncompliant lungs (COPD)
PEEP related issues X2
hypotension
H2O retention
when does VAP occur
48+ hours after intubation
VAP Risk factors X5
contaminated respiratory equipment
inadequate hand washing
environmental factors
impaired cough
colonization of oropharnyx
how to prevent VAP
minimize sedation and sedation vacation
early exercise and mobilization
conduct subglottic secretion removal
HOB 30-45
routine oral care
strict hand hygiene
when should you assess sedation level
q 1 hr
when is prone positioning used
in patients having severe oxygenation issues
how long should prone positioning last
12-20 hours
goal of prone positioning
improve oxygenation by decreasing pressure on lungs from abdomen, heart and lungs themselves
CI for prone positioning X5
shock
multiple fractures/trauma
pregnancy
raised ICP
tracheal surgery/sternotomy within 2 weeks
NI accidental extubation X3
assess respiratory effor and O2
call for help
BVM
cuff leak alarm NI X3
assess for leak
check pressure
call RT and MD
leak in vent circuit
assess connections and tubing
call RT and MD
pt stops breathing in PSV or SIMV
assess pt
call RT and MD
BVM (maybe)
NI if ETT is disconnected from circuit X2
reconnect tubing
assess pt
barotrauma alarm
assess subq emphysema
call MD and RT
mucous plug/increased secretions alarm NI
suction
patient bites ETT
insert bite block
pneumothorax alarm NI’s
assess for asymmetrical chest risk, decreased breathsounds
call MD
pt fighting vent
assess pt
emotional support
sedation/analgesia
kink in tubing
remove kink
water collected in tubing
empty water
pt is coughing
continue to monitor
bronchospasm alarm NIs X2
assess for non-productive consistent coughing
give breathing treatment
pulmonary edema NI when ETT X4
assess lung sounds and ETT for fluid
suction
pronation?
diuretics?
decreased lung compliance alarm NI X3
assess lung sounds, RR, BP, O2
RT and MD
vent mode may need to be changed
what type of fluid is used in a pressurized art line
NS
where should the transducer level be
level with the insertion point
ART line interventions X5
0 the BP every 4 hours
flush after drawing labs
infection control
hold pressure/pressure dressing if removed
no medications
