Mechanical Ventilation Flashcards by Megan Pirtle

indications for mechanical ventilation X4

apnea or impending loss of airway

acute respiratory failure

severe hypoxia

respiratory muscle fatigue

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short term artificial airway

endotracheal tube (ETT)

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long term artificial airway

tracheostomy (Trach)

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are ETT’s emergent or planned

can be both

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are trachs emergent or planned

usually planned

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after the ETT is inserted what do you do

confirm placement

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how do you confirm ETT placement X6

end tidal CO2

auscultate lungs bilaterally

auscultate epigastrium

chest wall movement

monitor SpO2

CXR

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end tidal CO2 detector confirmation

yes = yellow
problem = purple

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what should you hear in the epigastrium when checking ETT placement

no air sounds

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how far above the carina should the end of the ETT be

3-4 in above carina

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what should the ETT cuff pressure be

<25 cm H2O

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what is the carina

where the lungs branch off to the right and left

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what needs to be at the bedside in case of trach emergencies

obturator

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how often should you clean the trach stoma

q shift and PRN

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how should you clean the trach stoma

sterile saline, dressing change, and change the ties

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how often should you change the inner cannula

q shift and PRN

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how often should oral care be done with artificial airways

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when should inline suctioning be done

q shift and PRN

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how long should suctioning last

no more than 10 seconds

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how far should you insert the catheter when suctioning

until resistance is met

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f/RR

frequency/respiratory rate

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FiO2

fraction/percent of inspired oxygen

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I:E ratio

inspiratory time compared to expiratory time

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normal I:E ratio

1:2

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PEEP

positive end-expiratory pressure

normal PEEP

5-10

PIP

peak inspiratory pressure

normal PIP

15-20

minute ventilation/volume

normal Ve

6-8 L/min Vt X RR

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

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