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Cardio Pulmonary > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

list abbreviations that are important to know pertaining to ventilation

A
  1. PaO2
  2. MV → minute ventilation
  3. VC → vital capacity
  4. FIO2
  5. RR
  6. TV → tidal volume
  7. Intrapleural pressure
  8. Intra-alveolar pressure
  9. Transpulmonary pressure
  10. FRC → functional residual capacity
  11. Bradypnea/apnea
  12. Tachypnea
  13. PaCO2
  14. Negative/Positive Pressure
  15. Endotracheal tube
  16. Barotrauma
  17. PEEP → positive end expiratory pressure
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2
Q

what is minute ventilation (MV)?

A

the amount of air breathed per minute

normally = 5-8 L/min

equals TV x # of breaths per min

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3
Q

define VC

A

vital capacity

the max volume of air that can be expired following max inspiration

normal value 2-5 L

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4
Q

define FIO2

A

fraction of oxygen in a gas mixture

FIO2 of inspired air is 21%

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5
Q

define transpulmonary pressure

A

the pressure difference between intrapleural pressure and the intra-alveolar pressure

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6
Q

define FRC

A

functional residual capacity

the volume of air present in the lungs at the end of passive expiration

at FRC, the opposing elastic recoil forces of the lungs and chest wall are in equilibrium

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7
Q

distinguish between negative and positive pressure

A

Negative pressure = a pressure of gas less 760

Positive pressure = a pressure of gas greater than 760

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8
Q

define barotrauma

A

injury to your body because of changes in barometric (air) or water pressure

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9
Q

describe PEEP

A

a mode of therapy used in conjunction w/mechanical ventilation

  • maintains the pt’s airway pressure above the atmospheric level by exerting pressure the opposes passive emptying of the lung
  • limits alveolar collapse
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10
Q

when is PEEP effective?

A

when used in pts with a diffuse lung disease that results in an acute decrease in FRC

applying PEEP increases alveolar pressure and alveolar volume

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11
Q

how do we normally regulate respiratory function?

A

not known for sure with higher levels of exertion but the following are known factors that play a role:

  1. change RR
  2. change TV
  3. change intrapleural pressure
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12
Q

what is a mechanical ventilator?

A

a machine that assumes the work of breathing when a person is not able to breath well enough on their own

also called a ventilator, a vent, a respirator, a breathing machine

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13
Q

what are the most common reasons for a mechanical ventilator?

A

low oxygen levels or severe SOB from an infection such as pneumonia are the most common reasons

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14
Q

T/F: mechanical ventilation is curative

A

FALSE

the pt should have a correctable underlying problem that can be resolved with the support of mechanical ventilation

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15
Q

List Indications for mechanical ventilation

A
  1. Bradypnea or apnea with respiratory arrest
  2. acute lung injury
  3. tachypnea (RR >30)
    1. reduces TV which reduces air in alveoli
  4. MV greater than 10 L/min (normal is 6L/min)
  5. VC < 15 ml/kg (normal is 2-5L)
  6. clinical deterioration
  7. coma
  8. neuromuscular disease
  9. acute PaCO2 greater than 50 mmHg with an arterial pH less than 7.25
    1. normal PaCO2 = 35-45 mmHg
    2. normal blood pH = 7.35-7.45
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16
Q

list Types of mechanical ventilation

A
  1. Negative-Pressure Mechanical Ventilation
  2. Positive-Pressure Mechanical Ventilation
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17
Q

describe Negative-Pressure mechanical ventilation

A
  1. works by exposing the surface of the thorax to sub-atmospheric pressure during inspiration
  2. this pressure in turn causes thoracic expansion and decrease in intrapleural and alveolar pressures
  3. this in turn creates a pressure gradient favoring movement of air from the airway opening through the vascular tree and into alveoli
  4. “air is sucked into the lungs” much like normal breathing
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18
Q

T/F: negative pressure mechanical ventilation is used commonly

A

FALSE

  1. rarely used today
  2. bulky, cumbersome and poorly tolerated
  3. not suitable for use in the modern critical care unit
  4. blood tended to pool in the lower torso → reducing CO
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19
Q

describe Positive-Pressure mechanical ventilation

A
  1. airway pressure is applied at the pt’s airway (greater than atmospheric pressure)
  2. the positive nature of this pressure forces air to flow into and through the respiratory tract to the alveoli
  3. suspension of the positive pressure causes the elastic recoil of the chest to occur, pushing tidal volume out
  4. air is pushed into the lungs/alveoli and not “pulled” into the alveoli
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20
Q

how are modes of ventilation defined?

A
  1. the mode is one of the principle ventilatory settings
  2. a set of operating characteristics that control how the ventilator functions
  3. modes of ventilation describe the pattern of breath delivery to a patient
  4. a set of ventilator operations with one or more predefined mechanical breath types
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21
Q

list modes of non-invasive positive pressure mechanical pressure

A
  1. CPAP
  2. BiPAP
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22
Q

what is CPAP?

A

continuous positive airway pressure

  • continuously delivers + air pressure created by a tabletop device and delivered through a tube connected to a face mask
  • air is delivered at a constant pressure
  • the constant + pressure helps to ensure that the airway remains open during exhalation
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23
Q

what is SDB?

A

sleep-disordered breathing

  • an abnormal respiratory pattern during sleep
  • repeated episodes of upper-airway obstruction during sleep, and nocturnal hypoxemia
  • results range from fragmented sleep patterns to HTN to traffic accidents
24
Q

T/F: CPAP is the preferred treatment of those with COPD

A

TRUE

also for sleep apnea

but pts can find it difficult to exhale against this constant pressure

25
Q

describe BiPAP

A

the difference from CPAP is that on exhalation, the machine continues to deliver air at a predetermined pressure (less resistance to exhalation) → this helps keep the alveoli and smaller airways open

26
Q

list disorders that BiPAP may be used with

A
  1. COPD
  2. Obstructive sleep apnea
  3. pneumonia
  4. post operative breathing difficulties
  5. neurological pathologies that disturbs breathing
27
Q

invasive positive-pressure mechanical ventilation include the placement of what devices?

A
  1. endotracheal tubes
  2. tracheostomy tubes
  3. airway cuffs
28
Q

what is an endotracheal tube?

A

a plastic tube that is placed through the mouth (or sometimes the nose) into the trachea to help a pt breath

  • can be placed orally (most common) or nasally
  • passes through the vocal cords to the trachea
29
Q

what is tracheostomy?

A

a hole that surgeons make through the front of the neck and into the windpipe

the surgical procedure by which the tracheostomy tube is inserted into this opening is called a tracheotomy

30
Q

describe a tracheostomy tube

A
  • may have a cuff or may be without a cuff
  • inserted above the vocal cords but extends inferiorly to the vocal cords (loss of voice)
  • used in more long-term airway management
31
Q

what are airway cuffs?

A
  1. assist with holding the airway in place
  2. allow +pressure ventilation without a loss of TV (prevents leakage)
  3. may reduce risk of aspiration of oral and gastric secretions
  4. if pt can talk or is losing TV → cuff may not be fully inflated
  5. may damage the trachea
32
Q

immediate complications of a tracheostomy tube

A
  1. bleeding
  2. tube displacement
  3. air can become trapped in tissue under the skin of the neck (subcutaneous emphysema)
  4. buildup of air between the chest wall and lungs → pneumothorax
  5. a hematoma occurs in the neck which might compress the trachea
33
Q

long term complications of tracheostomy tubes

A
  1. displacement of the tube from the trachea
  2. damage, scarring, or narrowing of the trachea
  3. development of an abnormal passage between the trachea and the esophagus
  4. infection → tracheostomy, trachea bronchial tubes and lungs (pneumonia)
34
Q

list modes of ventilation

A
  1. controlled ventilation
  2. assist-control mode or pt initiated/supported ventilation
  3. volume controlled ventilation
  4. pressure control
  5. PRVC
  6. SIMV
  7. pressure support ventilation
  8. volume support
35
Q

what is controlled ventilation?

A

a mode in which the ventilator initiates all breaths at a pre-set rate and TV volume

the ventilator will block any spontaneous breaths

36
Q

describe the setup for controlled ventilation

A

assume ventilator was set up for controlled breaths at a RR of 10 bpm

every 6 seconds a breath will be delivered to your pt no matter what

37
Q

when is controlled ventilation used?

A

mainly in the management of pts with severe neurologic conditions, are deeply sedated or are in shock or severe respiratory failure

there are diminished risks for hypo-or hyperventilation

38
Q

T/F: spontaneous breathing is allowed with assist-control mode

A

TRUE

the pt triggers vent with an attempt to breath

39
Q

benefits/risks of assist-control mode

A
  1. this mode maintains normal ventilatory activity by the pt and, therefore, prevents atrophy of the respiratory muscles
  2. pt does at least some of the work
  3. carries a risk for some pts to develop respiratory alkalosis or to reduce venous return and CO
40
Q

describe volume controlled ventilation

A

preset TV is delivered at a set RR

in this mode the operator may control:

  1. TV
  2. RR
  3. TI (or I:E ratio or peak flow)
  4. pt trigger type and sensitivity
  5. PEEP
  6. FiO2
41
Q

how is Ti or I:E ratio related/relevant to Volume Controlled Ventilation?

A
  1. I:E → the ratio of inspiratory time to expiratory time
    1. in normal spontaneous breathing it represents a compromise between ventilation and oxygenation
  2. Ti → inspiratory time
    1. characteristics of a spontaneous breath. these characteristics may stimulate the ventilator to initiate a breath, the flow of O2
42
Q

T/F: PEEP prevents shunting

A

TRUE

and it allows for a decrease in FiO2

43
Q

describe Pressure Control Ventilation

A

predetermined amount of pressure at a set rate

  1. ventilator determines inspiratory time
  2. pt has no spontaneous breathing
  3. PEEP used to increase arterial oxygen, improve lung compliance
  4. prevents collapse, makes lungs easier to inflate
44
Q

describe PRVC

A

Pressure Regulated Volume Control

  • combines pressure and volume controlled ventilation
  • preset TV is delivered at set rate, but with lowest possible pressure
  • helps prevent barotrauma
45
Q

describe SIMV

A

Synchronous Intermittent Mandatory Ventilation

  • Used to assist pts who have some, but not sufficient breathing
  • pts can breath in between each machine assisted breath
  • used for weaning
  • delivers certain numbers of breaths in coordination with respiratory effort of pt
  • does increase pt work of breathing
46
Q

describe pressure support ventilation

A

small amount of pressure occurs on inspiration

  • pts initiates all breaths
  • assists pt in making a spontaneous breath
  • delivers a specific pressure
  • ventilator assists, but pt regulates the RR and TV
47
Q

describe volume support ventilation

A

TV and PEEP are set

  1. pt initiates
  2. ventilator delivers support in proportion to pt’s inspiratory effort and target volume
48
Q

what may trigger a red alarm on a mechanical ventilator?

A
  1. high pressure
  2. circuit disconnected
  3. apnea
49
Q

what may trigger a yellow alarm on a mechanical ventilator?

A
  1. low TV
  2. high RR
  3. low MV
  4. low inspiratory pressure
50
Q

list some complications of intubation

A
  1. injury to surrounding tissue
    1. upper airway
    2. nasal tissue
    3. vocal cords
    4. tracheal perforation
  2. intubation of the esophagus
  3. tracheal necrosis or stenosis
  4. ventilator associated pneumonia
51
Q

T/F: barotrauma can be a ventilator induced injury

A

TRUE

52
Q

what is ventilator associated pneumonia?

A

defined as a new infection of lung parenchyma that develops within 48 hours after intubation

  • reported to occur in 8-28% of pts given mechanical ventilation
  • mortality rates 33-50%
  • risk for developing it is highest immediately after intubation
53
Q

list cardiovascular effects of mechanical ventilation

A
  1. Positive-pressure ventilation can decrease preload, SV, and CO
  2. Reduces affects renal blood flow and function, resulting in gradual fluid retention
  3. positive pressure maintained in the chest may decrease venous return from the head, increasing ICP (worsening agitation, delirium, and sleep deprivation) and systemic edema
54
Q

what is Auto PEEP

A
  1. pt doesn’t expire full TV and air becomes trapped
  2. also called breath stacking
  3. can cause increased alveolar damage
55
Q

list other complications of mechanical ventilation

A
  1. anxiety/stress/sleep deprivation
  2. ulcers/gastric/malnutrition
  3. muscle deconditioning
  4. vent dependence
  5. increased intrathoracic pressure leading to systemic edema due to decreased venous return
56
Q

list several ventilator induced lung injuries

A
  1. volutrauma → the local overdistension of normal alveoli
    1. sets off an inflammatory cascade that augments/perpetuates the initial lung injury
  2. oxygen toxicity → due to increased FiO2 and duration of use
    1. results in the production of oxygen free radicals
    2. associated with FiO2 >50%

Cardio Pulmonary (21 decks)

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