Mechanical ventilation Flashcards
what is the purpose of mechanical vent
maintain homeostasis btw gas concentrations O2 and CO2
indications
airway protection cardiac arrest management of ICP airway obstruction surgery
FiO2
fraction of inspired oxygen
tidal volume
normal amount of air ventilated at rest
PEEP
positive end expiratory pressure
pressure at end of exhalation keeps alveoli from collapsing
what is the vent controlling
respiratory rate
invasive mechanical vent
- intubation of artifical airway into trachea
- endotracheal tube
- nasotracheal tube
- tracheostomy
non-invasive vent
BiPAP or CPAP
- last step before intubation
BiPAP
bilevel positive airway pressure
- decreases effort for pt to exhale
CPAP
continuous positive airway pressure
used to prevent airways from collapsing in inhalation and exhalation
what is a tracheostomy
when is it used
long term ventilation
vent placed in trachea
unable to be weaned from ventilator
difficult intubation –> severe morbid obesity
airway block or obstructed
passy-muir valve is used for what
placed on trach so pt can talk
the pt will have to work harder to breath with it on so be cautious of that
volume control
- preset tidal volume is delivered at a set respiratory rate
- pt has no spontaneous breathing
pressure control
- predetermined amoutn of pressure at a set respiration rate
- vent determines inspiratory time
- pt has no spontaneous breathing
what is PEEP used to do when using pressure control
increase arterial oxygen, improve lung compliance
makes lungs easier to inflate
assist control
delivers specific amount of tidal volume
forces air down into lungs
pt or vent can trigger when breaths are taken
pressure regulated volume control
PRVC
combines pressure and volume controlled ventilation
preset tidal volume is delivered at set rate, but with lowest possible pressure
synchronous intermittent mandatory ventilation
SIMV
assist pt who have some but not sufficient breathing
used for weaning
delivers certain numbers of breath in coordination with effort of pt
pressure support ventilation
- little bit of pressure in inhalation
- weanining off
- pt intiates all breaths
- delivers specific pressure
volume support
tidal volume and PEEP are set
pt initiates breathing
vent delivers support in proportion to pt
what do you need to know and document before touching pt on a vent
vent mode
PEEP
RR
FiO2
red alarms for vent
high pressure
circuit disconnected
apnea
yellow alarms for vent
low tidal volume
high RR
low minute ventilation
low inspiratory pressure
what is weaning
decreasing or discontinuing mechanical ventilation
PT work with pts during this process
what are the five major factors to consider during weaning
- respiratory demand and ability of neuromuscular system to cope with O2 demand - dont overexert the pt
- adequate O2 supply during activity
- cardiovascular performance
- psychological factors
- adequate rest and nutrition
what are the weaning signs of distress
- tachypnea >30
- decreased pH <7.25-7.30
- paradoxical breathing
- O2 saturation <90
- HR change of >20
- BP change of >20
- agitation, panic, diaphoresis, cyanosis, angina, arrhythmias
contraindications for PT
comatose, unresponsive, does not follow commands
severe agitation/combativeness
PEEP > 10 H2O or FiO2 >0.60
uncontrolled active bleeding
what can prolonged vent support lead to
skin breakdown
joint contractures
deconditioning
