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Acute Care > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

Mechanical Ventilation

A

• Mechanical ventilatory support
provides positive pressure to
inflate the lungs.
• Pts w/ acute illness, serious
trauma, exacerbation of chronic
illness, or progression of chronic
illness may require mechanical

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2
Q

Indications

A
  • Apnea
  • Acute hypercapnia (not quickly reversible w/ standard treatment)
  • PaO 2 <50 mmHg w/ supplemental oxygen
  • RR>30 breath per minute
  • Vital capacity <15 mL/kg normally ~ 50 mL/kg )
  • Negative inspiratory force <25 cm H 2 O (normally > 60)
  • Protection of airway from aspiration of gastric contents
  • Reversal of respiratory muscle fatigue
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3
Q

Noninvasive

(Types of Mechanical Ventilatory Support)

A
  • Includes continuous positive airway pressure (CPAP) and bi level positive airway pressure (BiPAP)
  • Interface to connect the pt to the ventilator tubing.
    • 6 types: full face (or oronasal) mask, total face mask, mouthpieces, nasal mask, nasal pillows orplugs, and a helmet.
  • Sleep apnea, exacerbations of or hypercarbic COPD, or cardiogenic pulmonary edema when the airway cannot be protected
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4
Q

Invasive mechanical ventilation

(Types of Mechanical Ventilatory Support)

A
  • Use of an artificial airway
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5
Q

CPAP

(Noninvasive Mechanical Ventilation)

A
  • Continuous positive pressure (> atmospheric) throughout the respiratory cycle.
  • To decrease the work of spontaneous breathing by reducing the airway pressure necessary to generate inspiration.
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6
Q

BiPAP

(Noninvasive Mechanical Ventilation)

A
  • Two levels of positive pressure support triggered during spontaneous breathing
  • Higher pressure (IPAP) to augment inspiratory airflow.
  • Lower pressure (EPAP) to maintain airway patency & prevent collapse.
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7
Q

Intubation

(Invasive Mechanical Ventilation)

A
  • A passage of an artificial airway (tube) into the pt’s trachea:
    • Through the mouth (endotracheal)
    • Through the nose (nasotracheal)
  • Intubation indications:
    • Presence of upper airway obstruction
    • Inability to protect lower airways from aspiration
    • Inability to clear pulmonary secretions
    • Hypoxemia despite supplemental oxygen
    • Respiratory acidosis
    • Progressive fatigue including mental status deterioration
    • The need for positive pressure ventilation
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8
Q

Cuff

(Invasive Mechanical Ventilation)

A
  • A cuff (balloon) is located ~ 0.5 inches from the end of endotracheal or tracheal tube.
  • The cuff is inflated to:
    • Ensure that all of the supplemental O2 enters the lungs.
    • Hold the artificial airway in place.
  • Cuff inflation pressure should be adequate to ensure that no air is leaking around the tube (should not exceed 20 mm Hg)
  • High cuff pressures –> tracheal damage & scarring –> tracheal stenosis.
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9
Q

Cuff (Clinical Tip)

(Invasive Mechanical Ventilation)

A

If the pt is able to phonate from mouth, a cuff leak is suspected. If so, the RT or the nurse should be notified.

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10
Q

Three basic cycling methods:

(Invasive Mechanical Ventilation)

A
  • Pressure cycled: Ventilators stop inspiration at a preset pressure.
  • Volume cycled: Ventilators stop inspiration at a preset volume.
  • Time cycled: Ventilators stop inspiration at a preset time interval.
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11
Q

Modes of Ventilation

A
  • Range from providing total support to minimal support.
  • Goal: allow the pt to do as much of the breathing as is physiologically possible, while meeting the intended objectives of ventilatory support.
  • Even short periods (11 days) of complete dependence can lead to respiratory muscle atrophy, reductions in diaphragm strength (25%) & endurance (36%)
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12
Q

Spectrum of Patient Participation

A
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13
Q

Ventilatory Settings

A
  • Parameters established to provide the necessary support to meet the pt’s individual ventilatory and oxygenation needs.
  • Settings are according to pt’s
    • Arterial blood gas levels
    • Vital signs
    • Airway pressures
    • Lung volumes
    • Pathophysiologic condition (ability to spontaneously breathe).
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14
Q

Oxygenation

(Ventilatory Settings)

A
  • Fraction of inspired oxygen (FiO 2
  • 21% yields a normal PaO2 of 95 100 mmHg. (Threshold:
  • Positive end expiratory pressure (PEEP)
  • Pressure maintained in the airways at the end of expiration (normally 5 cm
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15
Q

Ventilation

(Ventilatory Settings)

A
  • RR (s et according to the amount of spontaneous ventilatory by the pt) (12 20)
  • V T ((↑volume leads to ↑airway pressures barotrauma
  • Inspiratory flow rate (too slow, pt may attempt to continue to inhale against a closed circuit; too fast –> ↑peak airway pressure –> barotrauma)
  • Inspiratory to expiratory ratio (set as synchronous as possible with pt’s ratio)
  • Sensitivity (poor –> respiratory muscle fatigue. Too sensitive –> hyperventilation)
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16
Q

Auto PEEP

(Complications of Mechanical Ventilation)

A
  • Occurs when lung volumes fail to return to functional residual capacity before the onset of the next inspiration.
  • The process leading to auto PEEP is referred to as dynamic hyperinflation
  • Dynamic hyperinflation →↑air trapping → physiologic dead space →↓gas exchange →↑work of breathing due to higher demand.
17
Q

Auto PEEP can occur due to:

A
18
Q

Barotrauma

(Complications of Mechanical Ventilation)

A
  • Damage to the lungs caused by excessive airway pressure.
  • Normally, spontaneous inhalation takes place because of negative pressure.
  • The volume of inhaled air is limited by the return of intrapulmonary pressure back to atmospheric pressure in the lungs during inhalation.
  • Mechanical ventilation is predominantly delivered with positive inspiratory pressure (normal physiologic mechanisms are bypassed).
19
Q

Barotrauma Possible complications

A
  • May exacerbate acute lung injury associated with ARDS (ventilator induced lung injury (VILI)).
  • Pneumothorax and subcutaneous emphysema.
20
Q

Cardiovascular

(Complications of Mechanical Ventilation)

A
  • high positive pressures can result in decreased cardiac output from compression of great vessels by overinflated lungs.
21
Q

Oxygen Toxicity

(Complications of Mechanical Ventilation)

A
  • Oxygen toxicity: too high O2 for a prolonged time can result in:
    • Substernal chest pain, dry cough, tracheal irritation, dyspnea, nasal stiffness & congestion, sore throat, eye and ear
22
Q

Improper intubation can result in …

(Complications of Mechanical Ventilation)

A

Improper intubation can result in esophageal or tracheal tears.

23
Q

Weaning from Mechanical Ventilation

A
  • The process of decreasing or discontinuing mechanical ventilation in a pt.
  • A key factor is the resolution or stability of the condition that led to the need for ventilatory support.
  • A spontaneous breathing trial (SBT) is typically performed to evaluate the pt’s readiness.
    • The pt breathing spontaneously for 15 to 30 minutes while being closely monitored.
24
Q

Criteria for Weaning Attempt

A
  • Spontaneous breathing with a tidal volume of 5 L/kg
  • Adequate gas exchange (O2 sat >90%) w/ FiO 2 of <50% & PEEP <5 cm H2O
  • MIP> −20 to −30 cm H2O (>−30 is associated w/ successful extubation).
  • RR <35 bpm
  • Minute ventilation of 5 to 10 L/min
  • Respiratory rate/VT ratio <105. (A ratio >105 indicates shallow & rapid breathing and is powerful predictor of an unsuccessful wean)
25
Q

SIMV

(Examples of Weaning Meathods)

A
  • Decreasing the # of breath per minute the ventilator provides  requires the pt to increase spontaneous breaths.
  • Commonly used after surgery, while pts are waking up from anesthesia.
  • Pt have not been on support for an extended time.
  • Once spontaneous breathing returns, ventilatory support can be removed.
26
Q

PSV

(Examples of Weaning Methods)

A
  • Pt spends periods of time w/ ↓pressure support to ↑spontaneous ventilation.
  • Two factors can be manipulated:
    • To increase strength load on the respiratory muscles –> reduce the PSV.
    • To increase endurance requirement on the respiratory muscles –> increase the length of time that PSV is reduced.
27
Q

Factors to Consider During a Ventilator Wean

A
  • Respiratory demand & the ability of the neuromuscular system to cope w/ the demand
  • Oxygenation
  • Cardiovascular performance
  • Psychological factors
  • Adequate rest & nutrition
28
Q

Signs of Increased Distress During a Ventilator Wean

A
  • Increased tachypnea (>30 bpm)
  • Drop in pH to <7.25 to 7.30 associated with increasing Pa CO 2
  • Paradoxical breathing pattern
  • O2 saturation of <90%
  • Change in HR of more than 20 bpm
  • Change in BP of >20 mm Hg
  • Agitation, panic, diaphoresis, cyanosis, angina, or arrhythmias
29
Q

PT Considerations

A
  • Pts who require prolonged ventilatory support are at risk for developing pulmonary complications , skin breakdown, joint contractures, & deconditioning.
  • PT intervention of pulmonary hygiene & functional mobility training can help prevent or reverse these complications despite mechanical ventilation.
  • During the weaning process , the PT can play a vital role on an interdisciplinary team responsible for coordinating the wean.
30
Q

PT Considerations Continued.

A

•
PTs offer a combined understanding of the respiratory difficulties
faced by the pt , the biomechanics of ventilation , the principles of
exercise (weaning is a form of exercise), and the general energy
requirements of functional activities .
•
Pts should be placed in a position that facilitates the biomechanics of
their ventilation.
–
For many pts , this is seated & may also include the ability to sit forward w/ the
arms supported.
•
Inspiratory muscle resistive training –> weaning success particularly
in pts who have previously demonstrated a failure to wean.

Acute Care (7 decks)

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