Mechanical Ventilation Flashcards
What is the goal of mechanical ventilation?
- to give supportive respiratory therapy
- Support and improve ventilation and perfusion
- Bridge to recovery or until decision of EOL
- Non curative
What is mechanical ventilation?
oxygen is moved in and out of the lung by mechanical means. It requires a endotracheal tube or a tracheostomy
What are the two types of mechanical ventilation?
Negative pressure ventilation
Positive pressure ventilation
Examples of positive pressure ventilation
- Volume ventilation or pressure ventilation
2. PEEP and CPAP (NIVVP)
Indications for mechanical ventilation are?
- Apnea
- Unprotected airway
- Acute Respiratory Failure
- Acute Respiratory Distress Syndrome (ARDS)
- Severe Hypoxemia
- Severe Respiratory Muscle fatigue/impairment
What are some examples of severe respiratory muscle fatigue/impairment?
COPD or spinal cord injury (C5, C7)
When are PEEP and CPAP commonly used?
when the patient is over sedated or can’t protect their ariway
When is volume ventilation or pressure ventilation used?
when the patient cannot breath on their own
Data related reason to ventilate
- CO2 more than 50
- O2 less than 50
- RR ineffective, more than 40
- RR less than 8
- pH 7.3 or less
Others: diminished or absent breath sounds, swallow expansion, ARDS, respiratory muscle fatigue
What is a ventilator mode?
the way that inspiration/expiration are provide or set
How do you select the ventilator mode?
- based on the patient’s individual status
2. ABG, LOC, respiratory drive, therapeutic needs
How recommend the mode?
RT and RN
What considerations do you need to incorporate when setting up. a ventilator?
- Patient weight (ideal weight for height even if skinny or overweight)
- LOC
- Patients response
6 components of ventilator settings are?
- FiO2
- Rate: frequency of breaths per minute
- Tidal volume
- Positive end-expiratory pressure
- Sensitivity
- Max pressure limits
What is tidal volume?
how much air that the patient will get with each breath
What is normal tidal volume?
MV tidal volume? ARDS tidal volume?
Normal: 5mL/kg
MV: 6-8 mL/kg
ARDS: 4-8 mL/kg
What is permissive hypercapnia?
pCO2 of 50-70mmhg
May be allowed to avoid barotrauma
What is PEEP (positive end-expiratory pressure)?
The pressure in the lungs above atmospheric pressure that exists at the end of expiration that can be kept to maintain airway patency
Keeps positive pressure on the lungs at the end of respiration cycle to keep alevoli open
Vent setting: sensitivity
amount of effort from a patient that is required to innate a breath
What happens if the max pressure limit is met?
The ventilation will release any excess pressure to avoid barotrauma
What is the usual pressure limit on MV?
10-20 cm H2O above peak inspiratory pressure
What is the goal PaO2 for a patient of MV?
above 60
The way negative ventilation works
- A device chamber surrounds the outside of the chest with negative pressure
- Chest is pulled outward and air enter the lungs
- Expiration is negative
Examples of negative ventilation
Iron lung or cuirass