Mechanical Ventilation Flashcards
Indications for vent
- VD/VQ> 60%
-QS/QT >20%
-A-a gradient >300mmhg
-decreased VT< 5ml
-MIP<~20
-MEP<40cmh2o
Mv < 5 or > 10
-impeding respiratory failure
-refractory hypoxemia
RR <8 or 30>
VC< 5ml/Kg
MIP explanation
Strength of patients diaphragm
MEP explanation
Strength of pt abdominal muscles
VD/VQ explanation
How much VT is lost to VD
QS/QT explanation
Any condition that causes collapses or fill alveoli with fluid.. causes a pulmonary shunt
<20%
A-a gradient explation
Determine the source of hypoxemia
<300
VC explanation
Is the amount of air that can be forcefully blown out
Impeding respiratory failure
Indicates an increase in Co2 levels.
Presistant hypoximia
.
Respiratory rate <8 or >30
Intitubate
Static compliance
<25ml/cm indicates how stiff the lungs are.
Persistent hypoxemia
Patient is unable to oxygenate
IPPV
IPAP setting
12cm h2o
IPPV
EPAP setting
5cmh2o
Modified jaw trust indicated with
Patients with suspected cervical injury
Permissive hypercapnia MV tx
Use a low VT
High PEEP is used in ARDS to prevent
Atelectotrauma
Capnography
Measures end tidal CO2
Capnography indications
Confirms ETT placement
MV
CPR
Capnography provides rapid detection of
Circuit disconnect
Esophageal intubation
Hyperventilation
Hypo ventilation
Aveoliar Mv
(Vt-dead space) * rate
What increases work of breathing
Deadespace COPD
Do not add dead space to patients with
Closed head injury
SIMV mode
Alveolar minuet ventilation
Rate x (tidal volume - mechanical and anatomic deadspace)
Decrease in compliance causes
ARDS, atelectasis, pneumonia, pulmonary edema, pneumothorax, pulmonary fibrosis
Decreased compliance treatment on MV pt
Use low tidal volumes 4 to 6
Change mode to PC orHFOV
Decrease in compliance treatment
Rise in raw causes
Pip to rise
Increased raw causes
Bronhncospams
Secretions
Ett obstruction
Or too small
Static compliance formula
Tidal volume/plateau – PEEP
Complications of auto Peep
Cardiac output
Barotrauma
Increases work of breathing
Pvo2 definition
Is the pressure oxygen mixed venous blood.
Pvo2 decreases when
Cardiac output & peep decreases
Pvo2 decreases when
Cardiac output & peep decreases
Pvo2 range
35 to 45
How to determine optimal PEEP
expiratory hold
Bronchospasm and airway secretions both increase this
Airway resistance
Which waveform can airtrapping best be observed?
Flow-time
Dynamic compliance calculation
Exhaled volume/PIP - PEEP
Static compliance calculation
Exhaled volume/Plateau - PEEP
Minute ventilation calculation
Rate x tidal volume
ARDS, pulmonary fibrosis, atelectasis, and pneumothorax all decrease this…
lung compliance
Calculation for anatomic deadspace
Anatomic deadspace = approximately 1 ml per pound
IPPB is used to
Help the patient take deeper breaths
Stimulate cough
Prevent Atelectasis
IPPB helps to
Improve gas exchange
Increase lung compliance
Reduce work of breathing
IPPB improves
Breath sounds
Oxygenation
Improves VC
Chest X-ray
Cough
IPPB Pressure controls
VT
IPPB Flow controls
I- time
IPPB sensitivity controls
Patient triggered breath
IPPB- increasing the flow will decrease the …
I-time
IPPB- decrease the flow will…
Increase the I-time
IPPB- premature cycling is due to
Tongue blocking mouthpiece
Exhaling into mouthpiece
Static compliance
VT/Platue - peep
IBW male
50+2.3( height in”-60)
IBW female
45.5+ 2.3( height in”-60)
RSBI
<105
RSBI calculation
RSBI = rate/tidal volume in liters.
Use the following steps to determine RSBI:
First, convert ml into Liters.
Next, divide rate by VT in liters by 0.7 to get RSBI
RSBI calculation
RSBI = rate/tidal volume in liters.
Use the following steps to determine RSBI:
First, convert ml into Liters.
Next, divide rate by VT in liters by 0.7 to get RSBI