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Critical Care <3 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

Benefits of MV

A

facilitate lung expansion
improve gas exchange
decrease effort of ventilation

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2
Q

What is MV based on?

A

Pressure
volume
time and/or flow

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3
Q

Indications for MV

A

AFR
ARDS
hypoxemia
hypercapnia
airway protection
apnea/arrest
post op

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4
Q

What are 2 types of MV?

A

invasive and non invasive

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5
Q

What does invasive MV involve and why is it used?

A

ET-tube or trach
for prolonged respiratory support

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6
Q

What is non invasive MV and why is it used?

A

CPAP ( continuous positive airway pressure)
BiPAP (bilevel positive airway pressure)

for patients that can still breathe on their own but need resp support

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7
Q

Explain what FiO2 is?

A

Fraction of inspired oxygen
the concentration (%) of oxygen delivered to the patient

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8
Q

Why do you want the lowest possible FiO2?

A

avoid O2 toxicity

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9
Q

Explain tidal volume (Vt)?

A

Volume (amount) of air delivered to the lungs in one breathe

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10
Q

What is the typical range for Vt?

A

6-8 mL/kg

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11
Q

Why is choosing the correct Vt important?

A

to prevent lung trauma/injury

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12
Q

What can happen if Vt is too high?

A

Barotrauma or volutrauma

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13
Q

What can happen if Vt is too low?

A

atelectasis collapse of alveoli)

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14
Q

What is PEEP?

A

Positive End-Expiratory Pressure
pressure applied by the ventilator at the end of expiration to keep alveoli open

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15
Q

Typical range for PEEP

A

5-10

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16
Q

Purpose of PEEP

A

help improve oxygenation by preventing collapse of alveoli
maintains functional residual capacity

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17
Q

What is pressure support? When is it used?

A

Additional pressure applied during spontaneous breaths to reduce the work of breathing

when patients need extra help especially for weaning

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18
Q

What is the meaning of PaO2?

A

reflects how well oxygen is transferred from the lungs to the blood

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19
Q

PaO2 range

A

80-100

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20
Q

PaCO2 range

A

35-45

21
Q

What are the volume controlled modes

A

Assist-control
synchronized intermittent mandatory ventilation

22
Q

What are the pressure controlled modes?

A

pressure control and pressure support

23
Q

Explain Assist-control MV mode?

A

delivers a SET tidal volume with each breath
patient can still initiate a breath

24
Q

indications for assist-control?

A

pt can’t breathe or start breaths
pt cant protect their airway
ARF
post op

25
Q

Reason for Assist-control?

A

ensure patient receives full tidal volume

26
Q

Explain synchronized intermittent mandatory ventilation

A

delivers set number of breaths with PRESET Vt but allows spontaneous breathing
initiated breaths are not assisted

27
Q

Indications for SIMV

A

weaning
pt cant breathe on their own but needs assistance to maintain adequate ventilation

28
Q

Explain pressure-control ventilation

A

delivers breaths based on a set of inspiratory pressure
Vt will vary based on lung compliance

29
Q

indications for PCV

A

ARDS
pt with high risk of barotrauma
pt with severe lung injury or high PEEP requirements

30
Q

Explain pressure support mode?

A

only applies pressure during spontaneous breaths

31
Q

indications for PSV

A

used to ASSESS patients readiness to wean
pt who may have muscle fatigue from breathing

32
Q

Why is PSV used?

A

reduces work of breathing

33
Q

Explain inverse ratio ventilation

A

inspiratory time is LONGER than expiratory time

higher risk of air trapping

34
Q

indications for inverse ratio ventilation

A

Severe ARDS
patients with poor oxygenation
refractory hypoxemia

35
Q

Why is IRV used?

A

to allow more time for gas exchange
keep alveoli open to improve V/Q

36
Q

Explain Airway pressure release ventilation

A

A mode where pt breaths spontaneously while ventilator alternates between two levels of continuous positive airway pressure

37
Q

Indications for ARPV

A

ARDS
refractory hypoxemia
pt at risk for ventilator induced lung injury

38
Q

Reason for ARPV?

A

allows alveolar gas to be expelled by the lungs own natural recoil
allows maximum alveolar recruitment and oxygenation while allowing spontaneous breathing

39
Q

Explain independent lung ventilation

A

each lung is ventilated separately using two ventilators double lumen
requires sedation and paralytics

40
Q

indications for ILV

A

unilateral lung disease
ARDS in one lung
large lung abscess
single lung transplant

41
Q

Reason for ILV

A

allows for tailored ventilation of each lung

42
Q

Explain high frequency ventilation

A

uses very high respiratory rate
60-900 with low tidal volumes
pt must be sedated/NMB
breath sounds are hard to hear

43
Q

indications for HFV

A

ARDS
severe lung injury in peds/neonate

44
Q

Reasons for HFV

A

rapid rate for effective gas exchange
small Vt helps avoid overdistention of the alveoli

45
Q

Nursing care for mechanical ventilation

A

continuous monitoring hourly
resp assessment
patient safety
suctioning
necessary medications
positioning

46
Q

Signs of weaning intolerance

A

RR greater than 30 or less than 8
BP or HR changes
less than 90% SaO2
dysrhythmias
restlessness

47
Q

What does low pressure alarms indicate and what do you do?

A

low exhaled volume
check for disconnection, cuff leak, or tube displacement

48
Q

What do high pressure alarms indicate?

A

excess secretions
pt biting tube, kinks
coughing
PE
bronchospasm
pneumothorax

49
Q

What do apnea alarms indicate and what do you do?

A

vent does not detect spontaneous breathing
check the vent, tube and patient

Critical Care <3 (16 decks)

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