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Anesthesia > Mechanical ventilation > Flashcards

Mechanical ventilation Flashcards

1
Q

what is mechanical ventilation

A

it is assisting oxygenation and ventilation of the lungs by artificial means usually a ventilator

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2
Q

what are the types of ventilators

A

invasive and non invasive

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3
Q

what type of pressure does a ventilator give (2)

A
  1. negative
  2. positive
    ** we now focus on positive pressure ventilators
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4
Q

what is the indication for going on mechanical ventilator

A

Impending or Acute respiratory failure with pulmonary gas exchange abnormalities

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5
Q

what things could cause impending/ acute respiratory failure with gas exchange abnormalities (4)

A
  1. Mechanical failure:
    - neuromuscular diseases e.g. Myasthenia Gravis, Guillain-Barré Syndrome, and Poliomyelitis
  2. Musculoskeletal abnormalities:
    - chest wall trauma e.g flail chest.
  3. Infectious/non infectious lung conditions:
    - pneumonia
    - tuberculosis
    - asthma
    - chronic bronchitis
    - emphysema
    - pulmonary edema
    - atelectasis
    - pulmonary fibrosis.
  4. Others:
    - General anesthesia
    - Cardiac arrest
    - inhalational burns
    - moderate to severe head injury
    - other CNS pathologies.
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6
Q

what helps us to know that this abnormal gas exchange is an indication for ventilation

A

arterial blood gases:

  • PH < 7.25
  • PaO2 (mmHg) < 60mmHg
  • PaCO2 (mmHg) > 50mmHg
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7
Q

what are the modes of ventilation (2)

A
  1. pressure cycled
  2. volume cycled
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8
Q

what are non invasive ways of ventilation (2)

A
  1. CPAP
  2. BiPAP
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9
Q

what do you use in CPAP

A

tight fitting mask

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10
Q

CPAP is used on what type of patients

A

those that are spontaneously breathing

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11
Q

what does CPAP not provide

A

inspiratory support

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12
Q

what does CPAP do

A

delivers end expiratory pressure

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13
Q

what is the difference between CPAP and BiPAP

A

BiPAP provides inspiratory support

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14
Q

what are contraindications for NIV (6)

A

1, those with high risk of aspiration:
- pts with ileus/ gastric distention/ have recently eaten
2. agitated patients
3. impaired consciousness/ reduced gag reflex
4. severe respiratory failure
5. severe facial trauma
6. untreated pneumothorax

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15
Q

what is a possible limitation of NIV

A

high risk of aspiration

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16
Q

what do you use in invasive ventilation

A

intubation

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17
Q

for the pressure cycled mode how does the pressure control work (2)

A
  1. Delivers a constant pressure during each breath
  2. Gives full control but not all breaths are triggered by the machine
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18
Q

in the pressure cycled mode how does pressure support ventilation work (2)

A
  1. There is no minimum rate set
  2. All breaths triggered by patient
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19
Q

what can you use pressure support ventilation for

A

weaning off patients

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20
Q

under the pressure cycled mode what things can the ventilator provide (3)

A
  1. pressure control
  2. pressure support ventilation
  3. synchronized intermittent mandatory ventilation (SIMV)
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21
Q

under the volume cycled mode what things can the ventilator provide (2)

A
  1. volume control
  2. synchronized intermittent mandatory ventilation (SIMV)
22
Q

how does volume control work (2)

A
  1. Delivers a constant volume during each breath gives full control
  2. It has a set Tidal volume
23
Q

when setting mechanical ventilation what is it based on

A

underlying patient condition

24
Q

what things do you set on a mechanical ventilator (5)

A
  1. mode
  2. oxygenation
  3. minute volume
  4. sensitivity/ trigger
  5. I:E
25
Q

for oxygenation what parameters do you look at (2)

A
  1. FiO2 ( fraction of inspired oxygen)
  2. PEEP
26
Q

what is the initial FiO2 that is set

A

<0.6

27
Q

what is the initial setting for PEEP

A

5cmH2O

28
Q

what does PEEP do

A

Increases end expired lung volume

29
Q

what scenarios would you use a higher PEEP (2)

A
  1. pulmonary edema
  2. ARDS
30
Q

what is minute volume

A

tidal volume x RR

31
Q

how do you calculate tidal volume

A

6-8ml/kg of ideal body weight

32
Q

what is the ideal RR for a ventilator

A

10-12 breaths/ min

33
Q

what is sensitivity/ trigger

A

Level of negative pressure/gas flow required to trigger a breath

34
Q

what is the initial setting for I:E

A

1:2 for adults
1:1 for children

35
Q

how does I:E work in COPD/asthma

A

prolonged expiratory time

36
Q

in I:E what would an increase in inspiratory flow rate do

A

60L/min to 120L/min

facilitate having more time in exhalation

37
Q

what are methods of weaning (4)

A
  1. T-piece trial
  2. Continuous Positive Airway Pressure (CPAP) weaning
  3. Pressure Support Ventilation (PSV) weaning
  4. Synchronized Intermittent Mandatory Ventilation (SIMV)
38
Q

when would you discontinue weaning

A

if there are signs of fatigue or respiratory distress develops

39
Q

what would be the initial reason for weaning off mechanical ventilation

A

the reason for ventilation has improved/ resolved

40
Q

what is step 2 in the weaning off mechanical ventilation

A

to check daily screening of respiratory function
- Pao2/FiO2> 200
- PEEP < 5
- adequate cough
- t/V < 100
- no use of vasopressors or sedatives

41
Q

if daily screening of respiratory function does not show improvement what do you do

A

continue ventilation

42
Q

if daily screening of respiratory function shows improvement what do you do

A

you try a spontaneous breathing trial

43
Q

what are ways of initiating a spontaneous breathing trial (3)

A

30 mins with:
- T piece
- CPAP
- low level pressure support

44
Q

if spontaneous breathing trial is poorly tolerated what do you do

A

gradual weaning with daily T piece trials/ pressure support ventilation

45
Q

if the spontaneous breathing trial or gradual weaning is tolerated what do you do

A

extubate

46
Q

if pt gets respiratory failure post-extubation what should you do (2)

A
  1. consider trial of non invasive ventilation for 1-2h ( for cardiogenic pulmonary edema, COPD, immunosuppressed, post thoracic surgery)- if that doesnt work intubate
  2. intubate if appropriate
47
Q

what are complications of mechanical ventilation (4)

A
  1. Airway Complications
  2. Mechanical complications
  3. Physiological Complications
  4. Artificial Airway Complications
48
Q

what are airway complications (4)

A
  1. oxygen toxicity
  2. nosocomial or ventilator acquired pneumonia
  3. decreased clearance of secretions
  4. aspiration
49
Q

what are the mechanical complications (7)

A
  1. barotrauma
    - Closed pneumothorax
    - Tension pneumothorax
    - Pneumomediastinum
    - Subcutaneous emphysema
  2. Hypoventilation with atelectasis with respiratory acidosis or hypoxemia.
  3. Hyperventilation with hypocapnia and respiratory alkalosis
  4. Alarm “turned off”
  5. Failure of alarms or ventilator
  6. Inadequate nebulization or humidification
  7. Overheated inspired air, resulting in hyperthermia
50
Q

what are the physiological complications (7)

A
  1. Fluid overload with humidified air and sodium chloride (NaCl) retention
  2. Depressed cardiac function and hypotension
  3. Stress ulcers
  4. Paralytic ileus
  5. Gastric distension
  6. Starvation
  7. Dyssynchronous breathing pattern
51
Q

what are the artificial airway complications related to endotracheal tube (9)

A
  1. tube kinked or plugged
  2. tracheal stenosis or tracheomalacia
  3. laryngeal edema
  4. rupture of piriform sinus
  5. Mainstem intubation with contralateral (located on or affecting the opposite side of the lung) lung atelectasis
  6. Cuff failure
  7. Sinusitis
  8. Otitis media
52
Q

what are the artificial airway complications related to the tracheostomy tube (12)

A
  1. laryngeal nerve damage
  2. obstruction of tracheostomy tube
  3. accidental decannulation with loss of airway
  4. Acute hemorrhage at the site
  5. Air embolism
  6. Aspiration
  7. Erosion into the innominate artery with exsanguination
  8. Failure of the tracheostomy cuff
  9. Subcutaneous and mediastinal emphysema
  10. Swallowing dysfunction
  11. Tracheoesophageal fistula
  12. Infection

Anesthesia (12 decks)

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