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NPS Kettering Workbook > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

Four primary variables of mechanical ventilation

A

Trigger
Control/target
Limit
Cycling

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2
Q

How is tidal volume adjusted during time cycled ventilation

A

I time, flow, set PIP

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3
Q

Where should high pressure alarm be set

A

5-10 above peak airway pressure

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4
Q

Where should the low pressure alarm be set

A

5-10 below peak airway pressure

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5
Q

Where should the minimum exhaled tidal volume be set

A

10-20% below set tidal volume

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6
Q

What can cause low pressure alarm

A

Leak
Disconnect
Insufficient flow

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7
Q

What causes a minimum exhaled tidal volume alarm

A

Disconnect
Low Vt

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8
Q

Phase one MV

A

Initiate ventilation
Initiate ventilation settings

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9
Q

Phase 2 MV

A

Monitor
Changes to settings
Identify/correct problems

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10
Q

Phase 3 MV

A

Readiness for weaning
Implement weaning
Monitor during weaning

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11
Q

Newborn basic ABG values

A

7.25-7.35
45-55
50-70

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12
Q

Infant basic ABG values

A

7.34-7.46
30-45
85-100

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13
Q

Acceptable VD/Vt

A

<60%

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14
Q

Acceptable A-a 21%

A

10-15

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15
Q

Acceptable A-a 100%

A

66-300

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16
Q

Acceptable percent shunt

A

<20%

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17
Q

Initial PIP for infants/children

A

20-25 / 20-30 or PIP from manual ventilation

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18
Q

Initial VC infants/chilfren

A

4-6 ml/kg / 6-10 ml/kg

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19
Q

Corrected tidal volume equation

A

Set Vt - compressible gas volume

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20
Q

Compressible gas volume equation

A

(PIP-PEEP) x Tubing compliance factor

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21
Q

Tubing compliance factor equation

A

= volume delivered / (PIP-PEEP)

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22
Q

How to determine tidal volume from flow and I-time

A

Vt = flow (mL/sec) x I-time (sec)

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23
Q

How to convert L/min to mL/sec

A

L/min x 16.7

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24
Q

How to convert mL/sec to L/min

A

ML/sec x 0.06

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25
Q

How to calculate I-time

A

Total cycle time (60 / set rate) divided by I + E

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26
Q

How to calculate I:E

A

1) TCT = 60 / rr
2) Expiratory time = TCT - I time
3) I:E= TE / TI

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27
Q

Dynamic compliance formula

A

Vte / PIP - PEEP

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28
Q

Static compliance formula

A

Vte / Plat - PEEP

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29
Q

Normal Static for FT infants >8hrs old

A

50-55

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30
Q

Normal static for older children

31
Q

How to treat reduced lung compliance

A

Increase PEEP
Treat underlying cause
Consider low Vt

32
Q

Controls directly affecting MAP

A

PIP
Rate
I time/ I:E
PEEP (most)
Peak flow
Vt
Inflation hold

33
Q

Normal compliance and resistance MAP

34
Q

Increase Raw MAP NV

35
Q

Decreased LC MAP NV

36
Q

WOB equation

A

Change in pressure x change in volume

37
Q

When is IRV indicated

A

High FiO2/PEEP requirements
High PIP (>50)
Low PaO2 w decreased compliance

38
Q

Initial settings for APRV: P high

A

In conventional PC: 2-3cmH2O above MAP
In con VC: at plateau or 4-8ml/kg
Keep Phigh under 35, ideal is 30

39
Q

Initial settings for APRV: Plow

40
Q

Initial settings for APRV: T high

41
Q

Initial settings for APRV: T low

42
Q

Adjusting APRV for poor oxygenation

A

Increase P high by 2-3
Increase t high

43
Q

Adjusting APRV for poor ventilation

A

Increase P high or decrease P low
Increase T low

44
Q

Neurally adjusted ventilatory assist

A

NG catheter to measure diaphragm triggers
Insertion: measure distance from bridge of nose to earlobe then xiphoid
Confirm: ECG waveforms

45
Q

How to determine initial PSV level

A

PIP - Plat

46
Q

How to lower MAP in constant flow pattern

A

Higher flow with shorter I -time

47
Q

What effect will result when using a longer I time in conjunction with a decelerating flow pattern

A

Higher MAP

48
Q

If PaCO2 is above range

A

Get rid of dead space
Increase Vt or PIP
Increase rate

49
Q

When increasing FiO2 to fix low PaO2, always

A

Take smaller adjustment for increase in FiO2 over large jump

50
Q

When to increase PEEP with poor oxygenation

A

When FiO2 is at 60%, unless poor cardiac function or elevated ICP

51
Q

What to do in bird beak pattern

A

Decrease PIP or Vt

52
Q

What to do if auto peep is noted

A

Increase flow

53
Q

Anesthetics

A

Reduce pt ability to receive sensation: proposal, ketamine, etomidate

54
Q

Neuromuscular blockades

55
Q

How to assess pt readiness for weaning

A

Reason for vent resolved?
Spontaneous breathing?
Adequate nutrition?
Minimal vent settings
Spontaneous parameters

56
Q

Minimal vent settings for weaning

A

Peep <8
PIP < 30
Rate < 20 for infant
FiO2 < 40%

57
Q

Spontaneous parameters: RSBI

58
Q

Spontaneous parameters: VC

59
Q

Spontaneous parameters: minute ventilation

A

0.5-1 infant
4-9 child

60
Q

Spontaneous parameters: spontaneous Vt

61
Q

Spontaneous parameters: MEP

62
Q

Major advantage of HFV

A

Adequate oxygenation and ventilation at lower PIP and MAP

63
Q

Recommend HFV for children with

A

RDS
Air leak syndromes (pneumo, PIE, BPF)

64
Q

HFV delivers PP breaths at

A

High respiratory rates (>150)
3-15 Hz
1 Hz = 60 cycles/min
Low Vt, usually less than deadspace

65
Q

Vent settings in HFOV

A

Power (amp, delta P): primary control of PaCO2
frequency (Hz): secondary control PaCO2 (the lower the frequency the higher the tidal volume)
Ti%
Mean airway pressure: primary control PaO2
Flow
FiO2

66
Q

Initial settings for HFOV: mean airway pressure

A

1-2 higher than mean airway pressure on CV or 10-20% lower than PIP

67
Q

Initial settings for HFOV: frequency for 2-12 kg

68
Q

Initial settings for HFOV: frequency 21-30 kg

69
Q

Initial settings for HFOV: power (amp) <2 kg

70
Q

Initial settings for HFOV: power (amp) 2.5-4 kg

71
Q

Initial settings for HFOV: power (amp) 5-10 kg

72
Q

How to increase ventilation in HFOV

A

Increase power (amp)
Decrease frequency (Hz)
Increase Ti%

73
Q

How to increase oxygenation in HFOV

A

Increase MAP (Paw)
Increase FiO2

74
Q

Initial bilevel settings

A

IPAP 8-12
EPAP 4-6

NPS Kettering Workbook (8 decks)

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