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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
How to calculate I-time
Total cycle time (60 / set rate) divided by I + E
26
How to calculate I:E
1) TCT = 60 / rr 2) Expiratory time = TCT - I time 3) I:E= TE / TI
27
Dynamic compliance formula
Vte / PIP - PEEP
28
Static compliance formula
Vte / Plat - PEEP
29
Normal Static for FT infants >8hrs old
50-55
30
Normal static for older children
70-100
31
How to treat reduced lung compliance
Increase PEEP Treat underlying cause Consider low Vt
32
Controls directly affecting MAP
PIP Rate I time/ I:E PEEP (most) Peak flow Vt Inflation hold
33
Normal compliance and resistance MAP
5-10
34
Increase Raw MAP NV
10-20
35
Decreased LC MAP NV
15-30
36
WOB equation
Change in pressure x change in volume
37
When is IRV indicated
High FiO2/PEEP requirements High PIP (>50) Low PaO2 w decreased compliance
38
Initial settings for APRV: P high
In conventional PC: 2-3cmH2O above MAP In con VC: at plateau or 4-8ml/kg Keep Phigh under 35, ideal is 30
39
Initial settings for APRV: Plow
0-8
40
Initial settings for APRV: T high
2-4 sec
41
Initial settings for APRV: T low
0.5-1
42
Adjusting APRV for poor oxygenation
Increase P high by 2-3 Increase t high
43
Adjusting APRV for poor ventilation
Increase P high or decrease P low Increase T low
44
Neurally adjusted ventilatory assist
NG catheter to measure diaphragm triggers Insertion: measure distance from bridge of nose to earlobe then xiphoid Confirm: ECG waveforms
45
How to determine initial PSV level
PIP - Plat
46
How to lower MAP in constant flow pattern
Higher flow with shorter I -time
47
What effect will result when using a longer I time in conjunction with a decelerating flow pattern
Higher MAP
48
If PaCO2 is above range
Get rid of dead space Increase Vt or PIP Increase rate
49
When increasing FiO2 to fix low PaO2, always
Take smaller adjustment for increase in FiO2 over large jump
50
When to increase PEEP with poor oxygenation
When FiO2 is at 60%, unless poor cardiac function or elevated ICP
51
What to do in bird beak pattern
Decrease PIP or Vt
52
What to do if auto peep is noted
Increase flow
53
Anesthetics
Reduce pt ability to receive sensation: proposal, ketamine, etomidate
54
Neuromuscular blockades
Curonium
55
How to assess pt readiness for weaning
Reason for vent resolved? Spontaneous breathing? Adequate nutrition? Minimal vent settings Spontaneous parameters
56
Minimal vent settings for weaning
Peep <8 PIP < 30 Rate < 20 for infant FiO2 < 40%
57
Spontaneous parameters: RSBI
<100
58
Spontaneous parameters: VC
>10
59
Spontaneous parameters: minute ventilation
0.5-1 infant 4-9 child
60
Spontaneous parameters: spontaneous Vt
> 5ml/kg
61
Spontaneous parameters: MEP
40
62
Major advantage of HFV
Adequate oxygenation and ventilation at lower PIP and MAP
63
Recommend HFV for children with
RDS Air leak syndromes (pneumo, PIE, BPF)
64
HFV delivers PP breaths at
High respiratory rates (>150) 3-15 Hz 1 Hz = 60 cycles/min Low Vt, usually less than deadspace
65
Vent settings in HFOV
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
Initial settings for HFOV: mean airway pressure
1-2 higher than mean airway pressure on CV or 10-20% lower than PIP
67
Initial settings for HFOV: frequency for 2-12 kg
10 Hz
68
Initial settings for HFOV: frequency 21-30 kg
7 Hz
69
Initial settings for HFOV: power (amp) <2 kg
2.5
70
Initial settings for HFOV: power (amp) 2.5-4 kg
4.0
71
Initial settings for HFOV: power (amp) 5-10 kg
6.0
72
How to increase ventilation in HFOV
Increase power (amp) Decrease frequency (Hz) Increase Ti%
73
How to increase oxygenation in HFOV
Increase MAP (Paw) Increase FiO2
74
Initial bilevel settings
IPAP 8-12 EPAP 4-6

NPS Kettering Workbook (8 decks)

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