Mechanical Ventilation Flashcards by Lexi Sarradet

• The product of the elastic recoil of the lungs and chest
wall (elastance) and the volume of gas delivered.
• Increased by increased lung stiffness
• Increased by restricted excursion of the chest wall
• High elastance is the same as low compliance

Elasticity

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What are the indications for mechanical ventilation?

Respiratory failure, inability to maintain adequate oxygenation or ventilation, and certain surgical procedures

Indications must be evaluated based on individual patient needs and conditions

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Differentiate between spontaneous and mechanical ventilation.

Spontaneous ventilation relies on the patient’s own effort, while mechanical ventilation involves a machine assisting or controlling breathing

Mechanical ventilation is used when spontaneous breathing is inadequate

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What is elastic pressure?

The product of the elastic recoil of the lungs and chest wall (elastance) and the volume of gas delivered

Increased by lung stiffness and restricted chest wall excursion

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What causes increased elastic pressure?

Increased lung stiffness and restricted excursion of the chest wall

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Define resistive pressure.

The product of circuit resistance and airflow

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What is Continuous Positive Airway Pressure (CPAP)?

Continuous pressure throughout spontaneous inspiration and exhalation

Requires intact respiratory drive and adequate tidal volume

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What is Bi-level Positive Airway Pressure (Bi-PAP)?

A non-invasive ventilation mode with two pressure levels: inspiratory positive airway pressure and expiratory positive airway pressure

Used for conditions like neuromuscular disorders, CHF, COPD, and asthma

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What is Peak Airway Pressure?

The maximal airway pressure recorded at the end of inspiration during positive pressure ventilation

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What is Plateau Pressure?

The pressure applied to small airways and alveoli, measured during an inspiratory pause on the ventilator

Goal plateau pressure is <30 cm H2O to prevent volutrauma

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How is plateau pressure measured?

Set a tidal volume, press the inspiratory hold button, and observe the peak airway pressure

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What are the two main modes of mechanical ventilation?

Volume-controlled ventilation (VCV) * Pressure-controlled ventilation (PCV)

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What is the difference between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV)?

VCV delivers a set tidal volume while PCV controls airway pressure with variable tidal volume

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What is Continuous Mandatory Ventilation (CMV)?

A mode where every breath, whether mechanical or spontaneous, is fully supported

full support a set tidal volume at a set rate

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What is Assist Control (A/C) Ventilation?

MUST KNOW

Every breath is fully supported, with set tidal volume and set rate, allowing for spontaneous breaths

predetermined tidal volume

sedated post op surgical

stacking breaths will be the issue

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What is Synchronized Intermittent Mandatory Ventilation (SIMV)?

A mode that provides various levels of support with set breaths delivering a set tidal volume

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What is Airway Pressure Release Ventilation (APRV)?

A spontaneous breathing mode with continuous positive airway pressure and timed frequency release to a baseline pressure

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What is the role of Positive End Expiratory Pressure (PEEP)?

To maintain alveolar recruitment and prevent collapse at the end of expiration

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What are the initial settings for volume-controlled ventilation in diffuse lung disease?

Tidal volume: 6 mL/kg PBW * Respiratory rate: 14-18 * FiO2: 100% * PEEP: 5-10 cm H2O

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What are the clinical criteria for readiness for spontaneous breathing trials?

Cause of respiratory failure has improved * FiO2 ≤50% and PEEP ≤5-8 cm H2O * pH >7.25 * Hemodynamic stability * Able to initiate spontaneous breaths

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What is the Spontaneous Awake Trial?

A trial involving pressure support ventilation (5-7) with PEEP (1-5) or T-Piece for 30 min-2 hrs

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What are complications associated with mechanical ventilation?

Ventilator-associated pneumonia, barotrauma, volutrauma, and respiratory muscle atrophy

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What is the effect of early tracheostomy?

Lower costs * Shorter duration of ventilation * Less sedation required * Earlier autonomy * Lower rates of accidental extubations * More aggressive spontaneous breathing trials

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True or False: One mode of mechanical ventilation is superior to another in reducing overall mortality.

False

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Fill in the blank: The goal of ventilation in obstructive airway disease is to _______.

[rest the respiratory muscles, provide adequate oxygenation, and reduce hyperinflation]

things to consider before MV

sedation, analgesia, NM blockage, end point to MV, VAP prevention bundle and proning

proning pf ratio

<150

tidal volume

volume of gas entering patients lung during inspiratory

peak inspiratory pressure

point of maximal airway pressure

peep

pressure maintain in airways at end of exhalation

delta pressure

difference between PIP-PEEP

mean airwary pressure

an average of the airway pressure throughout the respiratory cycle

The maximal airway pressure recorded at the end of inspiration during positive pressure ventilation. Total pressure needed to overcome the resistance related to the ventilator circuit, ETT, and airway as well as the elastic recoil of the lungs and chest wall.

peak airway pressure

When would peak airway pressures be elevated?

secretions mucus plug foreign object biting the tube large bronchiole airway

pressure applied to small airways and alveoli It is measured during an inspiratory pause on the ventilator The goal plateau pressure is <30 cm H2O to prevent volutrauma; that is lung injury secondary to over distension of alveoli Without lung disease, peak inspiratory pressure (PIP) is only slightly above the plateau pressure

plateau pressure

plateu pressure

compliance of the lungs pressure applied to small airways and alveoli It is measured during an inspiratory pause on the ventilator Without lung disease, peak inspiratory pressure (PIP) is only slightly above the plateau pressure

The goal plateau pressure is ----------to prevent volutrauma; that is lung injury secondary to over distension of alveoli

<30 cm H2O

when would plateau pressures be elevated

ARDS, pulmonary edema, pneumonia, pneumothorax

inspiratory hold how to?

set a tidal volume press the inspiratory hold button, observe the peak airway pressure this will be your plateu pressure and will help differentiate between airway and or compliance problems

if you have high peak pressures and low plateau pressures

mucus plug, bronchospasm, biting, et blockage

high peak pressures and high plateau pressures

ards pulmo edema, pneumothorax, et migrating to single bronchus or effusion

a predetermined volume is delivered with each breath

a predetermined pressure and duration of inflation is set by the clinician

Acute lung injuryARDSObesitySevere burns what kind of ventilation

Severe asthmaCOPDSalicylate toxicity what kind of ventilation

Pressure support is unnecessary in this mode.

AC mode

SIMV weaning mode?

yes considered weaning because we can allow spontaneous breaths received pressure support

_____ we give in SIMV mode to assist with exhalation

pressure support when they breath spontaneously

SIMV components

r, ps, tv, peep

Ventilator Modes: Fall into two broad categories:

pressure and volume modes.

Each mode has three features:

* Trigger (T) – what initiates a breath? * Cycle (C) – what ends a breath? * Limit (L) – what stops a breath early?

Set rate delivered up to a set pressure Can be set as AC/PC or SIMV/PC TV will vary with each breath depending on the patient’s compliance Minute volume may be adversely affected with poor compliance if the tidal volumes are vey low

PCV

Goals for mechanical ventilation:

1. Oxygenation – support PaO2/SpO2 2. Ventilation – maintain pH 3. Patient comfort – vent synchrony, ↓ sedation 4. Facilitate weaning – minimize muscle loss, promote readiness to wean from support

Defined as pressure augmented breathing that allows the patient to determine the tidal volume and the respiratory rate Augments spontaneous breathing Does not provide full ventilatory support

PRESSURE SUPPORT VENTILATION

augmented ______ mode, not full ventilatory support

pressure support only spontaneous breathing

to get rid of co2, ventilation what do we change?

RR, TV, PIP OR DLETA P; ADD PS

to assist with oxygenation what would we change on the ventilator

fio2 and or peep

fio2

Set .21 to 1.0 Oxygen Toxicity Try to wean FIO2 <60 in first 24 hrs Use least amount possible, use PEEP to decrease

the bad with peep

dec venous return barotrauma too much peep can also cause pneumothorax

diffuse lung disease initial settings for what kind of patient population

ARDS, Aspiration pneumonitis, Pneumonia, Pulmonary Fibrosis, Pulmonary Edema, Alveolar hemorrhage

ards ventilation

Strong: Mechanical ventilation using lower tidal volumes (4–6***updated ****** ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure , 30 cm H2O) Prone positioning for more than 12 (usually 16 hours) h/d in severe ARDS Conditional: a. Higher positive end-expiratory pressure in patients with moderate/severe ARDS b. Recruitment maneuvers in patients with moderate/severe ARDS

what is the goal for initial settings on a ventilator

recruit vulnerable alveoli, prevent cyclical alveolar closure, provide adequate ventilation, and minimize volutrauma from over-distension.