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ICU > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

0
Q

How does pressure controlled ventilation?

A

Pressure is selected and duration of inflation is set to deliver the tidal volume

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1
Q

How does volume controlled ventilation?

A

Tidal volume is preselected

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2
Q

What is the peak airway pressure in volume controlled ventilation?

A

It is the pressure needed to overcome the resistive forced in the airway and elastic forces of the lungs and chest wall

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3
Q

What is Pres a function of?

A

Resistance to flow in the airways and the inspiratory flow rate

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4
Q

What is Pel a function of?

A

Elastic recoil of the lungs and chest wall

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5
Q

What is the plateau pressure in the volume ventilation mode?

A

It is the same as the peak pressure at the alveoli at the end of inspiration

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6
Q

Is there airflow at the end of inspiration in pressure controlled ventilation?

A

Yes

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7
Q

What is the end expiratory pressure?

A

The minimum pressure in the alveoli during a ventilatory cycle

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8
Q

What is ZEEP.

A

In a normal lung, there is no airflow at the end of expiration. Therefore the pressure in the alveoli is equivalent to the atmospheric pressure

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9
Q

What is applied PEEP?

A

Added via a pressure sensitive valve in the expiratory limb - stops the flow of air in expiration once the pressure drops below a threshold to be able to keep distal airways open

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10
Q

Which mode is the air movement at the end of inspiration?

A

Volume control

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11
Q

What is the peak alveolar pressure a reflection of in volume control?

A

Alveolar volume at the end of inspiration

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12
Q

What does the plateau pressure in the volume control mode need to be to decrease the risk of ventilator induced lung injury?

A

It represents the peak alveolar pressure so it must be kept less than 30 cm H2O

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13
Q

What is the advantage of volume control?

A

You can give a constant tidal volume despite changed in the mechanical properties of the lungs and airways

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14
Q

What is the disadvantage to volume control?

A

Uneven alveolar filling

Patient distress if inspiratory flow isn’t adequate

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15
Q

Which mode is inspiratory flow rate decelerating?

A

Pressure control

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16
Q

What is the peak alveolar pressure equivalent to in pressure control?

A

It is equivalent to end inspiratory airway pressure because there is no airflow at the end of inspiration in pressure control

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17
Q

What is the major advantage to pressure control?

A

The ability to control the peak alveolar pressure

More comfortable for the patient

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18
Q

What is the disadvantage to pressure control?

A

A decrease in alveolar volume when there is a change in the mechanics of the airways or lungs

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19
Q

What is pressure regulated volume control?

A

It provides a constant tidal volume but limits end inspiratory pressure.
Monitors mechanics of lungs and calculates lowest pressure needed to achieve the desired tidal volume

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20
Q

What is assist control ventilation?

A

Allows the patient to take a breath, but also gives patient breaths at a desired rate

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21
Q

What are the triggers in assist control ventilation?

A
  1. Generate a negative pressure of 2-3mmhg (double what it takes in quiet breathing though)
  2. Flow rate
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22
Q

Why is flow rate trigger easier for patients on ACV?

A

It involves little to no pressure change and volume.

Need flow rate of 1-10 l/min

23
Q

How can you increase the I:E ratio?

A
  1. Increasing the inspiratory flow rate
  2. Reducing the tidal volume
  3. Decreasing the inspiratory time
24
Q

What is intermittent mandatory ventilation?

A

Allows patient to take their own breaths while still delivering breaths

25
Q

How does IMV work?

A

Has unidirectional valve that opens in the circuit to allow spontaneous breath when ventilator breath is not delivered

26
Q

What are the adverse effects of IMV.

A
  1. Increased work of breathing

2. Decreased cardiac output

27
Q

When is IMV used?

A

Rapid breathing with incomplete exhalation

28
Q

Who is IMV not advised for?

A

Patients with respiratory muscle weakness or LV dysfunction

29
Q

What is pressure support ventilation?

A

Allows patient to terminate the lung inflation and therefore tidal volume and inspiratory time

30
Q

When does the pressure augmentation terminate in PSV?

A

When inspiratory rate falls below 25% of peak

31
Q

When is pressure support used?

A

During weaning to reduce the work of breathing without augmenting tidal volumes (5-10 mmHg)
Noninvasive ventilation
To augment tidal volumes (15-30)

32
Q

What is the closing pressure?

A

The transpulmonary pressure at which distal air spaces start to collapse

33
Q

What is a normal closing pressure?

A

3 cm H2O

34
Q

In what conditions is the closing pressures elevated?

A

Obstruction (COPD)

Reduced lung compliance

35
Q

What is the purpose of PEEP?

A

To keep the airway pressure above closing pressure

36
Q

What does PEEP do to the peak alveolar pressure and mean alveolar pressure?

A

Increases them proportionately

37
Q

What does the change in peak alveolar pressure influence?

A

The risk of lung injury from overdistention and volutrauma

38
Q

What does the change in mean airway pressure determine?

A

The influence of PEEP on cardiac output

39
Q

What do high levels of PEEP do?

A

Recruit alveoli

40
Q

How can you tell if PEEP is recruiting alveoli versus overdistending?

A
  1. Increasing lung compliance
  2. Increasing PAO2/FiO2
  3. Increasing O2 saturation
41
Q

How should you calculate a tidal volume?

A

8 mL/kg using predicted body weight

42
Q

What should you do to the tidal volume over the next 2 hours?

A

Reduce to 6 mL/kg

43
Q

Where should the peak alveolar pressure be kept?

A

Less than 30 cm H2O

44
Q

What should you set the inspiratory flow rate at if the patient is breathing quietly or not at all?

A

60 L/min

45
Q

When should higher inspiratory flow rates be used?

A

When patient is in distress

46
Q

What should you set the respiratory rate for if the patient isn’t breathing?

A

Set it to their minute ventilation just prior to intubation

47
Q

What should the initial PEEP be set at?

A

5 cm H2O

48
Q

When may PEEP be required to increase?

A
  1. FiO2 over 60%

2. Refractory hypoxemia

49
Q

What does PEEP do to preload?

A

Decreases it by:

  1. Decreasing the intrathoracic pressure gradient for venous inflow into the thorax
  2. Decreases the transmural pressure during diastole which impairs ventricular filling
  3. Increases pulmonary vascular resistance - impede RV stroke volume and therefore LV filling
50
Q

What is ventricular interdependence?

A

When the right ventricular septum bulges into the LV from back up of blood causing LV dysfunction due to RV dysfunction

51
Q

What does PEEP do to afterload?

A

It decreases afterload because it decreases the transmural pressure on the heart

52
Q

What does PEEP do to intra abdominal pressure?

A

Increases it so maintains venous inflow into the thorax

53
Q

How does PEEP act as a ventricular assist?

A

By decreases the transmural pressure across the heart and helping with systole (especially in failing heart which operates on flat part of starling curve)

54
Q

What is essential during positive pressure ventilation to avoid deficits in CO?

A

Maintaining volume status (preload)

55
Q

What is the most common organism to cause VAP in the first 48 hours of ventilation?

A

MSSA

Others include: Klebsiella, Enterobacter, Proteus, S. Pneumo, H. Flu

56
Q

What are the bugs associated with late onset VAP?

A

MRSA
Pseudomonas
Acinetobacte

ICU (17 decks)

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