Mechanical Ventilation 3A

Question 1

Vital capacity must be at least ___ to wean. (x2)

Answer 1

10 ml/kg or at least 1000

Question 2

Minute Volume must be lower than ___ to wean someone.

Answer 2

10 L/min

Question 3

Before weaning a patient, the PF ratio must be greater than ___.

Answer 3

300

Question 4

Before weaning, you must verify that that the original disease process ____.

Answer 4

…has been reversed. (Don’t fall for a trap! If the numbers look great but the original disease process hasn’t resolved, don’t try to wean.)

Question 5

An SBT is the best method to evaluate readiness to wean. What’s the minimum time for a spontaneous breathing trial? Maximum time?

Answer 5

30 min to 2 hours

Question 6

If the patient fails an SBT, how long should you wait to try again?

Answer 6

24 hours. (DO NOT try the SBT again earlier than 24 hours!)

Question 7

When weaning a patient, you may place the patient on SIMV and drop the rate down to a very low number. (True or false?)

Answer 7

False

Question 8

While weaning, SBT will fail if HR increases by ___ beats. If it increases less than 20 beats, ___.

Answer 8

20

Continue weaning, but consider increasing FiO2.

Question 9

Criteria for terminating SBT includes a resp rate above ___, or heart rate above ___. Also ___, and ___.

Answer 9

Resp rate increases above 35 for 5 min
Heart rate increases above 100
Anxiety
Arrythmias

Question 10

What’s the indication for recruitment maneuvers?

Answer 10

ARDS, atelectasis

Question 11

What’s the most common recruitment maneuver?

Answer 11

Increase PEEP to 40 for 40 seconds

20 for 20 seconds if pt is on CPAP

Question 12

What if you do a recruitment maneuver and the SpO2 rises, but then falls again?

Answer 12

Do the recruitment maneuver again. After the recruitment maneuver, increase the PEEP.

Question 13

The purpose of APRV is to increase oxygenation, not ventilation. When putting a patient on APRV, how high do you set the Phigh? (Pt is on PC)

Answer 13

2-3 cm H20 higher than MAP

Question 14

When putting a patient on APRV, how high do you set the Phigh? (Pt is on VC)

Answer 14

Same as Pplat

Question 15

How much volume should you set a patient who is starting on APRV?

Answer 15

4-8 ml/kg but keep pressure under 30-35

Question 16

When putting a patient on APRV, how high do you set the Plow?

Answer 16

0-8

Question 17

How long should Tlow be when setting APRV?

Answer 17

0.5-1 second

Question 18

What will the resp rate be when setting APRV?

Answer 18

8-12 breaths per minute

Question 19

What if you set your patient on APRV and they’re not getting good oxygenation?

Answer 19

Increase Phigh

Increase Thigh

Question 20

What if you set your patient on APRV and they’re not getting good ventilation?

Answer 20

Increase Tlow

Question 21

How do you wean someone from APRV?

Answer 21

“Drop and stretch method”
Gradually drop high pressure
Increase high time
Eventually high time becomes CPAP

Question 22

If you want to put the patient from APRV to another mode, what mode should you put him on?

Answer 22

Don’t do this! Once they’re on APRV, the patient should stay there until they wean off APRV onto CPAP.

Question 23

You put the patient on APRV and the patient keeps breathing at a high rate (45 bpm). This is okay, keep them on APRV. (True or false)

Answer 23

True. High rates on APRV are okay.

Question 24

What’s the purpose of HFOV?

Answer 24

Improves oxygenation in patients with severe lung injury.

Question 25

A hertz (Hz) is ___ cycles per ___.

Answer 25

1 Hz = 60 cycles per minute

Question 26

How much tidal volume to HFOV patients usually get?

Answer 26

3-5 ml

Question 27

HFOV: Amplitude is the same as ___ or ___

Answer 27

Power or Delta P

Question 28

When using HFOV, what's the primary control to adjust CO2? | What's a secondary control to adjust CO2?

Answer 28

Amplitude/Power/Delta P | Frequency is a secondary control but won't help much.

Question 29

If you turn up the amplitude, you're really increasing the ___.

Answer 29

Volume

Question 30

When using HFOV, what's a good I-time? (% and ratio)

Answer 30

30%, or 1-2 ratio. (I-time is expressed as a percent when using HFOV.)

Question 31

When using HFOV, what's the primary control for oxygenation?

Answer 31

Mean Airway Pressure

Question 32

HFOV initial settings: | Amplitude

Answer 32

60-70 cm H2O (Look for chest wiggle)

Question 33

HFOV initial settings: | Frequency

Answer 33

5-6 Hz

Question 34

HFOV initial settings: Bias flow You can adjust from ___ to ___ Bias flow affects ___.

Answer 34

30 lpm May adjust 25-40 Affects MAP.

Question 35

HFOV initial settings: | Mean Airway Pressure

Answer 35

20-30 cm H2O

Question 36

HFOV initial settings: | FiO2

Answer 36

Start at 100% then titrate down

Question 37

Making adjustments on HFOV: What should you do if you need to increase the PO2? (Primary and secondary options)

Answer 37

Increase the MAP | Secondarily, increase FiO2

Question 38

What two types of drugs should be given to all HFOV patients?

Answer 38

Sedation and NMBA

Question 39

Name some benefits of iNO.

Answer 39

``` Dilates pulmonary arteries Decreases PAP Decreases stress on R heart Improves hypoxemia Reduces pulmonary vascular resistance ```

Question 40

When should we use iNO?

Answer 40

Refractory hypoxemia related to high PAP (ARDS)

Question 41

What is the standard dosage for iNO? What is the maximum dose of iNO? When weaning off iNO, you may decrease the dose down to ___.

Answer 41

Start at 40 ppm Max dose is 80 ppm. When weaning off iNO, you may go down to 20 ppm.

Question 42

What are the side effects of iNO?

Answer 42

Methemoglobin levels increase Purple-blue cyanosis Low O2 sat

Question 43

How can you measure methemoglobin levels?

Answer 43

Co-oximeter/Heme-oximeter

Question 44

How do you treat high methemoglobin? | What's the secondary treatment?

Answer 44

Methlyne Blue | If they don't have that, Ascorbic acid

Question 45

What is a common dangerous side effect of iNO? (Not high methemoglobin)

Answer 45

Nitrogen dioxide

Question 46

What might happen if you turn off the iNO too quickly?

Answer 46

Rebound pulmonary hypertension

Question 47

True or false: It's okay to transport someone who is on iNO.

Answer 47

True.

Question 48

To wean someone, the RSBI must be less than ___.

Answer 48

100

Question 49

How do you regulate the flow using the O2 flowmeter to regulate the flow with heliox?

Answer 49

Multiply flow on flowmeter by 1.8 for an 80/20 mix | or 1.6 for 70/30 mix

Question 50

When pulling the ET Tube, you want to remove it at ___ ___.

Answer 50

Peak inhalation (prevents vocal cord damage)

Question 51

On HFOV, if you lower the frequency, you will (raise or lower) the tidal volume.

Answer 51

Lowering the frequency will raise the tidal volume. | Doesn't make sense. Just go with it.

Question 52

To increase ventilation on HFOV, what should you do? (x3)

Answer 52

First increase amplitude/ power/ Delta P Then decrease frequency Then increase I-time %.

Question 53

To increase oxygenation on a patient on HFOV, you what should you do? (x3)

Answer 53

Increase MAP | Then increase FiO2

Question 54

There are a few different inhaled vasodilators you can give, like iNO, floLan, and Illoprost. Which one should you give?

Answer 54

iNO

Question 55

When using iNO via an anesthesia machine, the minute ventilation must be greater than the patent's ___.

Answer 55

must be greater than the patient's minute ventilation.

Question 56

How often should the iNOvent delivery system should be calibrated? Can it be done while ventilating a patient?

Answer 56

Every 24 hrs. | Yes

Question 57

Two benefits of inhaled vasodilators:

Answer 57

Decreases V/Q mismatch and shunting.

Question 58

On the test, what patients should you extubate to NIV?

Answer 58

COPD'ers.