Mechanical Ventilation 3A Flashcards
Vital capacity must be at least ___ to wean. (x2)
10 ml/kg or at least 1000
Minute Volume must be lower than ___ to wean someone.
10 L/min
Before weaning a patient, the PF ratio must be greater than ___.
300
Before weaning, you must verify that that the original disease process ____.
…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.)
An SBT is the best method to evaluate readiness to wean. What’s the minimum time for a spontaneous breathing trial? Maximum time?
30 min to 2 hours
If the patient fails an SBT, how long should you wait to try again?
24 hours. (DO NOT try the SBT again earlier than 24 hours!)
When weaning a patient, you may place the patient on SIMV and drop the rate down to a very low number. (True or false?)
False
While weaning, SBT will fail if HR increases by ___ beats. If it increases less than 20 beats, ___.
20
Continue weaning, but consider increasing FiO2.
Criteria for terminating SBT includes a resp rate above ___, or heart rate above ___. Also ___, and ___.
Resp rate increases above 35 for 5 min
Heart rate increases above 100
Anxiety
Arrythmias
What’s the indication for recruitment maneuvers?
ARDS, atelectasis
What’s the most common recruitment maneuver?
Increase PEEP to 40 for 40 seconds
20 for 20 seconds if pt is on CPAP
What if you do a recruitment maneuver and the SpO2 rises, but then falls again?
Do the recruitment maneuver again. After the recruitment maneuver, increase the PEEP.
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)
2-3 cm H20 higher than MAP
When putting a patient on APRV, how high do you set the Phigh? (Pt is on VC)
Same as Pplat
How much volume should you set a patient who is starting on APRV?
4-8 ml/kg but keep pressure under 30-35
When putting a patient on APRV, how high do you set the Plow?
0-8
How long should Tlow be when setting APRV?
0.5-1 second
What will the resp rate be when setting APRV?
8-12 breaths per minute
What if you set your patient on APRV and they’re not getting good oxygenation?
Increase Phigh
Increase Thigh
What if you set your patient on APRV and they’re not getting good ventilation?
Increase Tlow
How do you wean someone from APRV?
“Drop and stretch method”
Gradually drop high pressure
Increase high time
Eventually high time becomes CPAP
If you want to put the patient from APRV to another mode, what mode should you put him on?
Don’t do this! Once they’re on APRV, the patient should stay there until they wean off APRV onto CPAP.
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)
True. High rates on APRV are okay.
What’s the purpose of HFOV?
Improves oxygenation in patients with severe lung injury.
A hertz (Hz) is ___ cycles per ___.
1 Hz = 60 cycles per minute
How much tidal volume to HFOV patients usually get?
3-5 ml
HFOV: Amplitude is the same as ___ or ___
Power or Delta P
When using HFOV, what’s the primary control to adjust CO2?
What’s a secondary control to adjust CO2?
Amplitude/Power/Delta P
Frequency is a secondary control but won’t help much.
If you turn up the amplitude, you’re really increasing the ___.
Volume
When using HFOV, what’s a good I-time? (% and ratio)
30%, or 1-2 ratio. (I-time is expressed as a percent when using HFOV.)
When using HFOV, what’s the primary control for oxygenation?
Mean Airway Pressure
HFOV initial settings:
Amplitude
60-70 cm H2O (Look for chest wiggle)
HFOV initial settings:
Frequency
5-6 Hz
HFOV initial settings:
Bias flow
You can adjust from ___ to ___
Bias flow affects ___.
30 lpm
May adjust 25-40
Affects MAP.
HFOV initial settings:
Mean Airway Pressure
20-30 cm H2O
HFOV initial settings:
FiO2
Start at 100% then titrate down
Making adjustments on HFOV: What should you do if you need to increase the PO2? (Primary and secondary options)
Increase the MAP
Secondarily, increase FiO2
What two types of drugs should be given to all HFOV patients?
Sedation and NMBA
Name some benefits of iNO.
Dilates pulmonary arteries Decreases PAP Decreases stress on R heart Improves hypoxemia Reduces pulmonary vascular resistance
When should we use iNO?
Refractory hypoxemia related to high PAP (ARDS)
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 ___.
Start at 40 ppm
Max dose is 80 ppm.
When weaning off iNO, you may go down to 20 ppm.
What are the side effects of iNO?
Methemoglobin levels increase
Purple-blue cyanosis
Low O2 sat
How can you measure methemoglobin levels?
Co-oximeter/Heme-oximeter
How do you treat high methemoglobin?
What’s the secondary treatment?
Methlyne Blue
If they don’t have that, Ascorbic acid
What is a common dangerous side effect of iNO? (Not high methemoglobin)
Nitrogen dioxide
What might happen if you turn off the iNO too quickly?
Rebound pulmonary hypertension
True or false: It’s okay to transport someone who is on iNO.
True.
To wean someone, the RSBI must be less than ___.
100
How do you regulate the flow using the O2 flowmeter to regulate the flow with heliox?
Multiply flow on flowmeter by 1.8 for an 80/20 mix
or 1.6 for 70/30 mix
When pulling the ET Tube, you want to remove it at ___ ___.
Peak inhalation (prevents vocal cord damage)
On HFOV, if you lower the frequency, you will (raise or lower) the tidal volume.
Lowering the frequency will raise the tidal volume.
Doesn’t make sense. Just go with it.
To increase ventilation on HFOV, what should you do? (x3)
First increase amplitude/ power/ Delta P
Then decrease frequency
Then increase I-time %.
To increase oxygenation on a patient on HFOV, you what should you do? (x3)
Increase MAP
Then increase FiO2
There are a few different inhaled vasodilators you can give, like iNO, floLan, and Illoprost. Which one should you give?
iNO
When using iNO via an anesthesia machine, the minute ventilation must be greater than the patent’s ___.
must be greater than the patient’s minute ventilation.
How often should the iNOvent delivery system should be calibrated?
Can it be done while ventilating a patient?
Every 24 hrs.
Yes
Two benefits of inhaled vasodilators:
Decreases V/Q mismatch and shunting.
On the test, what patients should you extubate to NIV?
COPD’ers.
