Mechanical Ventilation Flashcards
Why would a patient need mechanical ventilation?
high level spinal cord injury, resp. failure, multiple traumas
What is NIPPV?
non invasive positive pressure ventilation
tight fitting mask provided to awake patient , short term solution to help pt recover
can be used with CPAP or BiPAP
What is CPAP?
continuous positive airway pressure, constant air
all inhalations are initiated by pt
What is BiPAP?
bilevel positive airway pressure
different pressure is given with inhalation and exhalation ex: 12/5
all inhalations still initiated by pt
What is A/C?
assist control vent.
total ventilation control so it sets volume and rate
pt is usually sedated bc if breath is initiated it won’t work
What is an SIMV?
synchronized intermittent mandatory ventilation
administers a set volume and a minimum rate
pt can initiate some breaths and used for sedated or awake pt
What is PC?
pressure controlled ventilation, vent will not allow more than a certain designated pressure, reduces risk of barotrauma
only problem means there is no volume garuntee
What is PS?
pressure support ventilation like BiPAP but on a vent
all breaths initiated by pt but supports breath with present amount of pressure
What is important info to know on a vent?
tidal volume- normal is 500 cc
rate or frequency (F): set or actual rate
minute ventilation: tidal volume x rate
FiO2
What is PEEP?
positive end expiratory pressure- amount of pressure in the airways at the end of exhalation
What is normal physiological PEEP?
5 cm H2O to avoid alveolar pressure
might want more in obese pts
What is a normal inspiratory to expiratory rate?
1:2 but could be 1:1 in hyperventilation and exercise
What is a normal peak inspiratory pressure?
25 cmH2O, if over 40 check for an obstruction or agitation
What are 4 types of suctioning?
- oral- yankauer
- nasotracheal
- endotracheal
- inline
What is important to remember about suctioning?
most forms are very uncomfortable to pt
What is the purpose of sedation?
improve comfort and compliance with mechanical vent.
reduce overal metabolic demands
prevent awareness in pts treated with neuromuscular blockage
What is the ICU triad?
delirium, agitation and pain
What is shown to improve with decreased sedation?
decreased duration of mechanical vent, decreased in hospital deaths, reduced ICU stay
What is the RASS scale?
agitation and sedation scale
What are values for RASS?
4+ combative danger to staff 3+ very agitated 2 + agitated 1+ restless 0 alert and calm -1 drowsy -2 light sedation brief eye open with voice -3 mod sed. eye movements to voice -4 deep sed.- physical -5 unarousable
What is a SAS?
riker sedation agitation scale
What are values for SAS?
7- dangerous agitation 6- very agitated 5- agitated 4- calm and cooperative 3- sedated (verbal stimuli) 2- very sed. (physical sim) 1- unarousable
What is delirium?
disturbance in attention reduced ability to direct focus sustain and shift attention and awareness
What can be done to decrease delirium?
reorient, noise reduction, cog. stim., adequate hydration, early mobilization
What is ICU acquired weakness?
deconditioning x10, weakness with or without evidence of peripheral neurological involvement
What are risk factors for ICU acquired weakness?
hyperglycemia during ICU stay, corticosteroids, neuromuscular blockade
What is key in preventing this?
early mobility
What is take away message from lecture?
prioritize that pts in ICU receive PT- reduce mechanical vent time and delirium
pts can be safely mobilized in ICU
