Mechanical Ventilation

Question 1

Why would a patient need mechanical ventilation?

Answer 1

high level spinal cord injury, resp. failure, multiple traumas

Question 2

What is NIPPV?

Answer 2

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

Question 3

What is CPAP?

Answer 3

continuous positive airway pressure, constant air

all inhalations are initiated by pt

Question 4

What is BiPAP?

Answer 4

bilevel positive airway pressure

different pressure is given with inhalation and exhalation ex: 12/5

all inhalations still initiated by pt

Question 5

What is A/C?

Answer 5

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

Question 6

What is an SIMV?

Answer 6

synchronized intermittent mandatory ventilation

administers a set volume and a minimum rate

pt can initiate some breaths and used for sedated or awake pt

Question 7

What is PC?

Answer 7

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

Question 8

What is PS?

Answer 8

pressure support ventilation like BiPAP but on a vent

all breaths initiated by pt but supports breath with present amount of pressure

Question 9

What is important info to know on a vent?

Answer 9

tidal volume- normal is 500 cc

rate or frequency (F): set or actual rate

minute ventilation: tidal volume x rate

FiO2

Question 10

What is PEEP?

Answer 10

positive end expiratory pressure- amount of pressure in the airways at the end of exhalation

Question 11

What is normal physiological PEEP?

Answer 11

5 cm H2O to avoid alveolar pressure

might want more in obese pts

Question 12

What is a normal inspiratory to expiratory rate?

Answer 12

1:2 but could be 1:1 in hyperventilation and exercise

Question 13

What is a normal peak inspiratory pressure?

Answer 13

25 cmH2O, if over 40 check for an obstruction or agitation

Question 14

What are 4 types of suctioning?

Answer 14

1. oral- yankauer
2. nasotracheal
3. endotracheal
4. inline

Question 15

What is important to remember about suctioning?

Answer 15

most forms are very uncomfortable to pt

Question 16

What is the purpose of sedation?

Answer 16

improve comfort and compliance with mechanical vent.

reduce overal metabolic demands

prevent awareness in pts treated with neuromuscular blockage

Question 17

What is the ICU triad?

Answer 17

delirium, agitation and pain

Question 18

What is shown to improve with decreased sedation?

Answer 18

decreased duration of mechanical vent, decreased in hospital deaths, reduced ICU stay

Question 19

What is the RASS scale?

Answer 19

agitation and sedation scale

Question 20

What are values for RASS?

Answer 20

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

Question 21

What is a SAS?

Answer 21

riker sedation agitation scale

Question 22

What are values for SAS?

Answer 22

7- dangerous agitation
6- very agitated
5- agitated
4- calm and cooperative
3- sedated (verbal stimuli)
2- very sed. (physical sim)
1- unarousable

Question 23

What is delirium?

Answer 23

disturbance in attention reduced ability to direct focus sustain and shift attention and awareness

Question 24

What can be done to decrease delirium?

Answer 24

reorient, noise reduction, cog. stim., adequate hydration, early mobilization

Question 25

What is ICU acquired weakness?

Answer 25

deconditioning x10, weakness with or without evidence of peripheral neurological involvement

Question 26

What are risk factors for ICU acquired weakness?

Answer 26

hyperglycemia during ICU stay, corticosteroids, neuromuscular blockade

Question 27

What is key in preventing this?

Answer 27

early mobility

Question 28

What is take away message from lecture?

Answer 28

prioritize that pts in ICU receive PT- reduce mechanical vent time and delirium

pts can be safely mobilized in ICU