Mechanical Ventilation Flashcards
Room FiO2
21%
Indications for mechanical ventilation (4)
- apena or impending apnea
- acute respiratory failure (pH ≤ 7.25, PaCO2 ≥50)
- severe hypoxia
- respiratory muscle fatigue
Preparing for intubation
- Ambubag to O2 (15 mL/min)
- Set up suction
- Premedicate
- Intubation box
- Pulse ox
- Explain procedure to patient + family
- Remove dentures
- Hyperventilate
After intubation
- Hyperventilation
- Inflate with NO leak (20-25 mm/Hg)
- Ausculate for bilateral breath sounds
- O2 sat ≥ 95%
- Check ET position
- Cut excess ET
- Confirm with CXR and ABG 30 min after
ET position
- men
- women
Men: 23cm
Women: 21cm
CMV mode
- all done by vent
- pre set volume, pre set rate
AC / PRVC mode
- vent delivers pre set volume and rate
- but if patient takes their own breath, pre-set volume is still delivered
- for patients who are awake but can’t fully breathe on their own
In AC/PRVC mode, the RR will
NOT be less than the pre-set rate
SIMV
- intermittent pre-set volume at set intervals
- But if the patient takes their own breath, they take it at their own volume
- weaning mode
- encourage deep breaths, OOB, suction
Pressure Support
- positive pressure applied during inspiration to decrease work of breathing
- not set TV
- weaning mode, nocturnal support
In Pressure Support, who does all the breaths?
Patient
PEEP
- positive pressure applied during exhalation to prevent alveolar collapse
- 5 = physiologic PEEP
PEEP reduces amount of _____ given
FiO2
Complications of PEEP (3)
- barotrauma
- pneumothorax
- hypotension (fix water them first then pump)
Vent complications - Cardiovascular
- hypotension (water first, then pump!)
Vent complications - Resp (4)
- barotrauma
- pneumothorax
- volutrauma
- VAP
Vent complications - Rep interventions (5)
- turn q 1-2 hrs
- chest PT
- deep breathing and coughing
- suctioning PRN
- VAP bundle
VAP bundle
- HOB 30
- stress ulcer prophylaxis
- oral care BID
- suction q2-4 hrs or PRN
- DVT prophylaxis
- hand hygiene
Vent complications - GI (5)
- stress ulcers
- GI bleed
- translocation of GI bacteria r/t decreased CO, ischemia of intestines
- GI dilation from gas accumulation
- constipation
Vent complications - GI interventions
- stress ulcer prophylaxis (PPI (Protonix), H2 blocker (Pepcid))
- improve CO
- decompress with NG tube
Vent complications - Neuro
Increased ICP
Vent complications - Psychological
Address their feelings!
Vent complications - Fluid/Electrolyte
- fluid retention due to decreased renal perfusion
- sodium retention
Vent complications - Fluid/Electrolyte interventions
- hydrate
- monitor I/O
- cover patient to prevent insensible water loss
