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MS3 Exam 3 > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

What is it?

A
  • A machine that generates a controlled flow of gas into a patient’s airway!
  • O2 and air are generated from cylinders or wall outlets
  • The gas is blended according to prescribed “inspired oxygen tension” - FiO2
  • It accumulated in a receptacle in the machine
  • Then delivered to the patient using one of many available modes
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2
Q

Indications for Ventilation

A
  • Ventilatory failure
  • Inability to protect the airway
  • Failure to clear the airway
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3
Q

Airway Accesses

A
  • Non-invasive ventilation
  • Nasal cannula
  • Face mask
  • Non-rebreather mask
  • BiPAP
  • Laryngeal Mask Airway (LMA)
  • Endotracheal tube
  • Tracheostomy (for prolonged intubation)
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4
Q

Types of Ventilators

A
  • Negative-Pressure Ventilators
  • Positive-Pressure Ventilators
  • Non-invasive Ventilation
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5
Q

Negative-Pressure Ventilation

A
  • Creates negative pressure externally to draw the chest outward and air into the lungs
  • Mimics spontaneous breathing
  • Used for individuals with neuromuscular disorders
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6
Q

Positive-Pressure Ventilation

A
  • PUSHES air into the lungs
  • Can be invasive and non-invasive
  • Amount of air delivered in:
  • Volume (milliliters)
  • Specific pressure

•Used for individuals with Acute Respiratory Failure

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7
Q

Positive-Pressure Ventilators:

Noninvasive Ventilation (BIPAP)

A
  • Provides ventilator support, but uses a tight fitting mask
  • Used to AVOID intubation
  • Supportive for patients with:
  • Sleep Apnea•Impending respiratory failure
  • Success varies and is limited to patient tolerance
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8
Q

Positive-Pressure Ventilators

A

•Normal respiratory properties will be reflected in your mechanical ventilation settings

  • MODE (Spontaneous vs. Mechanical)
  • DEPTH (Tidal Volume)
  • OXYGEN (FiO2)
  • RATE
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9
Q

Modes of Positive-Pressure Ventilation

•Controlled Mechanical Ventilation (CMV)

A

•Breaths are delivered regularly and independent of the patient’s own ventilatory efforts

  • Used when the patient has NO DRIVE TO BREATHE!
  • Under anesthesia
  • Chemically paralyzed

•Very rarely used

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10
Q

Modes of Positive-Pressure Ventilation

•ASSIST-CONTROLLED MECHANICAL VENTILATION (ACV)

A

•Vent breath is triggered by patient inspiration

  • Used:
  • To initiate mechanical ventilation
  • Those at risk for respiratory arrest
  • If the patient does not initiate a breath in a pre-set time the vent fires a breath at the pre-set Vt

•Allows the patient to breath faster, but not slower

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11
Q

Modes of Positive-Pressure Ventilation

•SYNCHRONOUS INTERMITTENT MANDATORY VENTILATION (SIMV)

A
  • Allows the patient to breath spontaneously without vent assistance between delivered vent breaths
  • Vent has a pre-set rate and tidal volume and will not fire when the patient produces their own breath
  • COORDINATED with the patient’s own respiratory effort
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12
Q

Modes of Positive-Pressure Ventilation

•SIMV commonly used to:

A
  • Support ventilation
  • Exercise the respiratory muscles between vent-assisted breaths
  • During the weaning process
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13
Q

SIMV Setting

A
  • Vent is set on:
  • “SIMV of 4 and pt’s RR is 18”
  • How many spontaneous breaths is your patient taking?
    1. 4
    1. 18
    1. 14
    1. 22
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14
Q

Tidal Volume (VT)

A

•The volume of air delivered during each ventilator-augmented breath

  • Normal Adult VT is:
  • 6-10 mL/kg or approx. 400-500 mL
  • ↑ VT → ↑ risk of barotrauma & ↓ venous return / CO
  • ↓ VT → ↑risk of atelectasis
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15
Q

Oxygen

A
  • 3%pf the body’s oxygen is dissolved in the plasma
  • PaO2 – partial pressure of oxygen (mmHg)
  • Measures how much oxygen is available in the alveoli
  • SaO2 (oxygen saturation) measures the degree of oxygen bound to hemoglobin
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16
Q

Oxygen (FiO2)

A
  • Set at the lowest possible level for adequate tissue perfusion
  • FiO2 can be 21% - 100% oxygen
  • Try to keep FiO2 < 50% to avoid oxygen toxicity or fibrosis
  • Often have set parameters to keep:
  • SpO2> 90% and PaO2 > 60 mm Hg
17
Q

Hypoxemia

A
  • Results from ventilation or circulatory problems
  • VQ Mismatching (shunting)

PROBLEM VENTILATION CIRCULATION (PERFUSION)

MECHANISM Too little oxygen reaches the alveoli Too little blood reaches the alveoli

EXAMPLE Pneumonia Atelectasis Bronchospasm Pulm. Emboli Heart failure

18
Q

Rate of Ventilations

A
  • Normal RR is 12 – 20
  • Initially set at approx. 12 – 15 vent. Breaths/min.
  • ETCO2 (capnography) or the PaCo2 may be used to determine the rate
  • PaCO2 < 38 mmHg indicates –
  • ETCO2 > 45

•What does this tell us?

19
Q

Special Ventilator Settings

•Positive End-Expiratory Pressure (PEEP)

A
  • Used to maintain positive pressure in the lungs at the end of expiration
  • Improves the VQ relationship and diffusion across the alveolar-capillary membrane
  • Prevents:
  • Atelectasis
  • Reduces Hypoxemia
  • Allows for a lower % of FiO2
20
Q

Special Ventilator Settings

•Pressure Support Ventilation (PSV)

A
  • Preset pressure delivery augmenting patient own respiratory effort
  • Applies positive pressure during “spontaneous” inspiration
  • Can be used with all modes of ventilation
  • Used to:
  • Overcome dead space of circuit & pt’s airways
  • Decreases the work of breathing
21
Q

Special Ventilator Settings

•Continuous Positive Airway Pressure (CPAP)

A
  • Elevates end-expiratory pressure during spontaneous breaths
  • Used for intubated and non-intubated patients
  • Used to:
  • Maintain open airways
  • Decrease the work of breathing
22
Q

CPAP Mask or BiPAP

A
  • Used to improve oxygenation on patient’s who can breath on their own
  • Used for those experiencing sleep apnea at night
  • Masks must be very tight on the face!
23
Q

SO…WHATS ALL THE NOISE ABOUT?

A

High Pressure Limit

  • Secretions or Condensation in tubing
  • Kink in vent tubing
  • Biting ETT
  • Coughing or gagging
  • Bronchospasm or Pneumothorax

Low Pressure

  • Vent tubing disconnect
  • Displaced OETT or Trach tube

High Respiratory Rate

  • Anxiety or pain
  • Secretions
  • Hypoxia
  • Hypercapnea

Low Exhaled Volume

  • Vent tubing disconnect
  • Cuff leak or inadequate cuff seal
  • Another occurring alarm preventing breath delivery
24
Q

Complications of Mechanical Ventilation

A
  • Improper Tube Placement
  • Inflated lung vs. Uninflated lung
  • Gastric Distention
  • Aspiration
  • Facial Skin Necrosis
  • Crepitus
  • Drying of eyes & mucous membranes
  • Stress
  • Claustrophobia
  • Hospital Acquired Pneumonia
  • Normal respiratory defense mechanisms bypassed
  • Open epiglottis
  • Cough/Gag reflexes inhibited or impaired
  • Secretions often thick & tenacious
  • Increases the risk of atelectasis

•What is vital in preventing this?

25
Q

Complications of Mechanical Ventilation

A
  • Aspiration
  • Oxygen toxicity
  • Resp. acidosis/alkalosis
  • Failure to wean
  • ↓ BP & CO
  • Poss. Liver & renal dysfunction
  • ↑ Intracranial pressure
  • Fistulas
  • Barotrauma
  • Fluid retention
  • Loss of muscular conditioning
  • Malnutrition
26
Q

Ventilator Weaning

A

•The process of removing ventilator support and re-establishing spontaneous, independent breathing

•Process depends on:
•Preexisting lung conditions
•Duration of mechanical ventilation
•Patient’s general condition 
–physically and psychologically
27
Q

Ventilator Weaning

•Both SIMV and PSV are used for weaning

A
  • When duration of mechanical ventilation has been longer and respiratory muscle reconditioning is needed.
  • Duration of periods off the vent is gradually increased until patient can maintain adequate independent respirations for several hours
  • Using SIMV to wean:
  • Number of vent assisted breaths are gradually decreased
  • When pt is able to tolerate an SIMV of 4 bpm → a T-piece or CPAP weaning is attempted
  • Using PSV to wean:
  • Pressure support levels are gradually decreased
  • When PSV is just enough to overcome ETT resistance → support is DC’d →Pt. is extubated
28
Q

Ventilator Weaning

•Terminal Wean

A

•Gradual withdrawal of mechanical ventilation when survival without assisted ventilation is NOT expected

  • Nursing Considerations:
  • Need to discuss option with pt /family / SO
  • When? Where? What?
  • Provide education and comfort

MS3 Exam 3 (6 decks)

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