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RUSVM Anesthesiology > Mechanical Ventilation > Flashcards

Mechanical Ventilation Flashcards

1
Q

How does anesthesia affect ventilation?

A

Respiratory depression -> alter sensitivity to CO2

Relaxes respiratory muscles

Atelectasis develops

Impairs V/Q matching -> inhibits hypoxic pulmonary vasoconstriction

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2
Q

How can ventilation status affect anesthesia?

A

Uptake of inhalational anesthetics depending of ventilation

Controlled ventilation facilitates reliable uptake and smooth plane of anesthesia

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3
Q

How is ventilation monitored?

A

Arterial blood gas (PaCO2)

Capnograph

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4
Q

What values define oxygenation? How is it measured?

A

PaO2 or SpO2

Arterial blood gas or pulse oximetry

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5
Q

When breathing 100% O2, can oxygenation be improved more by ventilation?

A

Nope

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6
Q

How is resistance calculated?

A

Pressure difference/flow

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7
Q

How is compliance calculated?

A

Volume/pressure

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8
Q

__________ limits flow

A

Resistance

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9
Q

_____________ limits volume

A

Compliance

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10
Q

What are the stages of the respiratory cycle?

A

Inspiration

  • inspiration flow
  • inspiratory pause

Expiration

  • expiratory flow
  • expiratory pause
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11
Q

What is mechanical ventilation?

A

Artificial ventilation where mechanical means are used to assist/replace spontaneous breathing

Can be provided by ventilator or person

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12
Q

What is spontaneous ventilation?

A

Patient determines when and how

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13
Q

What is assisted ventilation?

A

Patient determines when and ventilator determines how

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14
Q

What is mandatory ventilation

A

Ventilator determines when and how

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15
Q

What is IPPV?

A

Intermittent positive pressure ventilation

-> positive pressure is maintained ONLY during inspiration

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16
Q

What is IMV?

A

Intermittent mandatory ventilation

Operator sets a predetermined number of positive breaths but patient can also breath freely between mechanical breaths

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17
Q

What is the highest pressure during inspiration called?

A

Peak inspiratory pressure (PIP)

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18
Q

What can occur at the PIP?

A

Pressure will inflate alveoli, opens atelectasis, or cause barotrauma

19
Q

What is the PEEP?

A

Positive end expiratory pressure

-positive pressure that is maintained during expiration (keeps alveoli open)

20
Q

What are indications for PEEP?

A

Open throax
Lung parenchymal disease
Following alveolar recruitment maneuver (ARM)

21
Q

For intubated patients that breathing 100% O2 the main indication to ventilate is to ??

A

Decrease PaCO2

22
Q

For patients that breathe air what are the indications for mechanical ventilation?

A

Hypoxemia
Decrease PaCO2
Decrease work of breathing

23
Q

What are side effects of mechanical ventilation?

A

Hypotension (esp in hypovolemic patients)

24
Q

What is the treatment of hypotension caused by MV?

A

Volume loading
Switch off ventilator
Decrease airway pressure
Inotropic drugs

25
Q

What are the direct effects of hypercapnia?

A

Peripheral vasodilation
Decreased myocardial contractility
Bradycardia
Increased ICP

26
Q

What are the indirect effects of hypercapnia?

A

Duct to catecholamine release

  • tachycardia
  • increased myocardial contractility
  • increased BP
27
Q

What is the respiratory rate for healthy lungs?

A

10-15 breath/min

28
Q

Tidal volume of healthy lungs ?

A

10-15 ml/kg

29
Q

When ventilating, PIP should be how much if BW <10kgs?

A

10 cmH2O

30
Q

When ventilating, PIP should be how much if BW > 10kg?

A

20 cmH20

31
Q

What should PEEP be when ventilating healthy lungs?

A

0-2 cmH2O

32
Q

How is ventilation performed?

A

Close pop-off
Squeeze reservoir bag to desired pressure
Release bag so patient can passively expire
Open pop-off
Repeat 10times/min

33
Q

What is the volume control ventilation mode?

A

Device sets tidal volume, pressure is a deepest variable

If compliance is decreased —> pressure would increase

Difficult to control tidal vol in small patients

34
Q

What is pressure controlled ventilation mode?

A

Device sets the airway pressure -> tidal volume is dependent variable

Resistance increase ->volume decreases

Works regardless of body size

35
Q

When is a volume controlled MV indicated?

A

When there are transpulmonary pressure changes

36
Q

When is pressure controlled ventilation MV indicated?

A

When lung volume changes (eg thoracic surgery)

37
Q

How do pneumatic ventilators work?

A

Consist of compressible bellows in a container

Pressurized drive gas in cylinder can compress bellows causing inspiration
When pressure is released, expiration happens spontaneously

An automatic pop-off valve in ventilator is controlled by the drive gas pressure

38
Q

What is er variable for a pressure mode MV?

A

Negative pressure generative by patients breath -» tiggers assisted breath

39
Q

What is the trigger variable for a flow controlled MV?

A

Inspiratory flow generated by patients breath

40
Q

What is a limit variable for MV?

A

Stops inspiration when value is reached

Eg volume or pressure limit

41
Q

What are common causes of patient-ventilator asynchrony during anesthesia ?

A

Inadequate anesthetic depth

Inadequate lung volume or tidal volume

42
Q

How are normal healthy patients weaned from the ventilator after anesthesia?

A

Decrease ventilator setting and cause hypercapnia to stimulate breathing

Or continue ventilating until fully awake

43
Q

What is cyclic recruitment?

A

Alveoli open and collapse with each breath (purposed mechanism of ventilator induced lung injury )

44
Q

How do you ventilate an atelectasis lung?

A

Requires a recruitment maneuver

Increase alveolar minute ventilation —> removes more CO2

RUSVM Anesthesiology (32 decks)

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