Mechanical Ventilation

Question 1

Inverse Ratio Ventilation

Answer 1

PCV plus prolong inspiratory time. Decreased insipratory flow rate is used to prolong the time for lung inflation (helps prevent aveolar collapse

Question 2

Indications for inverse ratio

Answer 2

Refractory hypoxemia, or hypercapnia

Question 3

Inverse ratio settings you can adjust

Answer 3

RR, Pressure support, I:E ratio, PEEP, FiO2

Question 4

Adverse affects of Inverse ratio

Answer 4

Can cause Auto PEEP

Question 5

Pressure Support (PSV)

Answer 5

Pt triggers each breath, but a set amount of pressure assists each breath

Question 6

Indications for PSV

Answer 6

Weaning mode, patient only needs airway protection

Question 7

PSV settings you can adjust

Answer 7

Pressure support, PEEP, FiO2

Question 8

Adverse effects of PSV

Answer 8

may not receive adequate tidal volumes

Question 9

High Frequency Ventilation (HFV)

Answer 9

Extremely small tidal volume ventilation with gas exchange occuring via diffusion. Lung is effectively kept open throughout ventilation. AKA open lung

Question 10

High Frequency Ventilation (HFV) indications

Answer 10

Acute resp failure with need to provide lung protection. which prevents (volutrauma)

Question 11

adverse effects of High Frequency Ventilation (HFV)

Answer 11

Very difficult mode of ventilation best used by those with alot of experience

Question 12

Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP

Answer 12

Mode used for a spontaneously breathing Pt in which you are trying not to intubate

Question 13

Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP indications

Answer 13

Acute resp failure, COPD, CHF, hypercapnic resp failure

Question 14

Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP adverse effects

Answer 14

May insuflate the stomach and the patient needs to be awake

Question 15

Noninvasive Positive Pressure Ventilation (NPPV) AKA BiPAP Settings

Answer 15

Insp. pressure and exp. pressure, FiO2

Question 16

Extrinsic PEEP

Answer 16

Prevents alveoli collapsing at the end of expiration and recruits already collapsed alveoli

Question 17

Extrinsic PEEP indications

Answer 17

Improve gas exchange and increase lung compliance

Question 18

Extrinsic PEEP adverse effects

Answer 18

Reduces cardiac filling and cardiac output, can over distend alveoli causing deadspace

Question 19

Intrinsic PEEP. AKA Auto PEEP

Answer 19

caused by prolonged inspirtory times and the vent doesn’t give enough time for full expiration by the Pt

Question 20

Ways to treat Auto PEEP

Answer 20

decrease the inspiratory time, increase the expiratory time and increase the PEEP to match the Pts

Question 21

Plateau Pressure

Answer 21

The pressure needed at the end of inspiration to keep the alveoli open

Question 22

What is the minimal flow resistance in a typical ETT

Answer 22

3-7 cm of H2O/liter/sec

Question 23

Ways to overcome persistent hypoxia

Answer 23

• increase Pt sedation
• paralytics
• placing pt in a prone position
• nitric oxide
• inhaled prostacyclin

Question 24

What is the greatest predictor of the pt being weaned off the vent

Answer 24

the RR/TV ratio

Question 25

Criterior for coming off the vent

Answer 25

FiO2 < 0.5 and PEEP (< or =) 7.5 cm H2O

Question 26

Assist Control (AC)

Answer 26

The Pt initiates the breath but a set tidal volume is delivered if the Pt doesn't initiate the breath then a set rate of breathes is delivered

Question 27

Assist Control (AC) Indications

Answer 27

Acute Resp failure, ARDS, Pneumonia

Question 28

Assist Control (AC) Settings

Answer 28

RR, TV, PEEP, FiO2

Question 29

Assist Control (AC) Adverse effects

Answer 29

Resp alkalosis due to hyperinflation or auto PEEP

Question 30

Intermittent Mandatory Ventilation (IMV)

Answer 30

Vent delivers periodic breaths however spontaneous breaths are allowed between ventilator delivered breaths

Question 31

Intermittent Mandatory Ventilation (IMV) Indications

Answer 31

reduce risk of alkalosis and hyper inflation, COPD, Asthma,

Question 32

Intermittent Mandatory Ventilation (IMV) Settings

Answer 32

RR, TV, PEEP, FiO2

Question 33

Intermittent Mandatory Ventilation (IMV) adverse effects

Answer 33

Large work of breathing and high pressures maybe needed to deliver the preset tidal volume

Question 34

Syncronized vs Asyncronized

Answer 34

SIMV are syncronized breaths with spontaneous breathing. IMV can cause breath stacking and a breath being delivered while the Pt tries to exhale.

Question 35

Pressure Control Ventilation (PCV)

Answer 35

Breathes are delivered at a certain pressure and rate with a variable TV.

Question 36

Pressure Control Ventilation (PCV) Indications

Answer 36

Reduce risk of barotrauma, Pneumothorax, ARDS

Question 37

Pressure Control Ventilation (PCV) Settings

Answer 37

RR, Pressure support

Question 38

Pressure Control Ventilation (PCV) adverse effects

Answer 38

Variable inflation volumes R/T changes in lung mechanics