Mechanical ventilation Flashcards
4 clinical conditions leading to mechanical ventilation?
- depressed resp drive
- excessive ventilator workload
- failure of ventilatory pump
- impending resp failure
Type I resp failure = decreased ____
PaO2
Type II resp failure = increase ____ and decreased _____
PaCO2; PaO2
2 types of mechanical ventilation?
- positive pressure
2. negative pressure
Pt is ________ in negative pressure ventilation
immobilized
In negative pressure ventilation, ________ _____ is applied to the outside of the chest wall
subatmospheric pressure
In negative pressure ventilation, chest wall _____ and air flows into lungs, closer to normal lung physiology
expands
In + pressure ventilation, pressurized air is _____ into the lungs
pushed
2 methods of + pressure ventilation?
- IPPV
2. NIPPV/ NIV
Mechanical ventilation _____ and ______ effects require monitoring
pulmonary; hemodynamic
5 pulmonary effects due to mechanical ventilation requiring monitoring?
- increased V/Q and dead space/ tidal volume ratio
- air trapping
- barotrauma
- pneumothorax / subcutaneous emphysema
- resp distress
4 hemodynamic effects due to mechanical ventilation requiring monitoring?
- decreased venous return
- decreased CO
- decreased BP
- decreased renal perfusion
Does prophylactic chest physio decrease incidence of ventilator associated pneumonia (VAP)?
NOPE
5 methods to reduce incidence of VAP?
- HOB elevation
- oral hygiene
- DVT and peptic ulcer prophylaxis
- daily sedation vacation
- reduced frequency of changing vent circuit
Less invasive method of ventilation is always preferred over more invasive (T/F)
TRUE
6 CI’s and precautions to NIC?
- facial trauma
- obstruction to upper airway
- hemodynamic instability and multiple organ failure
- decreased LOC
- undrained pneumothorax
- high risk of aspiration and vomiting
4 non invasive patient interfaces?
- face mask
- nasal mask
- nasal cannula
- full face mask
3 invasive patient interfaces?
- oral endotracheal tube
- nasal endotracheal tube
- tracheostomy
Most patients start with ______ _____ if on NIV
oronasal mask`
What is biggest factor in choosing type of NIV?
patient comfort
In IPPV, most adults are intubated with a _____ ____ ______ tube
cuffed oral endotracheal
Most frequent type of IPPV in infants ?
nasal endotracheal tubes
Is pt able to speak with endotracheal tube?
No
More sedation is required for tracheostomies than endotracheal tubes (T/F)
FALSE - opposite
Endotracheal tubes ____ dead space; tracheostomies _____ dead space
increase; decrease
6 control parameters in ventilation?
- pressure
- volume
- RR
- pressure support
- PEEP
- FiO2
You can only control pressure OR volume, not both (T/F)
TRUE
By controlling pressure and leaving volume variable, you risk ______ and ______
derecruitment; atelectasis
By controlling volume and leaving pressure variable, you risk ______
barotrauma
RR = ?
set rate + pt rate
Pressure support = pressure given to support _______ breaths
spontaneous
Physiological PEEP = __cmH2O
5
Therapeutic PEEP can be up to ___ - ___ cmH2O
15-20
Humidification is important for _______ clearance
mucociliary
Nasal passages act as ____ and ______ exchange
heat; moisture (HME)
_____ bypasses upper airway, whereas _____ delivers fast flowing dry gas which overwhelms normal HME mechanisms in upper airway
IPPV;NIV
______ = essentially only giving pt PEEP
CPAP
Strongest evidence to support CPAP use in which 2 conditions?
- acute cardiogenic pulmonary edema
2. COPD
CPAP improves FRC (T/F)
TRUE
In BiPAP =, _PAP and _PAP are set
I;E
BiPAP is more often used in settings that mimic _____ ______ ventilation
pressure support
_______ = high flow device that creates PEEP + has active humidification
optiflow
Big advantage of optiflow compared to other high flow O2 devices?
FiO2 and Flow are independent of each other
PEEP calculation = __cmH2O pressure for each __L/min flow increment
1; 10
_______ and ____ _____ ventilation = similar to BiPAP and CPAP with or without pressure support, is used for weaning
spontaneous & pressure support ventilation
_____ _____ trials = pt left on enough support to overcome resistance of the circuit and ETT
spontaneous breathing
Rapid shadow breathing index = ?
RR/Tv
Rapid shadow breathing index > ____ = indicative of weaning failure
105
_____ ______ ______ ventilation = periodic targeted breaths that occur at set intervals
synchronized intermittent mechanical (SIMV)
SIMV = ____ or ____ controlled
volume; pressure
With SIMV, pt can breathe spontaneously b/w mandatory breaths (T/F)
TRUE
______ ______ ______ = volume or pressure targeted and patient or time triggered
continuous mandatory ventilation (CMV)
Patient triggered CMV is also called _____ ____ and is most frequently used
assist control
Time triggered CMV is also called _____ ____ and is known as “full ventilation”
control mode
Neurally adjusted ventilatory assist (NAVA) = berths triggered by ____ of ______
EMG; diaphragm
In NAVA, the electrode is built into the ________ tube
nasogastric
High frequency oscillation = used in some centers for _____ pt’s
ARDS
Proportional assist ventilation (PAV) = ventilator adjusts flow and volume based on a set _____ ______
minute volume
PAV shouldn’t be used in difficult to wean pts (T/F)
FALSE
Protective lung ventilation is used for ___ tidal volumes and permissive ______
low; hypercapnia
Nitric oxide is a pulmonary ______
vasodilator
Nitric oxide is used in refractory ________ and pulmonary artery ______
hypoxemia; hypertension
_____ reduces resistance to airflow
helium
_____ improves ventilation in acute asthma
helium
Prolonged ventilation results in resp muscle ______
weakness
Important to work on resp muscle ____ and _____
strength; endurance
Resp muscle training = ______ training with sufficient _____ periods
submax; rest
Role of training with difficult to wean pts?
- consider timing of rx, discuss with team
2. specific IMT may be appropriate
