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PHTH 564 - ICU > Mechanical ventilation > Flashcards

Mechanical ventilation Flashcards

1
Q

4 clinical conditions leading to mechanical ventilation?

A
  1. depressed resp drive
  2. excessive ventilator workload
  3. failure of ventilatory pump
  4. impending resp failure
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2
Q

Type I resp failure = decreased ____

A

PaO2

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3
Q

Type II resp failure = increase ____ and decreased _____

A

PaCO2; PaO2

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4
Q

2 types of mechanical ventilation?

A
  1. positive pressure

2. negative pressure

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5
Q

Pt is ________ in negative pressure ventilation

A

immobilized

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6
Q

In negative pressure ventilation, ________ _____ is applied to the outside of the chest wall

A

subatmospheric pressure

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7
Q

In negative pressure ventilation, chest wall _____ and air flows into lungs, closer to normal lung physiology

A

expands

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8
Q

In + pressure ventilation, pressurized air is _____ into the lungs

A

pushed

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9
Q

2 methods of + pressure ventilation?

A
  1. IPPV

2. NIPPV/ NIV

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10
Q

Mechanical ventilation _____ and ______ effects require monitoring

A

pulmonary; hemodynamic

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11
Q

5 pulmonary effects due to mechanical ventilation requiring monitoring?

A
  1. increased V/Q and dead space/ tidal volume ratio
  2. air trapping
  3. barotrauma
  4. pneumothorax / subcutaneous emphysema
  5. resp distress
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12
Q

4 hemodynamic effects due to mechanical ventilation requiring monitoring?

A
  1. decreased venous return
  2. decreased CO
  3. decreased BP
  4. decreased renal perfusion
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13
Q

Does prophylactic chest physio decrease incidence of ventilator associated pneumonia (VAP)?

A

NOPE

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14
Q

5 methods to reduce incidence of VAP?

A
  1. HOB elevation
  2. oral hygiene
  3. DVT and peptic ulcer prophylaxis
  4. daily sedation vacation
  5. reduced frequency of changing vent circuit
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15
Q

Less invasive method of ventilation is always preferred over more invasive (T/F)

A

TRUE

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16
Q

6 CI’s and precautions to NIC?

A
  1. facial trauma
  2. obstruction to upper airway
  3. hemodynamic instability and multiple organ failure
  4. decreased LOC
  5. undrained pneumothorax
  6. high risk of aspiration and vomiting
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17
Q

4 non invasive patient interfaces?

A
  1. face mask
  2. nasal mask
  3. nasal cannula
  4. full face mask
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18
Q

3 invasive patient interfaces?

A
  1. oral endotracheal tube
  2. nasal endotracheal tube
  3. tracheostomy
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19
Q

Most patients start with ______ _____ if on NIV

A

oronasal mask`

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20
Q

What is biggest factor in choosing type of NIV?

A

patient comfort

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21
Q

In IPPV, most adults are intubated with a _____ ____ ______ tube

A

cuffed oral endotracheal

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22
Q

Most frequent type of IPPV in infants ?

A

nasal endotracheal tubes

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23
Q

Is pt able to speak with endotracheal tube?

A

No

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24
Q

More sedation is required for tracheostomies than endotracheal tubes (T/F)

A

FALSE - opposite

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25
Q

Endotracheal tubes ____ dead space; tracheostomies _____ dead space

A

increase; decrease

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26
Q

6 control parameters in ventilation?

A
  1. pressure
  2. volume
  3. RR
  4. pressure support
  5. PEEP
  6. FiO2
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27
Q

You can only control pressure OR volume, not both (T/F)

A

TRUE

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28
Q

By controlling pressure and leaving volume variable, you risk ______ and ______

A

derecruitment; atelectasis

29
Q

By controlling volume and leaving pressure variable, you risk ______

A

barotrauma

30
Q

RR = ?

A

set rate + pt rate

31
Q

Pressure support = pressure given to support _______ breaths

A

spontaneous

32
Q

Physiological PEEP = __cmH2O

A

5

33
Q

Therapeutic PEEP can be up to ___ - ___ cmH2O

A

15-20

34
Q

Humidification is important for _______ clearance

A

mucociliary

35
Q

Nasal passages act as ____ and ______ exchange

A

heat; moisture (HME)

36
Q

_____ bypasses upper airway, whereas _____ delivers fast flowing dry gas which overwhelms normal HME mechanisms in upper airway

A

IPPV;NIV

37
Q

______ = essentially only giving pt PEEP

A

CPAP

38
Q

Strongest evidence to support CPAP use in which 2 conditions?

A
  1. acute cardiogenic pulmonary edema

2. COPD

39
Q

CPAP improves FRC (T/F)

A

TRUE

40
Q

In BiPAP =, _PAP and _PAP are set

A

I;E

41
Q

BiPAP is more often used in settings that mimic _____ ______ ventilation

A

pressure support

42
Q

_______ = high flow device that creates PEEP + has active humidification

A

optiflow

43
Q

Big advantage of optiflow compared to other high flow O2 devices?

A

FiO2 and Flow are independent of each other

44
Q

PEEP calculation = __cmH2O pressure for each __L/min flow increment

A

1; 10

45
Q

_______ and ____ _____ ventilation = similar to BiPAP and CPAP with or without pressure support, is used for weaning

A

spontaneous & pressure support ventilation

46
Q

_____ _____ trials = pt left on enough support to overcome resistance of the circuit and ETT

A

spontaneous breathing

47
Q

Rapid shadow breathing index = ?

A

RR/Tv

48
Q

Rapid shadow breathing index > ____ = indicative of weaning failure

A

105

49
Q

_____ ______ ______ ventilation = periodic targeted breaths that occur at set intervals

A

synchronized intermittent mechanical (SIMV)

50
Q

SIMV = ____ or ____ controlled

A

volume; pressure

51
Q

With SIMV, pt can breathe spontaneously b/w mandatory breaths (T/F)

A

TRUE

52
Q

______ ______ ______ = volume or pressure targeted and patient or time triggered

A

continuous mandatory ventilation (CMV)

53
Q

Patient triggered CMV is also called _____ ____ and is most frequently used

A

assist control

54
Q

Time triggered CMV is also called _____ ____ and is known as “full ventilation”

A

control mode

55
Q

Neurally adjusted ventilatory assist (NAVA) = berths triggered by ____ of ______

A

EMG; diaphragm

56
Q

In NAVA, the electrode is built into the ________ tube

A

nasogastric

57
Q

High frequency oscillation = used in some centers for _____ pt’s

A

ARDS

58
Q

Proportional assist ventilation (PAV) = ventilator adjusts flow and volume based on a set _____ ______

A

minute volume

59
Q

PAV shouldn’t be used in difficult to wean pts (T/F)

A

FALSE

60
Q

Protective lung ventilation is used for ___ tidal volumes and permissive ______

A

low; hypercapnia

61
Q

Nitric oxide is a pulmonary ______

A

vasodilator

62
Q

Nitric oxide is used in refractory ________ and pulmonary artery ______

A

hypoxemia; hypertension

63
Q

_____ reduces resistance to airflow

A

helium

64
Q

_____ improves ventilation in acute asthma

A

helium

65
Q

Prolonged ventilation results in resp muscle ______

A

weakness

66
Q

Important to work on resp muscle ____ and _____

A

strength; endurance

67
Q

Resp muscle training = ______ training with sufficient _____ periods

A

submax; rest

68
Q

Role of training with difficult to wean pts?

A
  1. consider timing of rx, discuss with team

2. specific IMT may be appropriate

PHTH 564 - ICU (15 decks)

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