Mechanical Ventilation Hamilton T1 & MOVES SLC Flashcards
Hamilton T1
Adult Ivasive
> 12 yrs or 40kg
What are the circuit requirements?
- Adult BOMImed Circuit (QT-09091-1)
- Adult/Paed Expiratory Valve
- Flow Sensor (adult/paed)
- ETCO2 Sensor
- HME
- Inline Suction
Hamiton T1
Adult NIPPV
>12yres or 40 kg
What are the circuit requirements?
- Adult Circuit (BOMImed QT-09091-1)
- Colour: Clear
- Adult expiratory valve
- Adult flow sensor
- HME/filter
- Mask
Hamilton T1
Pediatric Invasive
12 years or less or 10 to 40 kg
What are the ciruit reqirements?
- Adult heated circuit (Fisher Paykel RT380)
- Set heat temperature to invasive mode
- Circuit colour: Blue/White
- Adult Expiratory Valve
- HMEF(2)
- Adult flow sensor
- ETCO2 Sensor
- Inline Suction
Hamilton T1
Pediatric NIPPV
12 yrs or 10 to 40 kg
What are the circuit requirements?
- Adult heated circuit (Fisher Paykel RT380)
- Set heater temperature to non-invasive mode
- Colour: Blue/White
- Adult Expiratory Valve
- Adult Flow Sensor
- HMEF(2)
- Mask
Hamilton T1
Infant/Neonate Invasive
< 10 kg
What are the circuit requirements?
- Infant Heated Circuit (Fisher Paykel RT 265)
- Set heater temperature to invasive mode
- Colour:Blue/White
- Infant Expiratory Valve
- HMEF (2)
- Infant Flow Sensor
- Infant/Neonatal ETCO2 Sensor
- Inline Suction
Hamilton T1
Infant/Neonate NIPPV
< 10 kg
What are the circuit requirements?
- Infant Heated Circuit (Fisher Paykel RT 265)
- Set heater temperature to non-invasive mode
- Colour: Blue/White
- Infant Expiratory Valve
- Infant Flow Sensor
- HMEF (2)
- Patient Interface
Hamilton T1
Adult/Pediatric HHFNC
>12 yrs or 40 kg
What are the circuit requirements?
- Adult single limb (Opitflow RT 232)
- Set heater temperature to invasive mode
- Colour: Blue
- Filter (1)
- Expiratory Valve
- Patient interface
Hamilton T1
Infant/Neonate HHFNC
What are the circuit requirements?
- Infant Heated Circuit (Fisher Paykel RT 265)
- Set heater temperature to invasive mode
- Colour: Blue
- Infant Expiratory Valve
- HMEF (1)
- Patient Interface
Hamilton T1
Infant/Neonate nCPAP
<10 kg
What are the circuit requirements?
- Infant Heated Circuit (Fisher Paykel RT 265)
- Set heater temperature to non-invasive mode
- Colour: Blue
- Infant expiratory valve
- No flow sensor but requires pressure sensing line
- HMEF (2)
- Patient Interface
Hamilton T1
What are the steps in the lung recruitment maneuver?
Lung Volume Recruitment Maneuver 30/30
- Set Apnea Alarm to 35 seconds
- MODE APRV: T High 30 sec. P High 30 cmH2O
- Initiate RM with Manual Breath button
- Set ventilation mode post RM
- Increase PEEP 2-3 cmH2O
What is Heated High Flow Nasal Cannula?
Heated High Flow Nasal Cannula (HFNC) is a respiratory therapy that delivers heated and humidified blended oxygen to patients at flow rates higher than those administered with conventional nasal cannula (NC) oxygen therapy.
These high flow rates generate predictable however not quantifiable positive pressure in the pharynx which in turn supports enhanced oxygenation.
Advantages of HFNC therapy over traditional NC O2 therapy
- Floods the oral cavity and the pharynx with fresh gas, this creates a reservoir of fresh blended oxygen which in turn provides a consistent breath-to-breath FiO2.
- Reduces anatomical dead space resulting in improved carbon dioxide elimination.
- May serve to reduce the work of breathing
- Designed to provide sufficient fresh gas flow to meet or exceed the patient’s peak inspiratory flow demands. FiO2 will vary if patient inspired flow rates exceed the set HFNC flow.
- Can generate low levels of positive distending pressure (PEEP). S
- Reduces the use of non-invasive or invasive ventilation through improved patient tolerance.
- Provides optimal humidity reducing the effects of cool, dry inspired gas, providing more effective secretion clearance
Indications for Heated High Flow Nasal Cannula
- Refractory hypoxemia despite optimized conventional nasal cannula and/or non-rebreather mask O2 therapy in individuals with an intact, acceptable respiratory drive
- Adults: SpO2 < 90 %
- COPD/CHF exacerbation requiring a minimal amount of PEEP
- Palliative respiratory support with no endotracheal intubation or non-invasive ventilation (NIV) support in the care plan
A flow rate of 10 Litres per minute on HHFNC will generate how much PEEP?
1.0 cmH2O
What is the initial recommended flow rate for HHFNC in Adult Patients.
- For adults an initial flow of 30 – 40 lpm is recommended.
- Titrate flow to effect. The maximum flow is 60 lpm
MOVES SLC
Theory of Operation
Intubated patients are ventilated with a circle circuit (called a ventilator circuit) used with a ventilator cartridge.
Oxygen and air enter the circuit from either the oxygen concentrator, the air pump or an external O2 supply.
The oxygen concentrator can be set to provide an intubated patient with an inspired O2 concentration (FiO2) between 30% and 85%.
In Ventilator mode, the air pump serves as a back-up source of air flow if the system concentration of oxygen is too low or carbon dioxide is too high or either is unknown
MOVES SLC
Ventilator Cartridge
The ventilator cartridge is designed to remove CO2 from the circle circuit when the system operates at room temperature.
The system provides a warning when the CO2 level in inspired gas exceeds 6 mmHg, which is indicative of cartridge exhaustion, so the cartridge can be changed.
If the cartridge is not changed, the system will enter Safe Gas Mode and increase oxygen production. It will also increase air supply if FiO2 is set to ≤ 40%.
MOVES SLC
Blower Operation
During patient inhalation, the blower pressurizes the ventilator chamber which displaces the gas from the ventilator bag into the patient’s breathing circuit.
The blower draws external air through an inlet filter.
During exhalation, the patient’s expired gas is directed to the ventilator bag.
The ventilator bag also receives oxygen from the concentrator or external O2 source and air from the air pump.
