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ECC respiratory > mechanical ventilation S&H > Flashcards

mechanical ventilation S&H Flashcards

1
Q

definition of oxygenation

A

movement of O2 from alveoli into the pulmonary capillaries

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2
Q

oxygenation primarily dependent on …?

A
  • on the surface area available for gas exchange
  • on the preservation of the gas exchange barrier
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3
Q

ventilation is primarily dependent on …?

A

fresh gas flow into the alveoli

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4
Q

definition of compliance

A

change in lung volume for a given change in pressure

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5
Q

what is an assisted breath?

A

the patient determines the respiratory rate, but tidal volume is generated by the machine

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6
Q

what is a controlled breaht?

A

the machine determines respiratory rate and tidal volume

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7
Q

what are the 2 basic ways a ventilator can generate breaths by

A
  • volume controlled
  • pressure controlled
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8
Q

what settings are made for the volume controlled breath

A

preset tidal volumes and inspiratory time

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9
Q

peak inspiratory pressure in volume controlled breaths depend on …?

A

…on tidal volume chosen and compliance of the respiratory system

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10
Q

what settings are made for the pressure controlled breath?

A

preset airway pressure and inspiratory time

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11
Q

tidal volume in pressure controlled breaths will depend on …?

A

…on airway pressure chosen and compliance of the respiratory system

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12
Q

what is the normal tidal volume in healthy dogs and cats?

A

10-15 ml/kg

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13
Q

what is the initial setting for FiO2

A

100%

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14
Q

what is the initial setting for tidal volume if the lungs are normal?

A

8-12 ml/kg

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15
Q

what is the initial setting for tidal volume in patients with lung disease

A

6-8 ml/kg

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16
Q

what is the initial setting for the respiratory rate in patients with normal lungs?

A

10-20 breaths/minute

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17
Q

what is the initial setting for the respiratory rate in patients with lung disease?

A

15-30

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18
Q

what is the initial setting for minute ventilation in patients with normal lungs?

A

150-250 ml/kg

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19
Q

what is the initial setting for minute ventilation in patients with lung disease?

A

100-250 ml/kg

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20
Q

What is the initial setting for pressure above PEEP in patients with normal lungs?

A

8-10 cm H2O

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21
Q

what is the initial setting for pressure above PEEP in patients with lung disease

A

10-15 cm H2O

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22
Q

what is the initial setting for positive end-expiratiory pressure in patients with normal lungs?

A

0 - 4 cm H2O

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23
Q

what is the initial setting for positive end-expiratory pressure for patients with lung disease?

A

4-8 cm H2O

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24
Q

what is the initial setting for inspiratory flow rate in both patients with normal lungs or lung disease?

A

40-60 L/min

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25
Q

what is the initial setting for inspiratory time in both patients with normal lungs or lung disease

A

0.8 to 1 seconds

26
Q

what is the initial setting for rise time in both aptients with normal lungs or lung disease?

A

0.1 to 0.5 seconds

27
Q

what is the initial setting for inspiratory-to-expiratory ratio in patients with normal lungs?

A

1:2

28
Q

what is the initial setting for inspiratory-to-expiratory ratio for patients with lung disease?

A

1:1 to 1:2

29
Q

what is the initial setting for inspiratory trigger in both patients with normal lungs or lung disease?

A

airway pressure drog by 1-2 cm H20

gas flow change by 1-2 L/min

  • lower triggers in smaller patient
  • don’t set too sensitive –> movements like patient handling could initiate breaths
30
Q

what is rise time? in what type of ventilation is it set?

A

time in which airway pressure increase from baseline to peak pressure –> setting in pressure-controlled ventilation

31
Q

what is the inspiratory time determined by?

A

the flow rate (40-60 L/min)

32
Q

how high may the inspiratory pressure be set to in patients with lung disease and decreased compliance?

A

may be set as high as 30 mm Hg (normally kept under 20, ideally closer to 10)

33
Q

what is PEEP (positive end-expiratory pressure)?

A

maintains positive pressure in the airway during exhalation and therefore prevents complete emptying of the lungs

  • initially often set at 2-5 cm H2O and then tirtrated
34
Q

how is PEEP though to increase oxygenation?

A
  • recruits previously collapsed airways
  • prevents further alveolar collapse
  • reduces ventilator-induced lung injury
35
Q

what is the definition of hypoxemia and severe hypoxemia?

A

hypoxemia –> PaO2 < 80 mm Hg and SpO2 < 95%

severe hypoxemia –> PaO2 < 60 mm Hg and SpO2 < 90%

36
Q

when does PCO2 fail to be an accurate predictor of hypoventilation?

A

in a patient that is not hemodynamically stable

37
Q

definition of severe hypoventilation?

A

PaCO2 > 60 mm Hg

38
Q

what are common causes for sever hypoventilation/hypercapnia

A
  • increased dead space in the breathing circuit
  • upper airway obstruciton
  • sedative overdose
  • neurologic or neuromuscular disease
  • post CPA
39
Q

indications for mechanical ventilation

A
  • severe hypoxemia despite O2 therapy
  • severe hypoventilation despite therapy
  • dysnpea with impending respiratory fatigue or failure
  • severe hemodynamic compromise
  • patients requiring > 60% FiO2 over prolonged period of time –> to prevent O2 toxicity
40
Q

important monitoring during mechanical ventilation

A
  • ECG
  • core body temperature
  • arterial blood pressure
  • end-tidal carbon dioxide
  • pulse oximetry
  • serial arterial blood gas measurements
41
Q

maximum tracheal cuff pressure

A

25 mm Hg

42
Q

goals of mechanical ventilation (PaCO2 and PaO2)

A

PaCO2 35-50 mm Hg and PaO2 80-120 mm Hg

with the least aggressive setting possible

43
Q

equation for V

A
44
Q

equation for VT

A

VT = respiratory rate x tidal volume

45
Q

equation for VA

A

VA = alveolar minute ventilation = VT - dead space volume

46
Q

what is dead space?

A

part of tidal volume that doesn’t participate in gas exchange

47
Q

what is the main determinant of PCO2?

A

VA = alveolar minute ventilation

48
Q

things to assess in hypercapnia and how to respond

A
  • check for increased dead space from excess tubing etc.
  • check for airway obstruction, e.g., kinked tube or obstruction from secretion
  • if those are not the case –> hypercapnia likely from decreased VA

next step –> increase respiratory rate and/or tidal volume –> reevaluate PCO2

49
Q

what to do if CO2 is lower than reference range?

A

decrease respiratory rate and/or tidal volume

50
Q

what is the goal FiO2 during mechanical ventilation?

A

< 60%

(risk of O2 toxicity if FiO2 > 60% for > 24 hours)

51
Q

what should you do if the patient becomes hypoxemia?

A
  1. increase FiO2 to 100%
  2. if still hypoxemic –> increase PEEP, peak inspired airway pressure/tidal volume or respiratory rate
  3. Keep animal in prone position/sternal recumbency
52
Q

groups of complications from mechanical ventilation

A
  • cardiovascular compromise (impairment of intrathoracic blood flow)
  • ventilator-induced lung injury
  • ventilator-induced pneumonia
  • pneumothorax
53
Q

pneumothorax during mechanical ventilation is likely a cause of …?

A

underlying lung disease

54
Q

indicators of pneumothorax during mechanical ventilation

A
  • acute decline in oxygenating ability
  • elevstion in PCO2
  • decreased chest wall movement and compliance
  • patient-ventilator asynchrony
55
Q

causes of patient-ventilator asynchrony

A
  • hypoxemia
  • hypercapnia
  • pneumothorax
  • hyperthermia
  • inappropriate ventilator settings
  • full urinary bladder or colon
  • inadequate depth of anesthesia
56
Q

causes of decreases in oxygenation during mechanical ventilation

A
  • loss of O2 supply
  • machine or circuit malfunction
  • deterioration of the underlying pulmonary disease
  • development of new pulmonary disease
57
Q

causes of hypercapnia during mechanical ventilation

A
  • pneumothorax
  • bronchoconstriction
  • obstruction of endotracheal or tracheostomy tube
  • inceased apparatus dead space
  • incorrect assembly of the ventilator circuit
  • increased pulmonary dead space (increases in PaCO2-ETCO2 gradient)
  • inadequate ventilator setting (low tidal volume, inspiratory or expiratory time)
58
Q

prognosis for successful weaning from mechanical ventilation and survival to discharge in animals with pulmonary parenchymal disease

A
  • 30% weaned off

20% survive to discharge

59
Q

prognossi for successful weaning from mechanical ventilation and survival to discharge in animals with intracranial or neuromuscular disease

A

50% weaned off, 40% survive to discharge

60
Q
A

ECC respiratory (3 decks)

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