MHI And VHI

Question 1

Types of ventilators (6)

Answer 1

SIMV- synchronised intermittent mandatory ventilation
PCSIMV- pressure controlled synchronised mandatory ventilation
ASV- adaptive support ventilation
CMV- controlled mandatory ventilation
SPSV- spontaneous pressure support ventilation (spont)
CPAP- continuous positive airway pressure

Question 2

How do SIMV and PCSIMV work

Answer 2

Volume controlled or pressure controlled. Set resp rate but Will synchronise to patients breaths

Question 3

How does adaptive support ventilator work

Answer 3

Calculates a minute volume, but adapts to how much support they need on insufflation and exsufflation. Used in weaning

Question 4

Complications of ventilators

Answer 4

Barotrauma, high pressure causing damage to airways
Infections e.g ventilator acquired pneumonia
VQ mismatch as air takes route of least resistance
Resp muscle weakness and wastage
Oxygen toxicity, absorption atelectasis, depression of respiratory centres

Question 5

Manual hyperinflation technique

Answer 5

Attach ambubag or waters bag to oxygen, and connect catheter to ET tube. 3-4 breaths at tidal volume, then 3-4 breaths of manual hyperinflation (up to 40cmH2O)
Use inspiratory hold for alveolar filling (collateral ventilation)
Can use a quick release to stimulate a cough/ mimic huff

Question 6

What flow of oxygen is used

Answer 6

100% at 15 L/min

Question 7

What attachment would you use if patient needed PEEP

Answer 7

PEEP valve

Question 8

Benefits of manual hyperinflation (5)

Answer 8

Clear secretions 
Treat atelectasis 
Increase lung compliance 
Improve gas exchange 
Preoxygenate before suction

Question 9

Manual hyperinflation description

Answer 9

Delivers a volume of oxygen into the lungs via positive pressure using rebreathing or self inflating bag.
Breath is delivered at volume 1.5 times greater than tidal volume
Used to treat atelectasis, sputum clearance and improve lung compliance.

Question 10

Benefits of manual hyperinflation

Answer 10

2 hours of better oxygenation
Treat atelectasis and sputum
Stimulate a cough
you can feel for lung compliance

Question 11

Complications of hyperinflation (manual and ventilator)

Answer 11

Barotrauma: high pressures can rupture respiratory tract and pneumothorax
Hypoxia: if not enough oxygen is being absorbed
Decrease in respiratory drive due to breaths being given

Question 12

Contraindications of manual hyperinflation

Answer 12

Peep above 15, risky above 10- cannot maintain airways so collapse, hypoxia etc
Undrained pneumothorax
Emphysematous bullae
Severe bronchospams- increases airway pressure

Question 13

Precautions of MHI

Answer 13

Recent surgery- anastamosis splitting etc
Unstable BP
Acute Head injuries- increase intrathoracic pressure increases intercranial pressure

Question 14

When would ventilator hyperinflation be used

Answer 14

If a patients FiO2 was high, and/ or had a PEEP over 10

Question 15

Ventilator hyperinflation technique

Answer 15

Adjust ventilator to give breaths of 1.5 times greater than tidal volume for 1 minute. Decrease resp rate.
Rest to pretreatment settings and repeat cycle 4-5 times.
Ensure pressures do not exceed 40cmH2O