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PA 2 (RESP 262) > Mod 4 (VILI & PPV) > Flashcards

Mod 4 (VILI & PPV) Flashcards

1
Q

What happens when cuff pressures are low?

A

1. Risk of aspirations and increase risk of pneumonia.

  1. Leak = poor ventilation = decreased Vt
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2
Q

How often should the position of the EDT be moved (side-side)

A

Q24h

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3
Q

Define purulent sputum

A

pussy sputum

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4
Q

Describe PPV impairment of ICP and Cerebral perfusion? what are the downstream repercussions?

A
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5
Q

Ventilator-induced lung injury:
what can result of too much of PPV?

A

Barotrauma

volutrauma

atelectrauma

bio trauma

oxygen toxicity

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6
Q

What is the most severe and acute form of lung injury?

A

Barotrauma: lungs pop

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7
Q

Volutrauma is characterized by

A

Over-distension of alveoli, they overstretch and get leaky.

Lungs become swollen and heavy.

regional

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8
Q

Atelectrauma is usually associated with and is characterized with

edit

A

Very stiff lungs; occurs in dependant areas.

Associated w/inadequate PEEP.

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9
Q

What does atelectruama lead to?

A

Huge risk factor of ARDS

Leads to shear stress
-(strain exerted on alveolar wall between expanded lung unit and derecruited lung unit

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10
Q

What is Atelectruma?

A

Injury that results in repeated openings and closing units at lower lung volumes

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11
Q

Define Biotrauma

A

The lung releases inflammatory mediators as a result of volutrauma and/or atelectruma.

Resembles ARDS

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12
Q

what do we want to keep delta pressures below?

A

below 15 cmH2O

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13
Q

Review slides before 24. fell asleep too much.

A
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14
Q

What affect will adding positive pressure have systemically?

A

Increases intrapleural and intrathoracic pressure;
- dependant off PEEP, PPV, and Lung compliance

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15
Q

What may cause a decrease in pulmonary vascular resistance?

A
  • decrease due to improved ABG
  • increase due to compression of alveolar cap by and over-distended alveoli; can result in decreased pul.perfusion
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16
Q

Atrial natriuretic peptide

A

Changes the level of salt released?

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17
Q

Describe typical Renal system response from hemodynamics changes?

  • When Urine output [U/O] decreases as a result of PPV?
A

Decreases CO -> decrease in renal perfusion

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18
Q

How does a Decrease in PaO2 affect renal function?

A

Decrease U/O
- function is dramatically decreased when < 40mmHg

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19
Q

PaCO2 > 65 mmHg decreases what in the renal system?

A

Kidney function

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20
Q

Liver function: PEEP has more impact on what, in comparison to PPV?

A

Hepatic blood.

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21
Q

Methods to assess gas exchange?

A

Monitor/manipulate oxygenation and ventiation

22
Q

Main causes of abnormal gas exchange

A

Shunt and deadspace

consider v/q as well

23
Q

Anion Gap?
- review calc.

A
24
Q

ARDS order of severity?

(in terms of values)

A

< 300
< 200
< 100

25
Q

Higher the Oxygen index values indicates?

A

More severity. Prone pts to as a counter to improve Pf ratios

26
Q

Do the lungs or chest wall have dynamic or static compliance

A

Generally, lung compliance is dynamic.

the chest wall us usually static

27
Q

Hysteresis reflects what from the compliance and volume pressure curve?

A

The effort to take a breath in. review and edit

28
Q

Factors that decrease lung compliance

A
  • Atelectasis
  • pneuomonia
  • ALI/ARDS
  • Pneumotrhoax
  • fibrosis
  • bronchial intubation
29
Q

Factors decrease thoracic compliance?

A
  • obesity
  • ascites
  • Chest wall deformity
30
Q

Factors that increase lung compliance?

A

Pulmonary emphysema

(add more later) slide 72

31
Q

Factors that increase thoracic compliance

A
  • Flail chest
  • position changing (sitting up)

add more later, slide 72

32
Q

COCA Abbreviation?

A

Amount for draining from the body?

  • Colour
  • Odour
  • Consistency
  • Amount

Helps determine how many passes for suction.

33
Q

Respiratory effects of PPV: what are some complications you could develop?
- [VALI] think precautions (5)

A

Ventilator induced lung injury

Barotrauma

Volutrauma

Biotrauma

oxygen toxicity

34
Q

What is the most acute and immediate severe form of volume induced lung injury [VILI]?

A

Barotrauma

35
Q

What increases the risk of barotrauma?

A

Increase in of alveolar pressure [Pplat] and the extent of lung injury/previous lung disease

36
Q

What does Barotrauma result in and what causes Barotrauma?

  • Think Mechanism of Action
A

Extra-alveolar air due to PPV rupturing the A/C membrane

37
Q

What are some complications that develop as a result of Barotrauma?

A

SubQ Emphysema

pneumothorax

pneumomediastinum

38
Q

What is Open lung ventilation?

A

Using PEEP to maintain recruit t/o the resp. cycle.

  • Vt is set to prevent over-distension.
39
Q

How is the heart affected by pneumothorax’s?

A
  1. Can cause the heart to shift
  2. when the heart is prevented from stretching then circulation is impaired
40
Q

How can PPV’s make a pneumothorax worse?

A

Can develop into tension and when left untreated PPV will push harder into the pleural spaces?

41
Q

What is shear stress in the lungs?

A

Occurs in the interstitial space between an open/closed alveoli.

  • Cap injury and release of inflammatory mediators results
42
Q

What is auto peep associated with?

A

Air trapping

43
Q

What are the positive affects of PPV?

A
  1. Increased FRC (via PEEP/CPAP is used)
  2. Mechanical bronchodilation in conducting airways
44
Q

What 2 factors both increase with PPV?

A

Deadspace ventilation and intrapulmonary Shunt increase.

45
Q

What are lung protective strategies to minimize volutrauma/barotrauma?

A
  1. set appropriate tidal volumes between 6-8 ml/Kg
  • only go to 4-5 if neccessary.
  1. Consider permissive hypercapnia
  2. Pay attention to PEEP, auto peep, ETT placement
46
Q

What are sigh breaths and when do you want to avoid them?

A

Sigh breaths are breaths to reexpand the lungs.

  • avoid them w/high tidal volumes or long insp. pauses
47
Q

How do you minimize de-recruitment and atelectrauma?

A

Use appropriate amount PEEP
.

48
Q

How can PPV breaths lower CO?

A

PPV compresses the blood vessels and atria reducing venous return, which in turn reduces preload form teh heart.

If the heart doesn’t have the same capacity or stretch, CO and BP drop.

49
Q

What does transmission of PPV dependent on what?

A
  1. Amount of PEEP and PPV
  2. Lung compliance
  3. Thoracic compliance.
50
Q

Pathology examples of low and high lung compliances?

A
  1. Low compliance = ARDS
  2. High compliance = COPD

Recall: compliance means air fills easy with last recoil/snap = easy transmission

PA 2 (RESP 262) (14 decks)

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