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Interventions 1 (RESP 266) > Mod 5 Invasive Vent. management > Flashcards

Mod 5 Invasive Vent. management Flashcards

1
Q

5 steps for the cuff leak test

A
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2
Q

Why would you adjust your I:E settings?

A

1:1 increase MAP

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3
Q

A-a gradient in ICU vs Normal person

A

5-10 for normal

10-15 for ICU Pt

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4
Q

In volume control what happens to you Te when you increase RR?

A

Decreases Te

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5
Q

In volume control what happens to you Te when you decrease RR?

A

Increases Te

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6
Q

Increasing your RR will have what affect on TCT?

A

Decreases TCT

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7
Q

Decreasing your RR will have what affect on TCT?

A

Increases TCT

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8
Q

In volume control, increasing your flow will have what affect on Tidynamic

(assume Vt stays constant)

A

Decrease Ti

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9
Q

In volume control, increasing your Vt will have what affect on Tidynamic

(assume Vt stays constant)

A

Increase Ti

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10
Q

In volume control, decreasing your flow will have what affect on Tidynamic (assuming Vt stays constant)?

A

Increase Ti

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11
Q

In volume control, decreasing your Vt will have what affect on Tidynamic

(assume Vt stays constant)

A

Decrease

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12
Q

When PaO2 does not respond to high FiO2, this is known?

A

Refractory hypoxemia

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13
Q

In volume control, your Ti set is your?

A

Ti Pause or Ti static

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14
Q

In volume control, if you increase your Ti set (Ti pause), what happens to Te?

A

Decreases Te

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15
Q

In volume control, if you decrease your Ti set (Ti pause), what happens to Te?

A

Increases

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16
Q

In volume control, how do you calculate your Tidynamic?

A

Vt/flow = Tidyna (sec)

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17
Q

How to measure auto PEEP?

A

expiratory hold maneuver

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18
Q

Patient factors that create auto-peep?

A

small airway obstructions to expiratory flow

air trapping
i.e asthma, emphysema

19
Q

Vent. factors that create auto-peep?

A

Insufficient time for expiration
-not long enough Te

20
Q

How do you improve your Te?

A

Decrease your Ti to increase Te

21
Q

PEEP total =?

A

Auto-PEEP + PEEP set

22
Q

How should you adjust vent settings when: Compliance increases?

A

The lungs become easier to inflate, and as a result, the tidal volume may increase even if the ventilator settings remain the same.

So:
-Decrease insp. pressure
** Decrease Vt (assuming constant flow)**
** Decrease Ti**

23
Q

How should you adjust vent settings when: Compliance decreases?

A

The lungs become harder to inflate, and as a result, the tidal volume may decrease even if the ventilator settings remain the same.

So:
-Increase Insp. pressures
**-Increase Ti

24
Q

Does decreasing Vt lower inspiratory pressure?

Consider constant flow and constant pressure

A

Decreasing Vt may lower the inspiratory pressure if the vent is set to deliver a constant flow.
-Because a smaller tidal volume requires less gas to be delivered
during each breath, and therefore, a lower inspiratory pressure is needed to achieve that lower tidal volume.

-If the vent set to deliver constant pressure, decreasing the tidal volume won’t lower inspiratory pressure.

25
Q

How can you increase Ti?

A

Increase flow rate and Vt

(Increasing the requirement of more gas delivered = higher insp. times)

26
Q

How should you adjust vent settings when: resistance increases?

A

The lungs become harder to inflate, and as a result, the patient may require higher inspiratory pressures to achieve adequate ventilation.

So:
-Increase RR
-Increase MV
Increase PEEP if pt is tolerant

27
Q

How should you adjust vent settings when: resistance decreases?

A

The lungs become easier to inflate, and as a result, the patient may require lower inspiratory pressures to achieve adequate ventilation.

So:
-decrease RR
-Lower PEEP if pt is tolerant

Avoid overextension on lungs.

28
Q

Given MV = Vt x RR

How can you increase Vt?

A
  1. Increase inspiratory pressure
  2. Increase RR
  3. Increase Insp. flow rate
29
Q

How does increasing RR increase Vt and MV?

A

More breaths per minute = longer

30
Q

How could increasing RR increase Vt and MV?

A
  1. Increasing RR can increase the amount of gas exchange by delivering more breaths per minute. This leads to an increase in MV, which is the volume of gas that is exchanged per minute.
  2. Increasing RR can also lead to an increase in Vt by reducing the amount of time available for exhalation.

Theory:
-When the RR is increased, there is less time to exhale before the next breath is delivered. This can lead to an increase in end-expiratory lung volume, which in turn can increase Vt.

31
Q

How can you increase inspiratory time?

A
  1. Increase Ti
  2. lower RR
32
Q

How can you increase Inspiratory pressure?

A
  1. Increase PIP = greater tidal volume
33
Q

What can increasing PEEP do for FiO2?

A

Increasing PEEP can help to recruit and maintain lung volume, allowing for improved gas exchange.

However, it can also decrease cardiac output and may require an increase in ventilator pressure settings.

34
Q

What are 2 ways to improve oxygenation in a patient

A

FiO2 and Mean Airway Pressure (longer Ti)

-FiO2 will increase the amount of available O2.

-PEEP will increase the amount of surface area for that O2 to use.

35
Q

How does increasing mean airway pressure improve oxygenation?

A

MAP can be manipulated via PEEP which in turn affects Ti

36
Q

Positive Pressure Ventilation [PPV] affects the following:
V/Q matching

A

PRO
-When positive pressure is applied to lungs, it can improve oxygenation and ventilation by increasing alveolar recruitment, which increases gas exchange, and improves distribution.

CON:
Too much PPV ventilation can decrease FRC, leading to decreased oxygenation and ventilation is regions of the lungs (over-distension of alveoli)
-DEADSPACE

37
Q

Define Deadspace

A

ventilation w/o perfusion

38
Q

Define pulmonary vascular resistance [PVR]

A

PVR is resistance to blood flow in pulmonary circulation. PVR is a critical determinant of pulmonary blood flow and plays a role in maintaining oxygenation and cardiac function.

39
Q

How do you know a dose of beta-blockers are effective on a vent?

A
  1. Increased peak expiratory flows
  2. Expiration time improves
  3. Revisit lung sask site for instructions on inhaler admin.
40
Q

What does the difference between flow flow rates and volumes reflect?

A

If there pathology is obstructive or restrictive

41
Q

Why can’t you determine resistance in pressure control?

A
42
Q

What are high levels of troponin in the blood a indicator of?

A

Sign of heart muscle damage.

  • troponin helps control muscle contractions in cardiac muscles.
43
Q

Can you calculate resistance in pressure control?

A

No, only at the teeth for PC.

The flow rates vary depending on airway resistance and compliance so flow rate is not fixed.

44
Q

What is delta pressure?

A

Pplat - PEEP

Interventions 1 (RESP 266) (16 decks)

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