Modes Flashcards
Machine does all the work
Mandatory
Patient triggers breath, machine controls and ends the breath
Assisted
Patient triggers, controls, and ends breath. Machine augments breath.
Spontaneous
CMV=VCV=?
Volume Control
Full Support
CMV
Used for Flail Chest
CMV
CMV Trigger
Time
Should only be used if patient is medicated/sedated/depressants/neuro muscular blockers.
CMV
Important alarm for CMV
Low Pressure, Low Exhaled Volume
CMV Limit
Volume (flow or vol. cont)
CMV Cycle
Volume or Time
CMV Trigger
Time
I—>E Ends Inspiration and Starts Expiration
Cycle
Starts Inspiration
Jesus… and Trigger.
CMV Therapist Controls
Flow
I-time
Volume
Rate (min and max)
CMV Patient Control
NONE
CMV comp/resis
Peak Pressure
What is the Limit Insp. for all Volume controlled ventilation?
Volume target (flow or volume content)
A/C
Volume Assist Control
A/C Trigger
Time or Patient
A/C limit insp.
Volume Target (flow or vol cont.)
What is the cycle for ALL Volume Control Ventilation?
Volume or Time
Assist Control =
A/C, VC-AC
A/C Patient Variable
Max Rate
What Two Modes have no spontaneous breaths?
CMV and A/C
according to the chart she handed
How does the patient tolerate if they are awake in A/C mode?
Poorly Tolerated
What may happen if you use A/C mode on a patient with COPD
Air Trapping
What will happen with patients who have a rapid drive to breathe in A/C mode?
They may hyperventilate
Which of the following are Common Causes of Rapid Drive to breathe?
I. Metabolic Acidosis II. Anxiety III. Stress IV. Irritable Bowel V. Hypoxemia VI. Pain VII. Inappropriate Vent Settings
All of them except IV
If patient starts to show signs of a rapid drive on A/C ventilation what would be two things you could do?
Switch to SIMV or sedate the patient
In A/C what does the patient have a guarantee of?
Minute rate.
Or its money back… That wasn’t funny
In A/C mode what does the patient determine
Maximum
How would you want to set the rate on A/C?
2 < patient Rate
Full Support on a Vent will do what to a patients WOB
Decrease it
A/C trigger settings
Operator sets trigger Sensitivity
Must have proper trigger setting
A/C What will vary with change in compliance and resistance
Pressure
A/C if flow is not set properly what will happen to pt’s WOB
Increase
A/C why is volume constant?
Because flow and I time are constant
IMV =
Intermittent Mandatory Ventilation
TRUE OR FALSE!
IMV is spontaneous and mechanical breathing?
TRUE
IMV trigger on mechanical
Time
IMV trigger on Spontaneous
Patient
IMV Limit Insp. Mechanical
Volume (flow)
IMV Limit Insp. Spontaneous
None
IMV (S) Therapist Control
Sensitivity for trigger of spontaneous breaths
IMV (M) Cycle
VOLUME OR TIME
IMV (S) Cycle
FLOW
In Spontaneous breaths what will be the cycle?
Flow (if demanded)
What Three Volume Modes have Spontaneous breaths?
IMV
SIMV
SIMV/PSV
Whats the old term she put in her PPT that describes the machine shooting more breath into a patients lung before they exhaled the last one that isn’t used anymore?!
Breath Stacking
How was breath stacking resolved?
SIMV
IMV (S) Patient Control
Flow
Volume
I Time
Spontaneous Rate
IMV (M) Patient Variable
NONE
IMV (M) COMP/RESIS
Peak Pressure
IMV (S) COMP/RESIS
Flow
Volume
I/E Time
Spontaneous Rate
SIMV
Synchronized Intermittent Mandatory Ventilation
SIMV can be considered partial vent support but can be considered full vent support if?
The rate is increased
TRUE OR FALSE!
The synchronous window is adjustable in SIMV?
FALSE!
The synchronous window is not adjustable in SIMV.
Do patients adapt themselves to the machine rate in SIMV
Yes
ON SIMV Patients can regulate A) pH B) Co2 C) Temperature D) A & B
D
ON SIMV patients can regulate their own pH and Co2
How are the weaning protocols on SIMV?
Excellent!
SIMV may help maintain _____ strength and _______
muscle; coordination
SIMV may provide a lower ______ than A/C
MAP (mean airway pressure?)
SIMV with high PSV can do what to WOB
INCREASE
SIMV what can occur at lower rates
Acute Hypoventilation
SIMV weaning can be?
prolonged
SIMV what is needed to overcome WOB?
PSV
(Common Sense) SIMV what can occur in patients who have rapid shallow breathing
fatigue
PSV
Pressure Support Ventilation
SIMV C PSV Spontaneous Limit. Insp.
Pressure Target (Press Cont)
According the Chart Denise handed back what is the only Volume control mode that has Limit Insp. in Spontaneous Breathing?
SIMV c PSV and it is Pressure Target.
What is Therapist Control in Spontaneous Breathing for SIMV c PSV
Sensitivity
Ramp
Pressure Level during Inspiration
Flow Cycle
is PSV mechanical or spontaneous or both?
Spontaneous
What is PSV doing to spontaneous breathing
Augments
PSV Like ____ delivers a high flow of gas at beginning and then it tapers are pressure gradient equalizes
PCV
PSV Like PCV delivers a _____ flow of gas at beginning and then it tapers are pressure gradient equalizes
High
PSV Like PCV delivers a high flow of gas at _______ and then it tapers are pressure gradient equalizes
Beginning
PSV What happens to the work of breathing by overcoming resistance to tubing and circuit?
Decreases
PSV Trigger
Patient
PSV Inspiratory Limit
Pressure Target
PSV Cycle
Flow
PSV Therapist Control
Sensitivity
Ramp
Pressure Level during inspiration
flow cycle
PSV Patient Control
Flow
Volume
I/E Time
Spontaneous Rate
PSV Compliance/Resistance
Flow
Volume
I/E Time
E Time
The ______ _______ % adjusts the flow cycle level of pressure supported breaths. In the event of a leak, the ETS % can be adjusted to that pressure supported breaths will end. Maximum setting is 45% which will be effective for all large leaks.
expiratory Sensitivity
The expiratory Sensitivity % adjusts the_____ _____level of pressure supported breaths. In the event of a leak, the ETS % can be adjusted to that pressure supported breaths will end. Maximum setting is 45% which will be effective for all large leaks.
flow cycle
The expiratory Sensitivity % adjusts the flow cycle level of ______ supported breaths. In the event of a leak, the ETS % can be adjusted to that pressure supported breaths will end. Maximum setting is 45% which will be effective for all large leaks.
Pressure
The expiratory Sensitivity % adjusts the flow cycle level of pressure supported breaths. In the event of a leak, the ETS % can be adjusted to that pressure supported breaths will end. Maximum setting is ___% which will be effective for all large leaks.
45%
The expiratory Sensitivity % adjusts the flow cycle level of pressure supported breaths. In the event of a leak, the ETS % can be adjusted to that pressure supported breaths will end. Maximum setting is 45% which will be effective for all ____ leaks.
Large
Fine Tunes the length on inspiration for the patient
Expiratory Time Sensitivity
CHART
Pressure Control Mode (PCV) VS. PSV
PSV= E-time are shorter
PCV= I Times are constant
What two modes are used to overcome resistance in tubing poor demand flow and airways
PSV and SIMV
PSV Level = ?
RAW
Raw =
Peak-Plat (cmH20)
Raw= —————–
Flow (Lps)
Refers to maximum to unloading of respiratory muscle
PSVmax
Whatever is needed to achieve Vt ___-____ ml/kg then titrated to let pt do more work.
10-12
Whatever is needed to achieve Vt 10-12 ml/kg then titrated to let ____ do more work.
patient
Looking at chart of a patient on CPAP what would you notice about the pressure?
The baseline has increased
Combines two modes of A/C (with limit number of breaths) and PSV during spontaneous Breaths
SIMV and SPV
How often is SIMV with PSV used?
ALL THE TIME
PSIMV
Pressure Synchronized Intermittent Mandatory Ventilation
Combination of pressure assist/control breaths and PSV during spontaneous breaths
PSIMV and PSV
PSIMV spontaneous or mechanical or both?
BOTH
SIMV c PSV and CPAP
adding peep to the mix
SIMV c PSV and CPAP are what kind of machine breaths
volume targeted machine breaths
SIMV c PSV and CPAP are volume targeted machine breaths
PSIMV c PSV and CPAP are what kind of machine breaths
pressure targeted
MMV
Mandatory Minute Ventilation
MMV is used in
Weaning
Set MV at __% - ____% of current VE
70% and 90%
MMV what does the vent monitor if it drops below set level of the vent and provides mechanical support to make-up difference
Spontaneous Minute Volume
CPAP
Continuous Positive Airway Pressure
MMV Bear 1000
Increasing breath rate
MMV Hamilton
Increases preset pressure
Machine reads total volume in one minute, patient can breath at low volume very fast and keep same ?
minute volume
What must you set correctly in MMA
High Frequency and low VT correctly
Airway pressure release ventilation
Two levels of spontaneous breathing and allow the patient to ____ and _____ at both levels
Inspire and Expire
Airway pressure release ventilation
Each pressure level is ____ and _____ triggered
time cycled and time triggered
Airway pressure release ventilation
Set high level by?
Oxygenation
Airway pressure release ventilation
High level is interrupted by allowing pressure to drop very briefly (1 sec) to _____ level
Lower
Airway pressure release ventilation
lower pressure allow patient is _____ and reduce _____
Exhale; FRC
Expiration flow not generally permitted to return to baseline so ______ is intentionally present
auto peep
Trigger - Time and Patient
Trigger Sensitivity Initiate Start Change from E to I Begin the breath
Inspiration
Pressure
Pressure Controlled
Pressure Target
Pressure Oriented
Pressure Limited
Inspiration
Pressure
the machine reaches a ___ pressure and maintains that pressure during the breath
set
Inspiration
Pressure
Flow varies with?
Lung changes
Inspiration
Pressure
Volume varies with
Lung Changes
Inspiration
Volume
volume oriented
volume targeted
volume limited
volume controlled
Inspiration
Volume
Flow?
Controlled
Inspiration
Volume
____ Guarentee
Volume
Inspiration
Volume
Volume Does OR does not change with lung
DOES NOT CHANGE
Inspiration
Volume
Pressure varies with
Lung changes
Cycle
Cycle End of breath Terminated Extinguish Begin Expiration Change from I to E
What is the mode
Inspiration is started by the machine or patient, pressure is guaranteed, inspiration is terminated when a set time has elapsed.
P-AC
VOLUME Modes
control A/C IMV (control and spon SIMV SIMV c PSV
PRESSURE MODES
PSV
PC/AC, P-AC, PCV
PSIMV- PAC (PC) and spon
PSIMV C PSV
