Modes of Ventilation Flashcards
What is endotracheal intubation used for?-5
- maintain an airway
- remove secretions
- prevent aspiration
- provide mechanical ventilation
- bypasses the patient’s normal protective airway mechanisms
What is the endotracheal tube cuff used for?
- prevents air leaks around the tube
- prevents aspiration
- ensures ventilator is 100% responsible for patient ventilation
What needs to happen to the balloon before extubating
deflate the balloon!!
How to Verify placement of ETT tube (5) and what to do after it is verified (2)
- ETCO2 detector (checks CO2 levels, makes sure the tube is in the trachea and not the esophagus)
- auscultate chest and epigastric area
- confirm bilateral breath sounds
- obtain an order for CXR for placement verification and documentation
- CXR –> shows it is 3-4 cm above carina
- secure tube when placement is verified
- record cm at lip line for reference
ETT nursing care: airway patency -4
- suction as needed- max pressure 120 mmHg (air way patency is priority)
- maintain and secure tubing with holder
- monitor and chart cm at the lip line
- monitor CXR for correct placement
Indications for tracheostomy-5
- long-term mechanical ventilation
- frequent suctioning
- protecting the airway
- bypass an airway obstruction
- reduce WOB
Indications for ventilation- 3
- hypoxemia (PaO2 < 60mmHg on FiO2 > 0.5)
- hypercapnia (PCO2 > 50mmHg with pH < 7.25)
- progressive deterioration (increased RR, decrease VT, increase WOB)
What needs to be in the patients room at all times?
manual resuscitation bag (ambu bag)
What is PEEP?
pressure applied by the vent at the end of each breath allowing alveoli to remain open
PEEP –> What does it do? pressure ranges
- recruits open alveoli in sick lung and improves oxygenation and max gas exchange can happen
- 5-20cm H2O
complication of PEEP
-may increase intracardiac pressure (decrease venous return and CO) MONITOR FOR DECREASED CO
What does PIP do?
maximum pressure is applied to lungs during inhalation
V-AC (volume) –> who triggers support
patient triggered support –> pt initiated breaths
What does V-AC do?
delivers specific volume, but back up respiratory rate
What is CMV?
continuous mandatory ventilation –> ventilator provides 100% respiratory effort and quality
What is P-A/C?
pressure control or assist ventilation
What happens in P-A/C?
patient triggered support –> delivers specific pressure with a backup respiratory rate
in P-A/C, what does volume get based on?
lung compliance –> decreased compliance leads to decreased volume in the lungs
What is the alarm set for in P-A/C?
volume
What is the alarm set for in VAC?
increased pressure
What disease process if P-A/C typically used for?
ARDS
Why isn’t volume control used in ARDS?
volume control may increase inflammation
ventilator settings for ARDS
- pressure control ventilation
- PEEP for alveoli recruitment (12-14)
- lower tidal volume
- monitor hemodynamics/CO
- alarm set for volume
What is pressure support?
aid for mechanical ventilation –> keeps the entire lung open, not just alveoli
What happens with pressure support?
-spontaneous efforts are assisted with preset positive pressure (6-12cm H2O)
pressure support uses-5
- decreased WOB through ETT
- target: bests pressure to achieve adequate TV
- used on most patients
- useful in weaning from ventilator
- keeps airway open
What is SIMV?
patient or ventilator-initiated breaths w/ their own tidal volume (volume or pressure control)
when is SIMV used
used more with long-term weaning-trached patients
What is high frequency oscillatory ventilation?
utilizes a RR greater than four times the normal RR
high frequency oscillatory ventilation-4
- very small tidal volumes
- reduces ventilator-associated lung injury
- especially useful in ARDS and acute lung injury
- lung protective ventilation
requirements for BiPAP
- tight seal of mask
- intact respiratory drive and effective respiratory rate
- able to protect airway
CPAP information-4
- requires spontaneous breathing
- better bronchodilator/steroid effect
- weaning from vent or delay need for intubation
- requires patient ready to sustain RR and some volume
Main difference between CPAP And BiPAP
CPAP is the same pressure throughout the respiratory cycle while BiPAP is higher pressure on inspriration
Can you shut off alarms?
no! can silence temporarily but cannot be shut off
What to do if an alarm is going off and you cannot find the problem?
remove pt from ventilator and manually ventilate the patient with ambu bag
When would a high inspiratory pressure alarm go off?-3
- coughing or attempting to talk
- kinks in ventilator tubing
- need for suctioning
Complications of mechanical ventilation-3
- ETT out of position
- unplanned extubation
- laryngeal/tracheal injury
how to prevent laryngeal/tracheal injury-3
-prevent excessive head movement
-routine monitoring of ETT cuff pressure
Cuff pressure shouldn’t be higher than 20-30 cm H2O
How does barotrauma occur?
alveolar over inflation and rupture due to elevated pressure
complications from barotrauma
air leaks into extra-alveolar tissue causing pneumothorax or tension pneumothorax
How to detect barotrauma-4
- decreased breath sounds
- tracheal shift
- subcutaneous emphysema
- hypoxema
What is volutrauma?
overdistension of alveoli –> damages lungs similar to ARDS
s/s volutrauma-5
- dyspnea
- tachypnea
- hypotension
- severe hypoxemia
- confusion and extreme fatigue
FiO2 of ____% causes and increased risk of airway damage and oxygen toxicity
50%
s/s oxygen toxicity
- tracheobronchitits
- atelectasis
How long can FiO2 of 100% be tolerated
24 hours
prevention of VAP –> VAP bundle (5)
- hob 30-45 degrees
- daily sedation interruption (assess readiness to wean)
- DVT prophylaxis
- PUD prophylaxis
- oral care: chlorhexidine
readiness to wean-6
- underlying cause for ventilation resolved
- hemodynamic stability; adequate CO
- adequate respiratory muscle strength
- adequate oxygenation without high FiO2 and/or high PEEP
- mental readiness
- minimal need for medicines that cause respiratory depression
complications of extubation (4)
- stridor
- hoarseness
- change in VS
- low O2 saturation
What can be used to prevent need for reintubation?
BiPAP
