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Basic Principles N928 > Modes of Ventilation > Flashcards

Modes of Ventilation Flashcards

1
Q

Goals of Mechanical Ventilation

A

Maintain homeostasis

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2
Q

OR Goal of MV

A

ensure adequate oxygenation and CO2 removal for safe and effective surgery

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3
Q

ICU goal of MV

A

treatment for severe respiratory distress
provide lungs with a “break” to rest and heal
decrease O2 consumption by providing rest for respiratory muscles

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4
Q

Flow

A

the amount of air moving through a system

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5
Q

Pressure

A

amount of force you build to distend lung

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6
Q

Driving Pressure:

A

peak plateau pressure- PEEP

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7
Q

restrictive pressure

A

overall pressure required to overcome pressure in airways

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8
Q

distending pressure

A

required to open up lungs to open up lunges to provide gas exchange

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9
Q

Peak Inspiratory Pressure

A

PiP
total pressure required to distend lungs and airways
pressure used to calculate dynamic compliance
signals pressure required to overcome both intrinsic factors and chest wall (extrinsic factors) to distend both pressure

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10
Q

Plateau Pressure

A

distending pressure to extend only the lungs
measure redistribution of air flow through the lungs
used to calculate static compliance
Measures intrinsic factors of lung compliance

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11
Q

How do you measure plateau pressure?

A

during an inspiratory hold

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12
Q

Control Variables

A

respiratory Rate
tidal volume
pressure (Pip/PAW/Pplateau)
I:E ratio

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13
Q

4 Parts of Respiratory Cycle

A

start of inspiration
inspiration itself
end of inspiration
expiration

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14
Q

Components of a breath

A

Ti
Te
TCT (total cycle time)

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15
Q

Total respiratory Cycle variables

A 
impact how each mechanical breath is initiated sustain and terminated
trigger variable (start of inspiration)
limit variable (maintenance of inspiration)
cycling variable (transition to expiration)
Baseline variable (end expiration)
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16
Q

Trigger Variable

A

represents the start of inspiration

can be affected with or w/o pt inspiratory effort by either Pressure, Volume, flow or time

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17
Q

trigger variable (pressure)

A

pressure decrease in circuit stimulates ventilator to deliver breath

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18
Q

Trigger Variable as Volume

A

volume change in circuit can stimulate ventilator to deliver breath

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19
Q

Trigger Variable as flow

A

change in flow in circuit stimulates ventilator to deliver breath

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20
Q

Trigger Variable as time

A

set time interval triggers ventilator to deliver breath (occurs independent of pt effort)

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21
Q

Limit Variable

A

controls how an inspiratory breath is maintained once threshold is reached variable will not exceed set limit

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22
Q

Limit variable does not

A

cause termination of inspiration

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23
Q

Pressure as the limit variable

A

sets upper pressure limit that cannot be exceeded

stops airway pressure, but maintains breath

24
Q

Volume as the limit variable

A

set upper volume limit that cannot be exceeded

decrease flow in gas, but Vt maintained

25
Q

Flow as the limit variable

A

sets maximum airflow that cannot be exceeded

used in ICU

26
Q

Cycling Variable

A

transition from inspiration to expiration

27
Q

Volume as Cycling variable

A

ventilator delivers flow until set volume is achieved

if inspiratory pause set (typically 10-20%) this variable changes to time based cycling variable

28
Q

Pressure as cycling variable

A

once pressure achieved flow will transition to expiration

29
Q

Flow as cycling variable

A

once inspiratory flow achieved flow drops below set threshold (default at 25%) ventilator will transition to expiration
noted in pressure support ventilation mode

30
Q

Time as cycling variable

A

ventilator terminated inspiratory breath after pre-determined inspiratory time has been delivered

31
Q

What is the most common cycling variable

A

time (d/t NMB)

32
Q

Baseline variable

A

pressure maintained in the circuit at end expiration (PEEP)
must be individualized to patient
used to prevent atelectasis

33
Q

PEEP

A

alveolar pressure above atmospheric

34
Q

Goal of PEEP

A

to improve oxygenation

35
Q

Intrinsic PEEP

A

secondary to incomplete expiration
auto peep
incomplete breath prior to initiation of next breath
causes progressive air trapping

36
Q

extrinisc PEEP

A

provided by mechanical ventilator

applied PEEP

37
Q

Causes of AUTO PEEP

A

high Minute ventilation
expiratory flow limitation
expiratory resistance

38
Q

Volume Control Ventilation (VCV)

A 
delivers set tidal volume as set respiratory rate
time is trigger variable
volume is limit variable
time is cycling variable
airflow will remain constant
39
Q

What changes in VCV?

A

airway pressure (PIP/Pplateau) will change on a breath. by breath basis during this mode of ventilation based on changing respiratory compliance

40
Q

Why choose VCV?

A

maintenance of set minute ventilation through direct manipulation of Vt and RR
must set individualized alarms for airway pressure to protect patient
increasing airway or lung resistance will stimulate generation of higher pressure to deliver set Vt

41
Q

Pressure Control Ventilation

A

Delivers set inspiratory pressure as set RR
time is trigger variable
pressure is limit variable
time is cycle variable

42
Q

in PCV, what is controlled by user?

A

airway pressures volumes change breath by breath basis depending on total respiratory system compliance

43
Q

Why choose PCV?

A

set pressure limit to avoid barotrauma from delivery of excessive pressure
decelerating flow pattern allows for homogenous distribution of inspired gas throughout lung
must set patient appropriate high and low VT alarms as change in respiratory compliance can affect Vt delivery

44
Q

Pressure control-volume guarantee (PCV-VG)

A

respiratory cycle variables are same as PCV, but ventilator adjust pressure delivered if current volume is not set volume
adjustments take 3-5 breaths to complete
can allow for atelectasis development if compliance decreases and ventilator is delayed in providing adequate pressure to distend lungs

45
Q

Most common mode of ventilation

A

PCVVG

46
Q

Variables for PCV-VG

A

trigger: time
limit: pressure
cycling: time

47
Q

SIMV

A

synchronized intermittent mandatory ventilation
delivers a set Vt at a set RR in conjunction with patients initiated breathes
time/patient : trigger variable
flow or volume (if in VCV) are limit variables
volume is cycle variable
patient initiated breaths are not supported (unless in SIMV-PSV)

48
Q

Why chose SIMV

A

useful when weaning from controlled mechanical ventilation to spontaneous respiration (less desynchrony) with pt initiated breaths

49
Q

When does Hypoventilation occur in SIMV

A

if set Vt and RR are too low adn patient’s spontaneous respiration effort adequate

50
Q

When does hyperventilation occur in SIMV

A

if using SIMV- PSV and pressure support level too high

51
Q

Pressure support ventilation

A

supported mode of ventilation for spontaneously breathing patient
pressure support level set by user
patient is trigger varaible
pressure is limit variable
flow is cycle variable
patient controls most aspects of ventilation, but the anesthetist can adjust certain variables to augment or limit support given to prepare patient for extubation

52
Q

Why choose PSV?

A

great for end of case in preparation for extubation
patient must be breathing spontaneously or ventilator will switch to backup mode
just like PCV pressure controlled, changes in respiratory system compliance will alter Vt delivered

53
Q

High PIP pressures with normal peak plateau pressures indicate

A

resistance problem

54
Q

What are resistance problems

A 
small ET tube
kinking bitiing obstructed
ET tube
high flow rate or Vt
ventilator asynchrony
mucous plug, blood clot
bronchospasm
55
Q

High PIP and HIgh peak plateau pressures indicate

A

compliance problem

56
Q

What are compliance problems

A 
ARDS, edema, ateletasis
pneumothorax, effusion
air trapping (auto peep)
R mainstem intubation
fibrosis, ILDs
obesity
abd compartment syndrome

Basic Principles N928 (10 decks)

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