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mechanical vent > modes of ventilation > Flashcards

modes of ventilation Flashcards

1
Q

Types of Breaths

A
  • Mandatory
  • Assisted
  • Spontaneous
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2
Q

What does mandatory mean?

A

machine starts breath and machine controls and ends the breath. Vent does all the work.

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3
Q

What does assisted mean?

A

Patient starts the breath and the machine controls and ends the breath.

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4
Q

What does spontaneous mean?

A

Patient starts the breath, patient controls and end the breath. Machine augments breath.

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5
Q

What is the difference between volume controlled and pressure controlled?

A
  • The term CMV usually refers to volume ventilation or VCV
  • Pressure controlled CMV is usually called PCV or P-AC
  • Most modes assume volume unless prefixed by “P”
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6
Q

Continuous Mandatory Ventilation (CMV)

A
  • All breaths are mandatory-full support
  • Only appropriate when a pt makes no effort at breathing or when you want to completely control ventilation.
  • The machine only triggers by time. Pt cannot add rate by assisting.
  • Can be used for frail chest (2 or more broken ribs in 2 or more places)
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7
Q

What are indications for CMV?

A
  • tetanus/seizure
  • complete rest-24hrs
  • crushed chest injury w/paradoxical movements
  • cerebral malfunction
  • spinal cord/phrenic nerve injury
  • paralysis
  • drugs
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8
Q

What are some complications with CMV?

A
  • potential for apnea/death with disconnection
  • important alarms-low pressure, low exhaled volume
  • therapist must recognize spontaneous effort by patient and correct
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9
Q

What triggers, limits, and cycles CMV?

A
  • trigger–>time
  • limit–>volume (flow)
  • cycle–>time/volume
  • expiration–>passive, PEEP
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10
Q

Assisted Control (A/C) Ventilation

A
  • all mechanical breaths-full support
  • may be poorly tolerated in awake pts
  • COPD pt may air trap
  • Pts with rapid drive may hyperventilate
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11
Q

What triggers, limits, and cycles AC?

A
  • trigger–>time/pts
  • limit–>volume
  • cycle–>volume/time
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12
Q

What are some common causes of rapid drive?

A
  • anxiety
  • pain
  • hypoxemia
  • metabolic acidosis
  • inappropriate ventilator settings
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13
Q

How do you correct the drive?

A

by switching modes or sedate the patient

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14
Q

Here is more info on Assist Control Ventilation

A
  • machine has a guaranteed min
  • Pt determines maximum
  • set rate @ 2 like pt is in control mode
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15
Q

Assisited Control (P-AC) Ventilation (PRESSURE)

A
  • can also be PCV or PC-AC

- May reduce WOB since pt chooses own flow

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16
Q

what is P-ramp?

A

sloping the inspiratory pressure curve

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17
Q

What does IMV stand for?

A

Intermittent Mandatory Ventilation

18
Q

What triggers, limits, and cycles IMV?

A

trigger–>time
limit–>flow
cycle–>volume/time

19
Q

Does IMV cause breath stacking?

A

yes, because even if the patient is spontaneous breathing the vent will still deliver a breath.

20
Q

What is SIMV?

A

synchronized intermittent mandatory ventilation

21
Q

What is the differnence between IMV and SIMV?

A
  • IMV is both mechanical and spontaneous breath and gives partial ventilatory support
  • SIMV is just like IMV but mechanical breaths are PT/time triggered. Pt can also regulate own CO2 and pH.
22
Q

What are some disadvantages of SIMV?

A
  • SIMV with high PSV may increase WOB
  • Acute hypoventilation may occur at lower rates
  • Weaning may be prolonged
  • PSV is needed to overcome WOB
  • Fatique may occur in pts who have rapid shallow breathing
23
Q

What triggers, limits, and cycles P-SIMV?

A
  • trigger–>pts/time
  • limit–>pressure
  • cycle–>time
  • compliance/resistance–>flow/volume
  • spontaneous breaths in between
  • they are pt triggered and pt cycled
24
Q

Pressure Support Ventilation (PSV)

A
  • spontaneous mode on vent
  • augmented spontaneous breathing
  • like PCV delivers a high flow of gas at beginning and then it tapers when pressure gradient equalizes
  • decrease WOB by overcoming resistance to tubing and circuit.
25
Q

What triggers, limits, and cycles PSV?

A
  • trigger–>patient
  • limit–>pressure
  • cycle–>flow
26
Q

What is expiratory time sensitivity?

A
  • ETS adjusts the flow cycle level of pressure supported breaths.
  • In the event of leak, ETS % can be adjusted that pressure supported breaths will end. Maximum setting is 45% which will be effective for all but large leaks.
27
Q

What are 2 applications for PSV?

A
  • PSV and SIMV: used to overcome resistance in tubing, poor demand flow and airways.
  • Stand alone PSV: what ever is needed to achieve VT of 10-12 mL/Kg than titrated to let pt do more work.
28
Q

What does CPAP and PEEP mean?

A

Continuous Positive Airway Pressure and Positive End Expiratory Pressure

  • used to describe baseline
  • CPAP is used with spontaneous breathing
  • PEEP is used with mechanical breathing
29
Q

SIMV with PSV

A
  • combines 2 modes of A/C (with limit # of breaths) and PSV during the spontaneous breaths
  • used all the time
30
Q

PSIMV with PSV

A

-a combination of pressure assist/control breaths and PSV during spontaneous breaths

31
Q

SIMV c PSV and CPAP

A
  • add PEEP to the mix
  • remember they are volume targeted machine breaths
  • machine breaths are pressure targeted
32
Q

Mandatory Minute Ventilation

A
  • used for weaning
  • set MV at 70-90% of current VE
  • vent provides rest
  • vent monitors spontaneous MV when it drops below set level the vent provides mechanical support to make up difference
33
Q

Two ways of Mandatory Minute Ventilation

A
  • increasing the breath rate (bear 1000)
  • increasing the preset pressure (Hamilton)
  • machine reads total volume in one minute, pt can breath at low volume very fast and keep same Min volume
  • must set high flow and low Vt correctly
34
Q

What are other terms for trigger?

A
  • trigger
  • sensitivity
  • initiate
  • start
  • change from E to I
  • begin the breath
35
Q

What are other terms for inspiration (pressure limited)?

A
  • pressure controlled
  • pressure targeted
  • pressure limited
  • pressure oriented
  • the machine reaches a set pressure and maintains that pressure during the breath
  • flow varies with lung changes
  • volume varies with lung changes
36
Q

What are other terms for inspiration ( volume limited)?

A
  • volume oriented
  • volume targeted
  • volume limited
  • volume controlled
  • flow controlled
  • volume does not change with lung
  • pressure varies with lung changes
37
Q

What are other terms for cycle?

A
  • cycle
  • end of breath
  • terminated
  • extinguish
  • begin expiration
  • change from I to E
38
Q

what mode is started by the machine or pt, pressure is guaranteed, inspiration is terminated when a set time has elapsed?

A
  • pressure mode

- pressure assist control

39
Q

What are all the volume modes?

A
  • control
  • A/C
  • IMV (control and spont)
  • SIMV (assist/control and spont)
  • SIMV c PSV (assist/control and PSV)
40
Q

What are all the pressure modes?

A
  • PSV
  • PC/AC, P-AC, PCV
  • PSIMV-PAC(PC) and spon
  • PSIMV c PSV
41
Q

What mode of ventilation is a mixture of assist/control, pressure oriented, time cycled breaths and flow triggered, pressure oriented, flow cycled breaths?

A

PSIMV/PSV

42
Q

What mode of ventilation begins inspiration with flow, allows volume to vary during the breath, and begins expiration after a predetermined low flow is reached?

A

PSV

mechanical vent (4 decks)

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