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Anesthesia Technology > Module 5 Ventilation Circuits > Flashcards

Module 5 Ventilation Circuits Flashcards

1
Q

Mechanical Ventilation Requirements Depend On:

A
  1. Type of Surgery 2. Length of Surgery 3. Patient Position 4. ASA Status
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2
Q

Driving Mechanism of Ventilator

A

02 or pressurized air

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3
Q

Piston-Driven Ventilators use _____ Motors and have no ______

A

Electric Motor, No driving gas

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4
Q

Piston-Driven Ventilator positive pressure relief valve opens at

A

Pressure reaches 75+/- 5 cm H2O the positive relief valve opens

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5
Q

Piston-Driven Ventilator negative relief valve opens at

A

If the pressure within the piston declines to - 8 cm H2O, the negative relief valve opens & room air is drawn into the piston

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6
Q

The negative relief valve in piston-driven ventilators protects patients from

A

Protects pt from Negative End Expiratory Pressure (NEEP)

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7
Q

How the anesthetist guards against vent disconnects/ What changes will be noted on disconnect

A

Pressure Changes
Capnography waveforms
Movement of manual breathing bag

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8
Q

In the event of a oxygen pipeline failure. Will the Piston-ventilator continue to work?
(Clinical Pearl)

A

Yes, the driving force of piston-ventilators is electric, NOT gas driven

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9
Q

Advantages of Piston Ventilators

A 
Quiet
No PEEP
Precise TV
Electricity Driving force
Capable of all ventilation modes
Manual bag remain in the breathing circuit during mechanical ventilation
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10
Q

Negatives of Piston Ventilators

A

Lack of visible standing bellows
Harder to hear is regular cycle
Potential for NEEP
+/- Relief valve

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11
Q

Vent high airways pressure alarm causes

A 
Tube in right main bronchus 
Bronchospasm
Mucus plug
Pneumothorax 
Air trapping
Pt. cough, biting tube 
Pt./Vent Dyssynchrony 
High peep
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12
Q

Vent low airway pressure alarm causes

A 
ETT cuff deflation
Esophageal intubation 
TV set too low
Chest wounds/drains allowing air to escape
Disconnect from vent circuit
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13
Q

Safety feature of modern ventilator equipment

Clinical pearl

A

Apnea (disconnect) alarms are enabled with the first breath sensed

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14
Q

Fixed Alarms

A

Disconnection

02 sensor

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15
Q

Set Alarms

A

Volume
Pressure
Rate
Apnea

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16
Q

Apnea/Disconnect alarm is based on:

A

Chemical monitoring (lack of ETCO2)

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17
Q

Tidal Volume settings are according to ____ ideal body weight

A

A setting of 4-8 mL/kg of Ideal Body Weight is considered a safe place to start

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18
Q

Fi02 settings are adjusted to produce a minimum of:

A

SPO2 >90 %
PaO2 > 60 mm Hg
** Airway fires <30%

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19
Q

Normal I:E ratio

A

1:2

Means expiration time twice that of inspiration

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20
Q

Increasing I:E ratio to 1:3 or 1:4 is used in the presence of what disease process

A

Increase E to 1:3 or 1:4 in presence of obstructive airway dz. in order to prevent air trapping- cause auto PEEP-I

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21
Q

Describe Inverse Ratio Ventilation (IRV) and how it applied used in ARDS disease process

A 
ARDS 
Goal is to improve oxygenation
Forced inspiratory time to be greater than expiration time 
Creates auto peep
2:1, 3:1, 4:1
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22
Q

Functions of PEEP

A

Reduces risk of atelectasis
Increase # of open alveoli
Decrease V/Q mismatch

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23
Q

Why do we need PEEP

A

Alveoli recruitment

**Placement of ET tube opens the epiglottis and knocks out physiologic PEEP-5 cm H2O recommended

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24
Q

Physiological PEEP

A

Physiological PEEP (3-5 cm H2O) preserves FRC in normal lungs

25
Q

PEEP works by

A

Increasing end expired lung volume & reducing airspace closure at the end of expiration. (Maintains alveoli open/promotes gas exchange)

26
Q

Trigger window is only seen what ventilator mode

A

Synchronized Intermittent Mandatory Ventilation (SIMV)

27
Q

The trigger window controls

A

the % of time during expiration that the ventilator is sensitive to the patients diaphragm

28
Q

Sensitivity of trigger window controls

A

how much negative pressure the patient needs to generate before a breath is triggered

29
Q

Volume Control Ventilation (VCV) is most common and has what features

A

Volume limited
Time cycled
Constant flow

30
Q

Piston Ventilator delivers exact ____ in comparison to VCV

A

Tidal volumes

31
Q

Under what vent mode is PIP uncontrolled and vary according to patients compliance and airway resistance
(Clinical Pearl)

A

Volume Control Ventilation

32
Q

PIP is the highest level of pressure applied to the lungs during inhalation and is recommended to be

A

< 35 cm H2O ( decrease barotrauma)

33
Q

Peak Airway Pressure:

A

Total pressure needed to deliver the tidal volume. It depends on airway resistance, lung compliance, and chest wall factors

34
Q

Plateau Pressure:

A

Pressure required to overcome tissue resistance & inflated alveoli
*Measurement of lung stiffness

35
Q

Resistive Pressure:

A

The difference between Peak & plateau pressure is the resistive pressure
Elevated resistive pressure > 10 cm H2O

36
Q

High PEEP >10 results in what hemodynamic effects

Clinical Pearl

A

Increase intrathoracic pressure

Decrease venous return & impair CO

37
Q

Why do mechanical ventilation benefit from the application of PEEP at 5 cm H2O?
(Clinical Pearl)

A

To replace physiological peep

38
Q

Pressure Control Ventilation (PCV):

A

Inspiratory pressure is controlled rather than volume

39
Q

PCV considerations

A

Target pressure is adjusted for the desired TV
may result in increased TV at a lower PIP
Pt. with low compliance PCV provides greater TV

40
Q

PCV standard settings

A

PCV 20 cm H2O
RR 6-12
I:E ratio 1:2
PEEP-may be O

41
Q

During PCV in a laparoscopic case if pulmonary compliance improves (release of pneumoperitoneum) TV may increase substantially. What does the anesthetist do?
(Clinical Pearl)

A

Change mode to pressure control volume guaranteed

42
Q

If airway resistant increase during PCV delivered VT will decrease substantially. What can cause this?
(clinical Pearl)

A

Bronchospasm

Kinked endotracheal tube

43
Q

PCV uses in clinical setting:

A 
Pregnancy
Laparoscopic surgery
Morbid obesity
ARDS
One-lung ventilation
44
Q

Pressure Control Ventilation-Volume Guarantee:

A

Adjust pressure limits to prevent significant variation in delivered VT

45
Q

One of 3 modes that supports spontaneous breathing. Utilizes trigger window

A

SIMV

Intermittent mandatory breaths are delivered in synchrony with and triggered by the patients spontaneous efforts

46
Q

SIMV-PSV

A

Pressure support may be added to assist the patient with any spontaneous breaths

47
Q

Supports spontaneous breathing and protects patient.

A

PSV-PRO
after 10-30 seconds of apnea adjustable, the mode will revert to PCV or SIMV, In newer machines, if the patient begins breathing again in backup mode the ventilator will switch back to PSV-PRO

48
Q

Trigger Window:

A

Controls the amount of time during each expiratory cycle that the ventilator is sensitive to negative pressure generated by diaphragm

49
Q

SIMV mirrors setting of which other modes

A

VCV or PCV

50
Q

Support Spontaneous respirations

Clinical pearl

A

PSV, SIMV, & (bag) valuable in supporting the patient with spontaneous respirations

51
Q

Vent mode with RR of 0 and responds to patients effort

A

PSV is like PCV in that it is a pressure-targeted ventilation mode- but with a RR of zero
PSV is useful to augment the VT of spontaneously ventilating patient during maintenance or emergence
Adults start at 10 cm H2O

52
Q

Goldilocks Principle and PSV

A

“Not to low”

“Not to high”

“Just Right”

Normal WOB

53
Q

If ventilation using PP > 20 torr the stomach may become inflated…Lead to ?
(Clinical Pearl)

A

Aspiration

54
Q

When a change in the patient’s condition is noticed what should you do?
(Clinical Pearl)

A

Think back to the last alteration made to the equipment and determine whether it might have contributed to the change

55
Q

Frequently encountered in ARDS but can occur in any patient receiving mechanical ventilation

A

Barotrauma

56
Q

Barotrauma is associated with?

A

high peak inspiratory pressure > 40 cm H2O & plateau pressures > 35

57
Q

02 Flush valve use during inspiration can lead to:

A

Barotrauma

58
Q

Ventilator relief valve may stick closed and lead to:

A

Barotrauma

Anesthesia Technology (10 decks)

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