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PVRS > output waveform and monitoring > Flashcards

output waveform and monitoring Flashcards

1
Q

What are the Maneuvers of evita

A
  • “Special Procedures”
  • Occlusion Pressure P 0.1
  • Rapid Shallow Breathing Index (RSB)
  • Negative Inspiratory Force (NIF)
  • Intrinsic PEEP
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2
Q

What is occlusion pressure P0.1

A
  • Negative mouth pressure after 0.1 seconds
  • -> Indicative of drive to breathe
  • ->a measurement of diaphragmatic strength

**the inspiratory valve is closed after 1 expiration and measures airway pressure produced by patient’s inspiratory effort during 100ms

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3
Q

What is the normal and abnormal occlusion pressure ?

A

normal: 0 to -2 cmh2o
too high: towards -6 cmH20
–>huge drive can only be maintained for a period of time
–>indicate distress

too low: respiratory muscle fatigue

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4
Q

When is occlusion pressure used?

A

for patient just started weaning

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5
Q

How does occlusion pressure work?

A

exhalation valve is closed during patient inspiratory effort

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6
Q

What is the Rapid Shallow Breathing Index

A

the quotient
of spontaneous respiratory rate and tidal volume

more reliable measurements of weaning status

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7
Q

What is the formula of RBSI

A

Fspn per min over Vt(in liter)

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8
Q

What is the implication of low RBSI

A

lower the RSBi index for a patient with spontaneous
breathing, the more probably he or she can
be weaned successfully

–>that patients who can
be weaned successfully tend to have a lower spontaneous
respiratory rate and a higher tidal volume
than those who are not yet ready to be weaned.

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9
Q

What is the criteria of low RSBI

A

<105
means lower RR and higher Vt
> 105 not likely to wean

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10
Q

Which mode can RSBI be used

A

spontaneous mode

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11
Q

What is the NIF

A

negative inspiratory force after exhaling

aka MIP

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12
Q

how is NIF performed

A
  • performed from RV after manually extended exhalation
  • no flow during maneuver, max of 15 seconds
  • some alarms will be turn off until maneuver is completed
  • not allowed to be performed in neonate and NIV
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13
Q

What are the 2 possible outcomes of NIF

A

< -30 cmH2O high probability of an effective cough

> -20 cmH2O unlikely

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14
Q

What is occlusion pressure P0.1

A
  • Negative mouth pressure after 0.1 seconds
  • -> Indicative of drive to breathe
  • ->a measurement of diaphragmatic strength

**the inspiratory valve is closed after 1 expiration and measures airway pressure produced by patient’s inspiratory effort during 100ms

How well did you know this?
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15
Q

What is the normal and abnormal occlusion pressure ?

A

normal: 0 to -2 cmh2o
too high: towards -6 cmH20
–>huge drive can only be maintained for a period of time
–>indicate distress

too low: respiratory muscle fatigue

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16
Q

When is occlusion pressure used?

A

for patient just started weaning

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17
Q

How does occlusion pressure work?

A

exhalation valve is closed during patient inspiratory effort

How well did you know this?
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18
Q

What is the Rapid Shallow Breathing Index

A

the quotient
of spontaneous respiratory rate and tidal volume

more reliable measurements of weaning status

19
Q

What is the formula of RBSI

A

Fspn per min over Vt(in liter)

20
Q

What is the implication of low RBSI

A

lower the RSBi index for a patient with spontaneous
breathing, the more probably he or she can
be weaned successfully

–>that patients who can
be weaned successfully tend to have a lower spontaneous
respiratory rate and a higher tidal volume
than those who are not yet ready to be weaned.

21
Q

What is the criteria of low RSBI

A

<105
means lower RR and higher Vt
> 105 not likely to wean

22
Q

Which mode can RSBI be used

A

spontaneous mode

23
Q

What is the NIF

A

negative inspiratory force after exhaling

aka MIP

24
Q

how is NIF performed

A
  • performed from RV after manually extended exhalation
  • no flow during maneuver, max of 15 seconds
  • some alarms will be turn off until maneuver is completed
  • not allowed to be performed in neonate and NIV
25
Q

How does intrinsic peep work?

A

phase 1:
- Ventilator implements a pause at PEEP (exp hold)

-Pressure equalizes and any intrinsic PEEP is reflected by an elevated baseline

phase 2
Once pressure stabilizes, the expiratory valve opens
Expiratory flow is measured

26
Q

What is a low flow PV Loop?

A

Slowly fills lung with low, constant flow

- look at compliance and optimal peep

27
Q

What is the risk when using PV loop?

A

high risk for air leak and cardiovascular compromise

28
Q

What is the contraindication of PV loop?

A

not for spontaneous breathing patients

29
Q

What are the PB840 waveform characterisitcs

A 
Pressure-time 
Flow-time
Volume-time 
***Only two at one time
***are drawn on the screen at the start of a breath, beginning with the last ½ second of the previous breath
30
Q

What are PB840 loops?

A

Pcari : crainal pressure
–>estimate of carinal pressure when TC and shadow trace active
Plung: lung pressure
–>when PA and shadow trace active

31
Q

what are the respiratory mechanics in PB840?

A 
Negative Inspiratory Force (NIF)
Occlusion pressure (P 0.1)
Vital Capacity (VC)
32
Q

In what mode is respiratory mechanics is not available?

A

Bilevel mode

33
Q

What alarms are cancelled when respiratory mechanics are engaged?

A

P peak alarm, P vent alarm, high tidal volume spontaneous and mandatory

34
Q

What are the manual events

A

Suctioning, ABG, circuit change, weaning trial

35
Q

What are the loops of avea?

A 
Flow – Vt
Paw – Vt
Pinsp – Vt
PTR – Vt* :   P tracheal
PES – Vt**  : P esophageal
-->require esophageal catheter 
PTp – Vt ** :  P Transpulmonary
-->This requires the use of an optional esophageal catheter and is
active for adult and pediatric patients only.
36
Q

What is the esophagea ballon test?

A

esophageal balloon can be placed to measure pressures in the thorax

37
Q

What is the balloon test

A

verifies the integrity and size of the balloon catheter. The ventilator will
display a Pass or Fail message in the message bar at the bottom of the screen.

The Balloon Test must be performed without the balloon in the patient

38
Q

What is the the precaution when using esophageal ballon?

A

Do Not inflate the balloon until after it has been placed in the patient. The balloon should be evacuated prior to
removal from patient.

39
Q

What happen when the ballon start to fill

A

, the ventilator delivers the volume specified below into thecatheter before esophageal pressure measurement commences.

Adult Catheter: 0.5 to 2.5 mL
Pediatric Catheter: 0.5 to 1.25 mL

40
Q

what alarms are inactive during the MIP manuevr?

A

Apnea Interval and

Low PEEP.

41
Q

What happens when the inflection point maneuvr is started?

A

Normal ventilation shall be suspended for the duration of the maneuver. The maneuver will be aborted if a patient effort is detected

42
Q

What waveform is used for infleciton point

A

square

43
Q

What is the purpose of a pflex maneuver

A

allows the clinician to determine opening pressures of the lung during a slow flow volume controlled
breath. Because this maneuver is performed at a slow inspiratory flow rate the effects of respiratory system resistance are minimized.

PVRS (17 decks)

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