output waveform and monitoring Flashcards
What are the Maneuvers of evita
- “Special Procedures”
- Occlusion Pressure P 0.1
- Rapid Shallow Breathing Index (RSB)
- Negative Inspiratory Force (NIF)
- Intrinsic PEEP
What is occlusion pressure P0.1
- 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
What is the normal and abnormal occlusion pressure ?
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
When is occlusion pressure used?
for patient just started weaning
How does occlusion pressure work?
exhalation valve is closed during patient inspiratory effort
What is the Rapid Shallow Breathing Index
the quotient
of spontaneous respiratory rate and tidal volume
more reliable measurements of weaning status
What is the formula of RBSI
Fspn per min over Vt(in liter)
What is the implication of low RBSI
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.
What is the criteria of low RSBI
<105
means lower RR and higher Vt
> 105 not likely to wean
Which mode can RSBI be used
spontaneous mode
What is the NIF
negative inspiratory force after exhaling
aka MIP
how is NIF performed
- 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
What are the 2 possible outcomes of NIF
< -30 cmH2O high probability of an effective cough
> -20 cmH2O unlikely
What is occlusion pressure P0.1
- 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
What is the normal and abnormal occlusion pressure ?
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
When is occlusion pressure used?
for patient just started weaning
How does occlusion pressure work?
exhalation valve is closed during patient inspiratory effort
What is the Rapid Shallow Breathing Index
the quotient
of spontaneous respiratory rate and tidal volume
more reliable measurements of weaning status
What is the formula of RBSI
Fspn per min over Vt(in liter)
What is the implication of low RBSI
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.
What is the criteria of low RSBI
<105
means lower RR and higher Vt
> 105 not likely to wean
Which mode can RSBI be used
spontaneous mode
What is the NIF
negative inspiratory force after exhaling
aka MIP
how is NIF performed
- 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
How does intrinsic peep work?
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
What is a low flow PV Loop?
Slowly fills lung with low, constant flow
- look at compliance and optimal peep
What is the risk when using PV loop?
high risk for air leak and cardiovascular compromise
What is the contraindication of PV loop?
not for spontaneous breathing patients
What are the PB840 waveform characterisitcs
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
What are PB840 loops?
Pcari : crainal pressure
–>estimate of carinal pressure when TC and shadow trace active
Plung: lung pressure
–>when PA and shadow trace active
what are the respiratory mechanics in PB840?
Negative Inspiratory Force (NIF) Occlusion pressure (P 0.1) Vital Capacity (VC)
In what mode is respiratory mechanics is not available?
Bilevel mode
What alarms are cancelled when respiratory mechanics are engaged?
P peak alarm, P vent alarm, high tidal volume spontaneous and mandatory
What are the manual events
Suctioning, ABG, circuit change, weaning trial
What are the loops of avea?
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.
What is the esophagea ballon test?
esophageal balloon can be placed to measure pressures in the thorax
What is the balloon test
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
What is the the precaution when using esophageal ballon?
Do Not inflate the balloon until after it has been placed in the patient. The balloon should be evacuated prior to
removal from patient.
What happen when the ballon start to fill
, 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
what alarms are inactive during the MIP manuevr?
Apnea Interval and
Low PEEP.
What happens when the inflection point maneuvr is started?
Normal ventilation shall be suspended for the duration of the maneuver. The maneuver will be aborted if a patient effort is detected
What waveform is used for infleciton point
square
What is the purpose of a pflex maneuver
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.
