paediatric ITU Flashcards

Question

two phase gas liquid interaction

Answer 1

The transfer of kinetic airflow energy onto liquid airway surface exerts a shear force moving sputum along the airway mucus layer in the direction of proximal airflow Airflow remains laminar when flow rates are low As flow velocity increases the mucus layer becomes unstable and forms ripples that move in the direction of the air flow

Answer 2

``` reposition manual techniques MHI saline instillation suction cough assist early mobility ```

Answer 3

Positioning to optimise ventilation or postural drainage Children preferentially ventilate the uppermost lung Head down tip avoided in babies as risk of GOR and aspiration * Used alongside other techniques, can be of benefit to advise nursing staff positioning over 24 hour period * Positioning specific programmes at bedside

Answer 4

Percussions: Rhythmical cupped hand or palm cup over chest wall ``` Contraindications: Undrained pneumothorax Raised intracranial pressure Rib fractures Osteopenia/Osteoporosis Platelets of <40 Pulmonary haemorrhage ``` expiratory vibrations compressive vibratory pressure on chest wall during expiration CI: as per percussions

Answer 5

Prevent atelectasis and recruit areas of collapsed lung Improve lung compliance and gas exchange Increases movement of pulmonary secretions toward central airways Prevent airway mucus plugging Use manometer 2 breaths at PIP/PEEP on ventilator, 3rd breath 10% above PIP Followed by end inspiratory hold with quick release to increase expiratory air flow

Answer 6

For effective treatment to mobilise secretions effectively: - Expiratory flow during MHI must be greater then inspiratory flow MHI with expiratory vibrations significantly increases expiratory flow to facilitate expulsive airflow and mobilisation of secretions - More effective than just MHI alone Expiratory vibrations should be applied at early expiration (during quick release phase) to achieve greatest expiratory flow, therefore mobilising the most secretions MHI with expiratory vibrations: 80% increase in expiratory flow

Answer 7

``` Contraindications/precautions for MHI: Cardiovascular instability Raised intracranial pressure Labile BP Undrained pneumothorax High ventilatory pressures Recent pneumonectomy Bullae Recent lung surgery Haemoptysis Clamped chest drain ```

Answer 8

To clear secretions thus maintaining a patent airway To improve ventilation and oxygenation To reduce the work of breathing Contraindications/Precautions for suctioning: - Unexplained haemoptysis - Laryngospasm (stridor) - Bronchospasm - Basal skull fractures (no nasal suction) - Recent oesophageal or tracheal surgeries - Severe hypoxia - Raised intracranial pressure - Acute hypo or hypertension

Answer 9

Oropharyngeal suctioning: Measure corner of mouth to ear lobe and add approx 2 cms Nasopharyngeal suctioning: Measure tip of nose to ear lobe to thryoid cartilage

Answer 10

tracheostomy patients Ensure appropriate depth of suction High risk of airway trauma and granulation tissue

Answer 11

``` Beta-2 agonists (Salbutomol, atrovent) Effects: Bronchodilates airways Reduces inflammation Improve mucocillary clearance ``` ``` Mucolytics (0.9%, 3%, 7% saline) Effects: - Rehydrate secretions - Increase airway surface liquid - Improve mucocilliary clearance - Stimulate cough Beta-2 agonist nebuliser ``` ↓ (Wait 15 mins) Mucolytic ↓ Chest physiotherapy

Answer 12

Appliance of a positive pressure to the airway, followed by a rapid shift to negative pressures Rapid shift increases expiratory flow aim ↑ peak cough flow Cough assist in ICU: Can reduce reintubation rates and ICU length of stay Shorten treatment time in ICU without any difference in secretion clearance As per positive pressure MHI - Cardiovascular instability - High intracranial pressure - Undrained pneumothorax - High ventilatory pressures - Recent pneumonectomy - Bullae - Recent lung surgery - Haemoptysis - Clamped chest drain

Answer 13

PICU mortality rates have ↓, however the proportion of children surviving their critical illness with significant functional morbidity is rising Prolonged immobility is an important predictor of poor functional outcome and the development of critical illness acquired morbidities There is growing evidence that demonstrates the benefits of early implementation of rehabilitation and mobilisation ``` Reduces length of stay in ICU and overall length of stay Secretion mobilisation and clearance Increased TV, RR, MV Improves levels of consciousness Assists fluid distribution Improves venous return Reduces length ICU delerium Improves sleep ``` ``` CV instability Spinal precautsios Unstable fractures Open abdomen Open chest ECMO <24 hrs admission to PICU ```