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Machines > Part 2 > Flashcards

Part 2 Flashcards

1
Q

Minute ventilation

A
  • Respiratory Rate x Tidal Volume
  • Normal range 5-6 L/min
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2
Q

Plateau pressure

A
  • Positive pressure applied to small airways & alveoli
  • Goal is to keep under 30 cmH2O because excessive alveoli stretch is thought to be a cause of ventilator-induced lung injury
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3
Q

Peak flow

A
  • Determines rate of tidal volume delivery to the patient during mandatory volume control breaths
  • Affects I:E ratio & peak pressure
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4
Q

Volume control ventilation

A
  • Tidal volume is preset & the resultant airway pressure is a function of lung compliance & other factors
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5
Q

Volume control ventilation advantages

A
  • Advantages
  • Guaranteed minute ventilation
  • May help lung compliance in certain surgeries (abdominal or chest surgery
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6
Q

Volume control disadvantages

A
  • Patient does not trigger breath, but can see patient effort in capnogram
  • May need to reduce tidal volumes if you get high PIP/PAP
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7
Q

Pressure control ventilation

A

Peak airway pressure is preset & the delivered tidal volume is a product of lung compliance & other factors

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8
Q

Pressure control ventilation advantages/disadvantages

A
  • Reduced ventilator-induced lung injury because able to limit peak inspiratory pressure which will also limit transalveolar pressure
  • Improved gas distribution because uses decelerating flow
  • More rapid improvement in lung compliance & oxygenation compared to VCV

Disadvantages
Does not guarantee minute ventilation

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9
Q

Volume Controlled Ventilation

Dependent variables

A

Dependent variables

  • PIP is determined from tidal volume set
  • Plateau Pressure is determined by applying an inspiratory hold (0.5-1 sec). Hold represents no flow, which gives pressure the alveoli are seeing
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10
Q

Pressure control ventilation

A
  • PIP usually same as Plateau Pressure because of how breath is delivered
  • There is an inherent inspiratory pause
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11
Q

Pressure support ventilation

A

Spontaneous ventilation mode that provides constant pressure once patient inspiratory effort is sensed.

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12
Q

Pressure support ventilation independent variables

A

Independent Variables (What you set)

  • Support Pressure
  • Inspiratory Time
  • Flow Trigger
  • FIO2
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13
Q

PSV dependent variables

A

Tidal volume
Respiratory Rate

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14
Q

PSV advantages

A
  • Able to have patient breath spontaneously & not “fight” the ventilator
  • Able to augment tidal volume
  • Able to adjust ETCO2 with support pressure
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15
Q

PSV disadvantages

A

Requires patient to be breathing spontaneously

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15
Q

SIMV

A
  • Breaths are given at preset time intervals
  • Patient can breathe spontanously between the ventilator breaths
  • Ventilator will not give a breath if the patient inspires at that same instant
16
Q

SIMV independent variables

A
  • Tidal Volume
  • Respiratory Rate
  • I:E Ratio
  • FIO2
  • Pressure Support Level
17
Q

SIMV dependent variables

A

Peak Inspiratory Pressure
Plateau Pressure

18
Q

SIMV advantages

A

Can be used as way to start building up CO2
Back-up mode for PSV

19
Q

SIMV disadvantages

A

May confuse patient’s brain because not physiological

20
Q

Set TV to adults? children?

A

10-15 mL/kg (adults)
6-10 mL/kg (infants, children, & COPD)

21
Q

minute ventilation formula

A

VT x RR
4 x BSA for Men
3.5 x BSA for Women

22
Q

Ventilator fresh gas flow coupling

A

Fresh gas flow adds to tidal volume delivered by ventilator

23
Q

inspiratory pause

A
  • Holds breath at end of inspiration (before exhalation starts)
  • Allows breath to diffuse better
  • Only available with VCV
  • Usually 25% of inspiratory time
  • Takes time from inspiration & adds it as a hold (expiration remains same)
24
Q

PEEP

A

Constant positive pressure applied at end of exhalation
Causes airway pressure to not return to 0 cmH2O

25
Q

PEEP benefits

A
  • Helps keep more alveoli open to participate in gas exchange
  • Helps prevent atelectasis by recruiting collapsed alveoli & improving V/Q mismatching
  • Increases functional residual capacity (FRC) & improves oxygenation
26
Q

PEEP problems

A
  • May cause high alveolar pressures resulting in
  • Increased dead space
  • Unnecessary increase in work of breathing
  • Increased intrathoracic pressure
  • Reduces pressure gradient of blood returning to the heart
  • Reduces right ventricular preload & output (cardiac output)
27
Q

Using PEEP

A
  • Set between 2-20 cmH2O
  • 5-10 cmH2O usually has little effect on patient hemodynamics

In circuit

  • On Excel: need to phyisically place PEEP valve in line on the expiratory limb
  • On Aestiva/Aisys/Avance: Set using a button
28
Q

Auto PEEP

A
  • Air trapping in the lungs because of insufficient exhalation time

Signs

  • Non-zero end expiratory pressure
  • Increasing PIP/PAP
30
Q

Peak inspiratory pressure (PIP) / Peak airway pressure (PAP)

A

The pressure measured by the ventilator in the major airways

31
Q
A

Machines (7 decks)

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