PNRC07 Flashcards
Two main complications of INO
Methemoglobinemia and Nitrogen Dioxide NO2
What can you do if the complications arise from INO?
decrease the Nitric
What are the levels that we are concerned with when it comes to MetHb and NO2
Need to wean if:
>5% methemoglobin
>5 ppm
Indications for weaning INO
hemodynamically stable on FIO2 <40% with Peep of 5 or less.
A pt that has ventilation problems can benefit from what
HELIOX
A pt that is having issues with oxygenation would benefit from what?
Nitric
Nitric Oxide enhances what vessels?
It will selectively produce pulm dilation.
**It will only dilate the blood vessels adjacent to functioning alveoli…NOT alveoli that is collapsed/fluid filled
Hyperoxygenating a pt who is ready to wean from INO
Set FiO2 to .6 to .7 OR 20% above before DCing the INO.
***This is done AFTER the INO has been reduced to lowest possible dose.
The FDA has approved INO tx for what ppl
Respiratory failure associated with pulmonary HTN and >34 weeks
OI formula
(Mean Airway Pressure x O2%) / PaO2
Why does INO work well with HFOV
Improves the response to INO by decreasing shunting
What likely causes methemoglobinemia vs Nitrogen Dioxide
Met Hb caused from high INO doses
NO2 caused from high PPMs and high FiO2
How to wean down INO
Reduce the INO to the lowest effective dose in increments of 50%. (10 to 5 to 2.5 ect)
What is the best attribute of Helium?
It has an extremely low density allowing it to decrease WOB, which is why it aids in ventilation NOT oxygenation.
Main indications for Heliox treatment
Upper airway obstruction (Foreign body aspiration) and Status asthmaticus.
How does heliox work?
It decreases Raw by creating more laminar flow and removes a much larger amount of CO2.
***DOES NOT treat the problem, only acts as a band-aid, this is called a temporizing agent
How do you deliver heliox if pt is not on ventilator?
non-rebreathing mask
**HAVE TO KEEP valves closed on the mask
Available ratios for heliox delivery
80/20 and 70/30
What patients receive 70/30 heliox?
Patients that are already on oxygen or pt that isnt on oxygen with an ABG showing hypoxia
**Think about it, 70/30 has more O2 in it than 80/20
Why do you need a special flow meter/regulator?
Because the flow meter will read a very false LOW
**Need to use conversions to calculate actual flow
How to calculate actual flow with Heliox delivery
80/20 mixture? Multiply flow by 1.8
70/30? multiply by 1.6
Some vents may cause what with some vents
erroneous flows and volumes
As someone goes up in altitude, what will you need to change to maintain the same PaO2
you need to increase the % of O2 (FiO2)
Temperature vs altitude
Almost always has to do with hypothermia, and fix this by blankets and warming all IV fluids
Positioning of patient on flight transport
parallel with the wings to decrease acceleration forces
do you place someone with the good lung up or down?
Good lung DOWN
*This helps match the ventilation with perfusion
OI of >30
Needs HFOV
OI >25
Needs INO
OI >40
ECMO
Mortality rates associated with OI values
> 25 is 50% mortality
>40 is 80%
How to calculate P/F ratio
PaO2/FiO2
PF ratio values and indications
200-300= ACUTE lung injury
100 to 200 moderate ARDS
<100 is severe and NEEDS ECMO
Two types of high frequency ventilators
Jet and Oscillatory
Similar characteristics between Jet and Oscillatory
Breaths delivered at 150+ rates
Very non-compliant vent circuits (very stiff)
TV that are small 1-3ml/kg
Primary goal of HFV
to minimize negative consequences of ventilatory support through lung protective strategies
Requires a special ETT adapter and requires a ventilator
HFJV
Range is 4-11Hz
HFJV
Has PASSIVE exhalation
HFJV
What verifies adequate amplitude in HFOV?
waves that produce a vibration aka “wiggle”
Hz for HFOV
3-15Hz
1Hz = ?
60 breaths per minute or one cycle per second
How is the breath generated in HFJV?
delivered by a high-pressure pulse of gas
Active exhalation
This is a characteristic of HFOV. The machine, during exhalation, actively “pulls” the gas out of the lungs
Three main things that the HFJV
Creates sigh breath via CMV to prevent atelectasis and produce surfactant
PEEP
Cont. flow to allow for jet propelled breaths
**How do you decrease the amount of CO2 on the oscillator?
You want to DECREASE the frequency (Hz) because it will increase the minute ventilation
**On the oscillator how does changing the amplitude effect CO2 ventilation?
Increase the amp/power will remove CO2, decreasing the PaCO2
If you need to increase elimination of CO2 on the oscillator what would you adjust first, second?
First change the AMP then the frequency (Hz)
On the oscillator, what are the two settings you can change to effect oxygenation?
MAP and FiO2
How do you know if you have enough ‘wiggle’
wiggle needs to be below the nipple line. If it isn’t, you need to increase the AMP via the power
**Want it past the nipple line or even down to groin/feet
Difference in weaning from HFOV and HFJV
If on HFJV, reason for being placed on the jet is resolved. For HFOV, you want FiO2 <60 and MAP <20
