Possible Exam Flashcards
What are 4 reasons that asynchrony is bad?
1) O2 consumption
2) Muscle injury
3) V/Q Mismatch
4) Dynamic hyperinflation
What are 6 indications to NIPPV?
1) CHF, Pulmonary Edema
2) COPD Exacerbation
3) Post extubation
4) Post lung or abdominal surgery
5) Febrile neutropenia
6) Preoxygenation/Preintubation
What is the staged approach to a hypoxemic patient?
What should you look for/evaluate at each step
1) Optimize FiO2 - Start 1.0 and work down after safe ground
2) Optimize PEEP - Consider PEEP scale, monitor Pplat and hemydynamics
3) Consider switching to PC from ACV (more area under the curve which is where oxygenation occurs)
4) Recruitment maneuver (repeat x ? - evaluated pH and effects when considering repeat)
5) Increase RR (more area under curve) - increase risk of dynamic hyperinflation though
6) Prone positioning
7) Inverse ratio ventilation (more area under curve)
8) ECMO
What are the 3 steps in evaluating ventilation?
1) Are we oxygenating adequately?
2) Are we ventilating appropriately?
3) What is the acid/base status (are we on “safe ground”)
What are my goals in mechanical ventilation and how do I know if its working?
1) Primary - provide O2, remove CO2
2) Secondarily - Maintain acid/base (pH)
3) How do I know if its working?
ABG
What is more effective at reducing CO2 (reduce RR or reduce Ti to prolong expiratory time)
Reducing rate is more effective
What is the different between BiPAP and CPAP?
What defines failed BiPAP?
BiPAP has both an inspiratory support (IPAP) and expiratory pressure (EPAP)
CPAP only has positive end expiratory support
Failed BiPAP - Look at physiological numbers and also at patient. If patient looks worse or number get worse (Especially PCO2), then BiPAP failed.
If you notice increasing peak pressures and increasing plateau pressure, what does it mean is physiologically going on with the lung and why?
It means you have a compliance problem because the same volume of gas is causing an increase in Pplat meaning compliance has decreased.
This CAN be caused by air trapping as the lung become more distended - an expiratory hold/autoPEEP would show whether there is residual air left in lung at end expiration
