Protection Strategies For Invasive Ventiation l

Question 1

What are optimal settings on the ventilator for ARDS

Answer 1

RR 12-20(higher with hypercapnia)
VT 6-8mg/kg/IBW
FIO2 100%- wean down as able
PEEP - start low but increase to decrease FIO2 needs

Question 2

What are two ways to increase oxygenation?

Answer 2

Increase PEEP and FIO2

Question 3

What is typically happening if a patient is inadequately oxygenating despite 100% FIO2

Answer 3

pulmonary shunting. IE; atelectasis, pneumonia, ARDS, CHF, Hemorrhage

Question 4

How does peep increase oxygenation?

Answer 4

Increases Functional Reserve Capacity (FRC)
Decreases shunting and atelectasis
Decreases repetitive injury
Recruits collapsed alveoli to decrease VQ mismatch
Improves compliance

Question 5

What are disadvantages of increased PEEP

Answer 5

Increased intrathorasic pressure
May lead to ARDS
Rupture leading to pneumothroax or pulmonary edema

Question 6

What are two ways to improve ventilation on the ventilator

Answer 6

Adjust TV and RR

Question 7

What are ways to improve ventilation without changing vent settings

Answer 7

Reduce muscular activity and seizures
Minimizing carb load
Decrease hyper metabolic state

Question 8

What is the I:E ratio and how can that be manipulated to improve ventilation

Answer 8

Inspiration: Expiration ratio
Increasing inspiration may increase TV but lead to auto peep

Question 9

What vent changes can be made to adjust for elevated PIP

Answer 9

Patient may need pressure cycled mode instead of volume cycle

Question 10

What is the goal Plateau pressure to prevent barotrauma

Answer 10

<30cm H2O

Question 11

What is I:E inverse ratio ventilation (IRV) and when is it indicated

Answer 11

Instead of the traditional 1:3 ratio it is switched to 3:1 ratio
Used in severe ARDS and severe refractory hypoxemia
Typically used before ECMO
Elevated pressure may increase alveoli recruitment

Question 12

What is high frequency oscillatory ventilation?

Answer 12

High frequency ventilation meant to use a constant mean airway pressure with pressure variations oscillating near the MAP. This creates small tidal volumes and less dead space. May cause hemodynamic compromise, pneumothorax, needs neuromuscular blocking agents

Question 13

What are pulmonary complications of mechanical ventilation

Answer 13

Barotrauma, venti induced lung injury, oxygen toxicity, VAP, tracheal stenosis

Question 14

What are cardiac complications of mechanical ventilation

Answer 14

Reduced output, hypotension, RV ischemia, Right to left shunting, Intra atrial shunt

Question 15

GI complications of mechanical ventilation

Answer 15

Illeus
Hemorrhage

Question 16

Renal complications of mechanical ventilation

Answer 16

Fluid retention
Hyponatremia

Question 17

Cerebrovascular complications of mechanical ventilation

Answer 17

Increased ICP