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Interventions 3 > Pt getting better strats (Mod 4) > Flashcards

Pt getting better strats (Mod 4) Flashcards

1
Q

Why should we titrate to the patients WOB if they’re getting better?

A
  1. To promote patient/ventilator synchrony
  2. Support muscles of ventilation (based on patient/vent work)
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2
Q

What is tube compensation?

A

When the ventilator nullifies the resistance imposed by the airway via ETT

  • similar to PS, Inspired pressure is used to compensate for imposed WOB
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3
Q

How are time constants affected by tube compensation?

A

TC varies the pressure depending on the tube size and Pt inspiratory flow

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4
Q

How is Tube Compensation calculated?

A

Ptrachea = (Paw - Ktube) x Flow^2

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5
Q

What are benefits of tube compensation?

A

Increase patient comfort over Psupport

  • could indicate readiness for extubation
  • Reduce risk of air trapping caused by expiratory resistance (some allow insp and exp comp)
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6
Q

What settings are required for tube compensation? (ATC mode)

A
  1. Type of airway (ETT vs Trach)
  2. Size of airway
  3. % compensation (0-100)
  4. Inspiratory and expiratory or inspiratory or expiratory only (set up configuration)
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7
Q

What is Tube compensation mode on the Evita?

A

Automatic tube compensation (ATC)

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8
Q

What is Tube compensation mode on the Hamilton G5?

A

Tube Resistance Compensation (TRC)

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9
Q

What is Tube compensation mode on the GE?

A

Airway Resistance Compensation (ARC)

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10
Q

What is Tube compensation mode on the PB 840/980?

A

Tube compensation (TC)

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11
Q

What does Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive) do?

A

A mode that guarantees a min MV even though a Pts spontaneous ventilation may change.

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12
Q

In Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive), what happens if the patient maintains a MV above the set MV?

A

Then the mode functions like CSV-PS

  • all breaths are supported breaths
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13
Q

In Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive), what happens if the patient MV falls below the set MV?

A

Mandatory breaths will be delivered (at the set Vt) to makes the total MV = set MV

  • Only the M breaths required to return the Pts MV to the set MV
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14
Q

How does Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive) differ from SIMV?

A

SIMV will always provide the set number of mechanical breaths a minute, regardless of the patients spontaneous MV

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15
Q

what does the number of M breaths per minute depend on in Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive)?

A

How much the patient is breathing own their own

  • assisted breaths are technically possible if the pt made an inspiratory effort during the window
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16
Q

What happens in Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive) if the patient becomes totally apneic?

A

They will get mandatory breaths at the set rate

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17
Q

What breath types are delivered in Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive)

A

All breath types (M,A,S), but usually only mandatory and spontaneous supported are seen.

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18
Q

In Mandatory Minute ventilation (VC-IMV or PC-IMV adaptive) what happens if the patient makes an inspiratory effort in the trigger window?

A

The breath is considered to be assisted

19
Q

What are the goals of Adaptive Support Ventilation (ASV)?

A

Provide MV while minimizing the WOB and avoiding ineffective breathing patterns

20
Q

What ineffective breathing patterns does ASV aim to avoid?

A
  • Rapid and shallow
  • Breath stacking
  • Excessively large breaths
  • Excessive dead-space ventilation
21
Q

What is Adaptive Support ventilation (ASV)?

A

An optimal control type of closed loop mode

  • Should result in the least amount of WOB and least amount of pressure supplied by the ventilator
  • a complicated form of MMV basically
22
Q

What phase variable breaths are delivered if the breath is mandatory?

A

VC or PRVC

23
Q

What phase variable breath type is delivered via ASV if the breath is mandatory?

A

Mandatory breaths in ASV are PC and volume targeted?

24
Q

What phase variable breath type is delivered via ASV if the breath is spontaneous?

A

Spontaneous breaths in ASV are Psupp and volume targeted

25
Q

What are ventilator breaths based on in ASV?

A
  1. Based on operator set % Minute vol
  2. Pressure controlled and volume targeted

Vent will deliver a mix of PC and PS breaths depending on patients drive to breath

26
Q

what is set %minvol based on in ASV?

A

ASV % minvol is based on 100ml/kg IBW for 100% settings (if normal)

The following %MinVol adjustments would be made

  • Normal Pt =100%
  • COPD = 90%
  • ARDS = 120%
27
Q

What do you setup on ASV?

A

Patients IBW and %min vol

28
Q

how does hyperthermia affect %MinVol set?

A

We need to add extra 10% per degree C increase

29
Q

How does altitude affect %MinVol set?

A

5% per 500m above sea level

30
Q

Left off at slide 19

31
Q

What peak flow is required for a patient with moderate to strong ventilatory demands?

A

60 L/min or greater

32
Q

What parameters should be assessed when weaning off ASV? (3)

A
  1. Oxygen and Peep for Oxyegnation
  2. %Minvol for CO2 elimination
  3. Spon: RSB and %Fspont
33
Q

When weaning in ASV, how should a SBT trial be conducted?

A
  1. Decreased PEEP to 5
  2. Lowering the target minute volume (%MinVol)
  3. Reduce Pressure support as needed
34
Q

What adjustments can be made to pressure support to reduce %MinVol when weaning on ASV?

A

When performing a SBT, If the pressure support on the current %MinVol setting is higher than 15 cmH2O, the %MinVol setting can be lowered first to 70% and then 25% to reduce pressure support gradually to 5‑8 cmH2O for the SBT.

35
Q

What is Proportional Assist Ventilation (PAV)?

A

A PC-CSV Adaptive mode designed to assist spontaneous ventilation

  • similar to PS but the pressure lvel delivered is variable and proprtional to the patients spontaneous effort.
  • Harder pt works = more support the vent delivers = positive feedback
  • Less work = less support
36
Q

How does Proportional Assist Ventilation work (PAV)?

A

Positive feedback system.

  • More Pt effort = more support, less effort = less support
  • Based on equation of motion: Pmuscle + Paw = (Vt x E) + (Flow x R)
37
Q

Proportional Assist Ventilation (PAV) Phase variables

A
  • Trigger: patient only
  • Limit: Pressure-limited
  • Cycle: Flow
38
Q

2 forms of assistance that Proportional Assist Ventilation (PAV) provides

A
  • Flow assist: Helps overcome WOB due to resistance
  • Volume assist: Help overcome WOB due to elastance (1/C)
39
Q

What is Proportional Assist Ventilation (PAV) best suited for?

A

Pts with abnormalities in resistance and compliance

  • not suitable for pts with neuromuscular weakness or CNS depression who cannot generate adequate insp effort
40
Q

What is Neurally Adjusted Ventilatory Assist (NAVA)

A

Mode designed to assist spontaneous ventilation.

  • Similar to PS but the pressure support level delivered is variable and is proportional to the pts spontaneous effort
  • Uses Edi catheter to support the diaphragm
  • Like PAV is a positive feedback system
41
Q

How does NAVA differ from PAV?

A

NAVA uses a Edi catheter (electrical activity of the diaphragm) to send stronger signals to the diaphragm to breath, which in turn increases support level.

42
Q

What is Volume support?

A

A spontaneous mode only (adaptative PC-CSV) can’t be added to combined modes like SIMV

  • Delivers pressure limited, volume targeted breath.
  • PS level is adjusted breath to breath (all pt triggered)
  • Works on a negative feedback mechanism (like APV)
43
Q

Advantages of volume support?

A

Guarantees tidal volume, pt still determines rate and Ti

  • considered a self weaning mode

Interventions 3 (19 decks)

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