Respiratory Complications & Support Flashcards
What are the benefits of high flow nasal cannula?
(1) Heated/Humidified gas helps to increase secretion clearance and decrease bronchoconstriction.
(2) Washout dead space in the upper airways and decrease upper airway resistance.
(3) Positive airway pressure increases recruitment of atelectasis.
(4) Decreased entrainment of ambient air results in increased FiO2 delivery.
In which two scenarios should you NOT use NIV?
(1) Failed Extubation
(2) PREVENTION of hypercapnia in COPD exacerbation.
What are the two DEFINITE indications for NIV therapy in acute respiratory failure?
(1) COPD exacerbation with RR > 20, pH < 7.35 and PaCO2 > 45.
(2) Cardiogenic pulmonary edema (CHFe), excluding acute MI and cardiogenic shock patients.
What are the contraindications to NIPPV?
(1) Facial surgery, trauma or obstruction.
(2) Decreased LOC (relative)
(3) Inability to clear secretions
(4) Hemodynamic instability
(5) Clear indication for intubation
What are the benefits of NIV, if used in the appropriate setting (4)?
(1) Reduced intubation
(2) More vent-free days
(3) Less health care associated infections
(4) Reduced mortality
What is the target tidal volume in patients with acute respiratory distress syndrome?
4-8 ml/kg predicted body weight
How are the different severities of acute respiratory distress syndrome defined?
Based on the PaO2/FiO2 ratio with PEEP or CPAP of at least 5 cm H2O, as follows:
Mild - 200 < PaO2/FiO2 < or = 300 mmHg
Moderate - 100 < PaO2/FiO2 < or = 200 mmHg
Severe - PaO2/FiO2 < or - 100 mmHg
What are the targets for oxygen saturation, PaO2 and pH in patients with ARDS?
Oxygen Sat: 88-95%
PaO2: 55-80
pH 7.25-7.35
What is the target plateau pressure for a patient ventilated with acute respiratory distress syndrome?
Plateau Pressure < 30 cm H20
Which interventions in acute respiratory distress syndrome have mortality benefit?
(1) High PEEP in moderate to severe ARDS
(2) Prone positioning when P/F ratio < 150
When would you consider neuromuscular blockade for patients with ARDS?
Consider when P/F ratio is < 150 and there is difficulty achieving lung protective ventilation or ventilator synchrony.
When should you consider early intubation for patients with COVID-19 infection (3)?
(1) If an FiO2 > or = 0.6 cannot maintain an SpO2 > 90%
(2) If the patient is in septic shock
(3) If pH is < 7.30
What did the RECOVERY trial show?
An overall reduction in 28-day mortality in hospitalized patients receiving mechanical ventilation or supplemental oxygen on dexamethasone of 6 mg IV daily x 10 days.
What are the criteria for extubation (4)?
(1) Reversal of the underlying cause for intubation.
(2) Adequate oxygenation (PaO2 > 60 on FiO2 of < or = 40% and PEEP 5-8)
(3) Stable cardiac status.
(4) Adequate mentation
What rapid shallow breathing index (RSBI) score predicts failed extubation?
> 105
