Respiratory review part 3 (mechanical ventilation)

Question 1

endotracheal tube placement

Answer 1

chest radiograph: should be 3-5 cm above the carina

waveform capnography is most accurate

assess and document tube placement at the teeth or gum line

Question 2

If the endotracheal tube migrates down, it most often migrates to:

Answer 2

the right lung d/t the anatomyy of the mainstem bronchi

Question 3

Get ABG’s within ____ of intubation to assess acid-base status.

Answer 3

20-30 mins

Question 4

Ventilator breaths may be delivered as a set ___ or a set ___.

Answer 4

volume (most common for adults) or pressure

Question 5

Assist control (AC) mode

Answer 5

patient receives a SET TIDAL VOLUME at the the set breath rate. The patient also receives the SET TIDAL VOLUME for each spontaneous breath triggered by the patient above the set breath rate.

all breaths are machine breaths

provides full ventilatory support

NOT a weaning mode

can result in over-ventilation or hyperinflation of the lungs at higher spontaneous breath rates

Question 6

Synchronized intermittent mandatory ventilation (SIMV) mode

Answer 6

The patient receives the SET TIDAL VOLUME at the set breath rate, and all breaths above the set rate are spontaneous breaths at the patient’s OWN TIDAL VOLUME.

all machine breaths are synchronized with the patients breathing effort

provides partial or full ventilatory support

reducing SIMV rate allows the patient more work of breathing

spontaneous breaths may be pressure supported

Question 7

PEEP

Answer 7

positive end expiratory pressure

positive pressure is applied to the airways at the end of exhalation

Question 8

CPAP

Answer 8

continuous positive airway pressure

this is PEEP applied to a spontaneously breathing patient

last step in weaning process

patient can experience fatigue if left on CPAP for and extended time

Question 9

PSV

Answer 9

Pressure Support ventilation

the patient receives an increase in pressure during inspiration to boost the tidal volume

this is a patient triggered mode and patient cannot be paralyzed or sedated

not used with assist control mode

frequently used during weaning to reduce the work of breathing

Question 10

tidal volume (Vt)

Answer 10

generally 6-8 mL/kg

for ARDS 5-6 mL/kg

Question 11

FiO2

Answer 11

fraction of inspired oxygen

generally set at 100% on intubation and adjusted down according to PaO2 with a goal of 50% or less asap

Question 12

High pressure alarms

Answer 12

think a block causing more pressure

agitation, coughing, secretions, aspiration, kinked/occluded line, bronchospasm, decreasing lung compliance (ARDS), pneumothorax

Question 13

low pressure alarm

Answer 13

think a leak releasing pressure

disconnection or leak, inadequate tidal volume, cuff leak, chest tube leak

Question 14

If you are unable to troubleshoot an alarm, what should you do?

Answer 14

Disconnect from ventilator and BAG THE PATIENT