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PVRS > subgroup settings > Flashcards

subgroup settings Flashcards

1
Q

What are some specific patient subgroups

A
  1. COPD
  2. neuromuscular
  3. asthma
  4. closed head injury
  5. acute respiratory distress syndrome (ARDS)
  6. acute cardiogenic pulmonary edema (CHF)
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2
Q

What is the R and C in COPD?

A

increase resistance and compliance

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3
Q

What is the goals when ventilating COPD?

A
  1. reduce WOB
  2. increase pt-ventilator synchrony
  3. long and complex wean
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4
Q

which modes are suitable for COPD?

A

PC- CMV or DC-CMV

  • descending flow waveform better match patient flow demand
  • allow longer E time

VC-CMV

  • need to match patient demand
  • use decending ramp to avoid high pressure and maximizing distribution of ventilation
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5
Q

What is the tidal volume range for COPD?

A

5 - 8 ml/kg

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6
Q

What is a precaution for COPD patient?

A

monitor for Autopeep

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7
Q

How to reduce chance of autopeep?

A
  • lower VE
  • permissive hypercapnea
  • bronchdilators
  • optimal E time
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8
Q

What is the PaCo2 accept for these patient?

A

normal paCo2 : 50 - 60 mmhg

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9
Q

What is the normal PaO2 for these patient?

A

55 - 75 mmhg

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10
Q

Why not use PSV for COPD patient?

A
  • patient is controlling the trigger and cycling meaning:
    1. I time can be too short or long
    2. can increase WOB and poor patient ventialtor synchrony
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11
Q

What is the deal with neuromuscular disease?]

A

patient have normal:

  • ventilatory drive
  • normal or near to normal lung function
  • require mechanical venilation because of respiratory msucle weakness
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12
Q

What can respiratory muscle weakness lead to?

A
  • limits patient ability to cough and clear secretion

- result: develop atelectasis and pneumonia , broncho-hyigene problem

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13
Q

What is the ideal setting for NM?

A

Vt: 7 - 8ml/kg

mode: VC-CMV, with higher flowrate
weaning: straight forward

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14
Q

What are the indication of ventilating Asthma patient?

A
  1. exhaustion
    - ->RR decrease
    - ->decrease ph, increase Paco2
    - ->respiratory acidosis superimposed on metabolic acidosis
  2. poor air entry
    - ->bilateral wheezes
    - ->air trapping increases
  3. severe hypoxemia
    - ->refractory hypoxemia
  4. depression of hemidiaphrams
    - ->air trapping
  5. altered mental state
    - -> decrease LOC
  6. dysrthymias
  7. cardiac or resp arrest
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15
Q

What are the ventialtor settings for asthma?

A

Fio2: as needed as long as it keeps Pao2 above 60

permissive hypercapnea: allow but watch ph because there maybe underlying metabolic acidosis

I:E: allow for longer E time

Vt: 4 - 8 ml/kg

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16
Q

What is a closed head injury?

A
  • brain injured but skull remains intact

- swelling of the brain leads to increase IP

17
Q

What is the formula of CPP?

A

CPP = MAP - ICP

18
Q

What happens to the CPP when there is a closed head injury?

A

due to increase in ICP, assuming no change in MAP, the CPP will decrease

19
Q

What does brain do when the CPP drops?

A

it decreases the CVR to increase the flow of blood

20
Q

what is the normal ICP?

A

less than 10 mmhg

21
Q

What is iatrogenic hyperventilation?

A

deliberate lowering of

PaCO2

22
Q

what is the effect of reducing PaCo2?

A
  • result in cerebral vasconstriction, thus decreasingg ICP
23
Q

Whhat is the relationship between ph and CVR?

A

increase ph will increase CVR, decreasing the ICP

24
Q

What is another effect of increasing CVR

A

increase CVR decrease the blood flow reach to the brain–> decrease CPP

25
Q

What is the current recommendation for close head injury?

A
  • PaCO2 < 35 mmHg is not recommended during first 24 hours because CBF is already lessened
  • It may be helpful for brief periods of time when ICP rises or until other measures can be instituted to decrease ICP
  • In normal ICP settings, hyperventilation should not be used
  • All attempts should be made to decrease Paw (low PEEP, moderate VT)
26
Q

What are the ventilator settings for close head injury?

A

Mode:
- Full support is needed (VC, PC, DC CMV)

VT:
- 5-8 mL/kg and keep Pplat < 30mm

MV:

  • to keep PaCO2 ~35mm,
  • target 30 - 35 mmhg if necessary

Keep PaO2 70-100mmHg

27
Q

What is the primary strategy when treating ARDS?

A
  1. Employ lung protective strategy

2. keep pplate <30mmhg withh adequate oxygenation

28
Q

what are the settings for ARDS according to the guidlines?

A

VT: initially 8 ml/kg and titrate down from there, depending on Pplat

–> If 4 mL/Kg still causes high Pplat then allow for permissive hypercapnia (pH as low as 7.20)

RR: as high as possible without causing autopeep

Flow: higher flow to reduce I time

29
Q

Why is Peep important for ARDS?

A

Prevents atelectrauma, improves shunt, improves compliance

30
Q

What is the optimal peep for ARDS?

A

be just above the inflection point on the deflation limb of a PV curve after the lung is maximally recruited

31
Q

What is the purpose of putting ARDS patient in a prone position?

A

improve V/Q, improve oxygenation

32
Q

how to position patient if they have unilateral lung disease (alveolar consoldiation)?

A

put the good lung down

–>gets better ventilation and gravity dependent lung always get better blood flow

PVRS (17 decks)

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