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Life Support > Test 1 > Flashcards

Test 1 Flashcards

1
Q

“iron lung” is referring to what?

A

negative pressure ventilation

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2
Q

mechanisms of positive pressure ventilation

A

pressure at mouth inc, air flows into lungs and diaphragms flatten, machine cycles off and mouth pressure returns, alveoli recoil and air flows out of lungs, and then a pause happens

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3
Q

Cycle definition

A

transition from inhalation to exhalation

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4
Q

What are some desired physiological effects of + pressure ventilation

A

dec. WOB, normalize blood gas, inc min.ventilation, inc alveolar ventilation, improved distribution of gases

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5
Q

What are some effects on circulation during normal ventilation (spontaneous)

A

inc. venous return, sends blood to heart, inc preload, inc stroke volume, inc CO

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6
Q

effects on circulation during + pressure ventilation

A

dec. venous return, dec preload, dec. stroke volume, and dec CO, BP might drop

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7
Q

complications of mechanical ventilation

A

dec. CO, barotrauma (pneumomediastinum, subcutaneous emphysema, pneumo, damage to pulm. capillaries, renal malfunction, CNS malfunction, stress ulcers, psychological trauma, deep vein thrombosis, dec hepatic blood flow, deconditioning of respiratory musc. and infections

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8
Q

What is a simple pneumo

A

collection of air in the space around the lungs, may need to be treated (look at BP)

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9
Q

What is a tension pneumo

A

collection of air in the thoracic cavity which builds up air and puts pressure on the lung so it cannot expand normally, this MUST be treated

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10
Q

equation for MAP

A

systolic +2(diastolic)/3

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11
Q

VAP bundle definition

A

a pneumonia infection that must have developed more than 48 hours after the patient was intubated

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12
Q

What is the leading cause of death among hospital acquired infections?

A

VAP

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13
Q

What are some things you can do to prevent VAP

A

elevate HOB 30 degrees, daily sedation vacations, assessment of readiness to wean, peptic ulcer prophylaxis, use non invasive forms when possible, oral hygiene, closed system suction, rotate ETT every 24 hours,

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14
Q

Compliance definition

A

stiffness or stretchiness of resp. system

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15
Q

High compliance

A

stretches easily, not very elastic

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16
Q

Low compliance

A

difficult to stretch, very elastic

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17
Q

Is static or dynamic compliance more accurate?

A

static

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18
Q

State compliance equation

A

Delta V/Pplat-PEEP

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19
Q

On vent how do you calculate static compliance

A

VT/Pplat-PEEP

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20
Q

Normal range for static compliance during spontaneous breathing

A

50-100 mL/cm H2O, acceptable >25

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21
Q

Equation for dynamic compliance

A

Delta VT/(PIP-PEEP)

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22
Q

Resistance (Raw) definition

A

the drag of friction on gas flow in the airways

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23
Q

Raw equation

A

Pmax-Pplast/VI (VI needs to be in L/sec)

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24
Q

Time constant definition

A

amount of time needed to inflate a lung region to 60% of capacity

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25
Q

Time constant equation

A

Raw X CL

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26
Q

What will inc. time constant?

A

resistance, compliance

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27
Q

An increased time constant is associated with what?

A

Auto PEEP

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28
Q

Assisted spontaneous breaths definition

A

a breath during which some or all flow is generate by the vent doing work for the patient, patient effort still beings and ends breath and determines tidal volume

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29
Q

continuous mandatory ventilation (CMV) definition

A

all breaths are mandatory

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30
Q

Continuous spontaneous ventilation (CSV) definition

A

all breaths are spontaneous

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31
Q

Intermittent Mandatory Ventilation (IVM) definition

A

breaths can be mandatory or spontaneous

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32
Q

During CMV all breaths are either what?

A

pressure control or volume control, full vent support

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33
Q

What are the 3 types of triggering in CMV

A

control, assist, assist/control

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34
Q

Assist/Control definition

A

breaths can be time or patient triggered, patient can breathe more often than the set rate, provides backup if patient becomes apneic

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35
Q

IMV mechanisms

A

combo of spont. breaths with mandatory breaths

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36
Q

Advantages of IMV

A

dec. muscle atrophy, improve CO, and support can be withdrawn gradually

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37
Q

Disadvantages of IMV

A

inc WOB during spontaneous breaths, potential for breath stacking if mandatory breaths are sychronized with patient effort

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38
Q

SIMV definition

A

vent opens up a window of time to wait for patient effort

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39
Q

CSV mechanisms

A

all breaths are initiated and ended by the patient, used to wean

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40
Q

Bubble CPAP

A

uses blender, flowmeter, has water seal on exhalation limb, exhale against water level resistance which creates elevated pressure in chest. Used only in PEDS

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41
Q

Pressure Support Ventilation (PSV) definition

A

PS can be done with other modes like SIMV and VC, spontaneous breaths are supported with positive pressure, helps patients overcome WOB

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42
Q

Airway Pressure Release Ventilation

A

used with CPAP, pt breathes spontaneously at elevated baseline pressure, reduces MAP, typically regarded as a FULL SUPPORT MODE

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43
Q

Servo Controlled Modes

A

computer monitors patient volumes during pressure or spontaneous breaths, if volume falls below the minimum the vent provides assistance

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44
Q

Pressure Regulated Volume Control

A

full support, flow is delivered in a way to dec. PIP

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45
Q

PEEP mechanism

A

positive end expiratory pressure, elevated baseline, used to inc. FRC and O2, common starting point is 2-5 cmH2O

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46
Q

Benefits of PEEP

A

inc FRC, dec shunt, inc CL, dec WOB, inc PaO2

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47
Q

Bad effects of PEEP

A

inc incidence of baratrauma, dec. venous return, inc WOB if peep isnt at right level, inc PVR, inc ICP, dec renal blood flow, inc deadspace

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48
Q

Best level of PEEP is achieved at what?

A

best static compliance, best mixed venous O2

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49
Q

Inspiratory hold mechanism

A

improves distribution of gas, dec. atelectasis, inc. alveolar recruitment

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50
Q

Ventilator classification schemes

A

input power (power source), power conversion and transmission, control system

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51
Q

Pneumatic vents mechanisms

A

have moving parts, needles, venturi entrainers, flexible diaphragms, spring loaded valves and all are used to control flow, volume delivery, and inspiratory/expiratory function

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52
Q

Fluidic vents mechanisms

A

rely on special principles to control gas flow, not really used to ventilate in acute care setting

53
Q

Power conversion definition

A

used to deliver gas under pressure to patient circuit

54
Q

Drive mechanism definition

A

convert input power to output work, they determine characteristic flow and pressure patterns the vent produces

55
Q

Compressors (Blowers) definition

A

reduce internal volumes within the ventilator to generate a positive pressure for gas delivery

56
Q

Compressors may be what?

A

piston driven, rotating blades, moving diaphragms, bellows

57
Q

Spring loaded bellows

A

adjustable spring at top of bellows applies force per unit area or pressure, contains pre blended gas

58
Q

Linear Drive Piston

A

electrical motor connected by special gearing mechanism to piston rod or arm, may be seen in high frequency vents

59
Q

Rotary drive piston

A

non linear drive, sine wave

60
Q

flow control valves

A

newer vents have this, rapid flow time and greater flexibility for flow

61
Q

proportional vavles

A

uses electrical plunger

62
Q

most vents are what type of system

A

closed loop

63
Q

What is the closed loop system

A

intelligent system because they compare set control variable to measure control variable this allows the vent to respond to changes in the patients condition

64
Q

Control variables definition

A

parameter that can be manipulated by the vent

65
Q

What are the 4 control variables

A

pressure, flow, volume, time (cant control all 4 at the same time)

66
Q

What is the equation of motion

A

Pressure=(elastance X volume) + (Resistance X Flow)

67
Q

When thinking about flow what other control variable should you think of?

A

volume

68
Q

What is the the total time equation

A

Tt= TI + TE

69
Q

What are the 4 phases of ventilation

A

begin inspiration (trigger), inspiration (limits), end insp/start exp (cycle), expiration (baseline)

70
Q

what trigger is very common

A

negative. set 0.5-3 cm H2O below baseline pressure

71
Q

What is a limit variable?

A

does not end on inspiration, only applies a limit to some parameters to not exceed a preset value during inspiration

72
Q

Limits vs. Cycles

A

cycles shut off breath, and limits dont shut off breath

73
Q

Tidal volume equation

A

VE/f

74
Q

normal range for tidal volume

A

5-8 ml/kg

75
Q

tidal volume definition

A

volm of air expired in one normal spontaneous respiratory cycle

76
Q

Vital capacity definition

A

max vol of air that can be inhaled after a max inspiration

77
Q

vital capacity range

A

65-75, acceptable >10

78
Q

Minute ventilation equation

A

VE= f X VT

79
Q

minute ventilation definition

A

volume of air breathed in one minute

80
Q

Max voluntary ventilation definition

A

largest volume of air that can be breathed in 10-20 second period.

81
Q

Normal MVV

A

120-180 LPM, acceptable >20

82
Q

Negative inspiratory force definition

A

amount of negative pressure generated by the patients inspiratory effort

83
Q

NIF range

A

-80-100 cm H2O or less, acceptable -20 or less

84
Q

Max Expiratory Pressure defintion

A

highest pressure achieved during max expiration

85
Q

Normal range for MEP

A

60-100, acceptable 40

86
Q

Rapid shallow breathing index equation

A

f/Vt

87
Q

rapid shallow breathing definition

A

number of breaths per minute divided by average spontaneous tidal volume in liters

88
Q

What is the best single indicator of weaning success

A

rapid shallow breathing index

89
Q

Normal range for rapid shallow breathing

A

<100 breaths/min/L

90
Q

Airway occlusion pressure definition

A

inspiratory pressure measures at 100 milliseconds after airway occlusion

91
Q

Number that correlates with lack of weaning success

A

<-6 cm H2O

92
Q

Vd/Vt ratio definition

A

indicated the percentage of the patients tidal vol that is not participating in gas exchange

93
Q

normal range for Vd/Vt

A

20-40% spontaneous breathing, 40-60% ventilated pts

94
Q

Equation for Vd/Vt

A

PaCO2- PeCO2/PaCO2

95
Q

Capnography/end tidal CO2 definition

A

the amount of carbon dioxide in the patients expired gases

96
Q

Normal end tidal CO2

A

35-43 mmHg, acceptable 35-55

97
Q

Arterial Oxygen tension gradient definition

A

difference b/w alveolar and arterial oxygen pressures, changes with FIO2

98
Q

normal tension gradient

A

5-10 on RA, 25-65 on O2, acceptable 66-300

99
Q

alveolar air equation tension gradient equation

A

(Pb-47)FiO2-(PaCO2 X 1.25)-PaO2

100
Q

a/A ratio definition

A

percentage of oxygen that passes from alveolar gas to arterial blood

101
Q

normal range for a/A ratio

A

75-95%, acceptable >60

102
Q

PaO2/FiO2 ratio definition

A

used in determining whether or not a patient has acute lung injury or ARDS

103
Q

normal range PaO2/FiO2

A

<200 ARDS normal is 380

104
Q

Mixed venous O2 (SvO2) normal

A

75% acceptable >60%

105
Q

how do you determine mixed venous

A

BP or catheter

106
Q

Shunt definition

A

measures the percentage of CO not participating in gas exchange

107
Q

Normal shunt

A

healthy <20%

108
Q

shunt equation

A

(PAO2-PaO2) X 0.003/(CaO2-CvO2)+(PAO2-PaO2) X 0.003

109
Q

Goals of noninvasive ventilation

A

inc. FRC, dec shunt, inc lung compliance, dec WOB, inc PaO2

110
Q

what are some common uses for CPAP

A

obstructive sleep apnea, reverse atelectasis, respiratory distress in infants, adults with acute lung injury

111
Q

hazzards and complications due to inc pressure

A

barotraume, dec CO/venous return, inc PVR, inc ICP, gastric distention, dec. renal/portal blood flow

112
Q

Potential contraindications to NIV

A

patients unable to tolerate inc WOB, ICP >20, hemodynamic instability, acute sinisitis, recent facial surgery/trauma, epitaxis, esophageal surgery, nausea, middle ear issures, active hemoptysis

113
Q

Typical CPAP blower units

A

common in HC, continuous flow, hard to exhale, filters air, can add humidity

114
Q

Typical critical care vents

A

very expensive, extra alarms, may not work well with masks that leak,

115
Q

general guidelines to NIV

A

needs spont. breathing pts, may require N-G tube, usually used at moderate levels, not appropriate for acute resp. failure

116
Q

noninvasive positive pressure ventilation (NPPV)

A

blows off CO2, good for COPD patients, IPAP/EPAP

117
Q

common uses for NPPV

A

copd exacerbations, asthma, pulmonary edema, community acquired pneumonia, respiratory failure, immunocompromised, no not intubate order, post operative status, difficulty weaning

118
Q

Selection criteria for NPPV

A

use of accessory muscles, paradoxial breathing, resp rate >25, SOB, PaCO2.45 with pH <200

119
Q

minimal leak allowed for masks during NPPV

A

<15 LPM max of 30 LPM

120
Q

During CPAP what do you set

A

set only EPAP in using a BiPAP capable machine

121
Q

what is Cflex

A

optional seting, gives a drop in pressure during exhaltion to reduce effort required

122
Q

volume control is good for what patients

A

good when lungs are easy to open

123
Q

pressure control is good for what patients

A

for inflammation/fibrotic lungs (ARDS, severe pulm edema)

124
Q

how do you find Pplat

A

inc peak pressure and inspiratory hold, if >30 want to dec peak pressure

125
Q

trigger sensitivity during initial vent settings

A

flow trigger 1-3 LPM below base flow

126
Q

What is the formula for adjusting FiO2

A

Know FiO2/Known PaO2 = Desired FiO2/Desired PaO2

127
Q

if PaCO2 is too low for vent settings what should you change?

A

dec RR, dec Vt

128
Q

Formula for adjusting PaCO2

A

Known Vt X Known PaCO2= Desired Vt X Desired PaCO2

Life Support (1 decks)

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