Test 1 Ch. 7 Intial Ventilator Settings Based on Pulmonary Disorder Flashcards
Normal lungs
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
Mode: VC or PC-CMV
IBW: 6-8
RR: 10-15
Flow: 60
FW: Descending or constant
Ti: 1
PEEP: greater than or equal to 5
Fio2: greater than or equal to 50%
COPD
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
- Mode: VC or PCMV
- IBW: 6-8
- RR: 8-12
- Flow: >60 (80-100)
- FW: Descending or constant
- Ti: 0.6-1.2
- PEEP: greater than or equal to 5 or 50% of intrinsic PEEP
- FiO2: <0.5
Neuromuscular disorder
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
- Mode: VC-CMV
- IBW: 6- 8
- RR: 8-12
- Flow: greater than or equal to 60
- FW: Descending or constant
- Ti: 1
- PEEP: 5
- FiO2: 0.21
Asthma
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
- Mode: VC or PC- CMV
- IBW: 6-8
- RR: 10- 14
- Flow: 60- 70
- FW: Descending
- Ti: less than or equal to 1
- PEEP: Only to offset intrinsic PEEP and improve triggering
- FiO2: greater than or equal to 0.5
Closed head injury
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
- Mode: PC or VC- CMV
- IBW: 6- 8
- RR: 15- 20
- Flow: 60
- FW: Descending or constant
- Ti: 1
- PEEP: 0-5 w/ caution, only in severe hypoxemia
- Fio2: 1.0
ARDS
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
- Mode: PC or VC- CMV
- IBW: 4-8
- RR:12-35
- Flow: greater than or equal to 60
- FW: Descending or constant
- Ti: 1
- PEEP: 5 to >15
- Fio2: 1.0
CHF
Mode
IBW
RR
Flow
Flow waveform
Ti
PEEP
Fio2
- Mode: VC or PC-CMV
- IBW: 6- 8
- RR: greater than or equal to 10
- Flow: greater than or equal to 60
- FW: Descending or constant
- Ti: 1- 1.5
- PEEP: 5-10
- Fio2: 1.0
Why would a pt with normal lungs be on Mechanical ventilation?
- Drug overdose
- Surgical pts not waking up after
Because COPD pts have a resistance issue, what can we do to give them more time to exhale?
Lower the RR to increase expiratory time
Why is I-time lower in COPD pt’s?
The less time for inspiration will give the pt more time in expiration
Why do we hyperventilate pt’s with closed head injuries?
It decreases the amount of blood flow to the brain and helps control ICP and swelling
Why are we cautious w/ PEEP in closed head injuries?
What should we do instead?
The pressure can increase ICP. If it is not necessary then we do not need it. Start w/ 100% FiO2
Why do we use higher PEEP in CHF?
To push fluid out of the alveoli. 100% FiO2 is used to help oxygenate
Anatomic Dead Space is calculated as
1mL/lbs
Anatomic Dead space is defined as volume lost in the pt’s
conducting airways where no gas exchange occurs
Examples of anatomic dead space
- trachea
- bronchi
Examples of Mechanical dead space
- Long ETT
- Closed system suction
- HME
Minute Ventilation equation
VE= Vt x RR
Alveolar minute ventilation equation
VA=(Vt - Vd) x RR
I:E ratio is adjusted by 3 vent controls
- Vt
- Flow rate
- RR
Adjustments in flow rate alters…
inspiratory time (I- time)
What are the 2 types of ventilation?
- Minute ventilation (VE)
- Alveolar ventilation (VA)
As you change flow…
you change the I-time
The higher the flow…
the lower the I-time
(ex: If I increase the flow rate, it lowers the I-time)
