Test 3 Flashcards
General indicators for Mechanical ventilation
When support is needed bc patients inability to ventilate the lungs or maintain effective gas transport across the alveolcapillary membrane. This could be the result of lung disease or things such as, drug overdose or the need to paralyze and sedate for a surgical procedure
Apnea
the absense of spontaneous breathing, which can be the result of many factors, including drug overdose, paralysis, or neurologic insult
Acute Ventilatory Failure defined as
rising levels of PaCo2 with corresponding decrease in pH, resulting in respiratory acidosis
Acute ventilatory failure can be the result of
respiratory muscule dysfunction, excessive ventilatory load, impaired ventilatory drive, or dysfunctions of the lung parenchyma affecting gas exchange
Impending Ventilatory Failure based on
patient presentation and clinical judgement.
-known factors such as hx of pulmonary disease and acute physical manifestations such as increased WOB, Decreasing OX and or ventilation, and progressive worsening of symptoms such as dyspnea, may lead to clinician to suspect the acute vent failure is close at hand
Severe oxygenation defects is when
Result of an acute or chronic lund disease
- very high levels of inspired oxygen (FiO2) are required to maintain a minimally acceptable o2 status.
- Severe are unresponsive to O2 therapy (refractory hypoxemia)
Need for mech ventilation condensed into four primary factors
- Apnea
- Acute vent. failure
- Impending vent. failure
- Severe oxygenation defects
Two major types of mechanical ventilation are
- Volume control ventilation (VCV)
- Pressure control ventilation (PCV)
VCV
tidal volume is set and delivered regardless of pressure
- Method selected whenever a constant volume is needed to maintain a desired level of arterial carbon dioxide
- tradeoff is that changes in system mechanics such as resistance and compliance will influence PIP
PCV
inspiratory pressure is set and delivered regardless of tidal volume
PIP
Peak inspiratory Pressure, highest level of pressure applied to lungs during inhalation
As compliance goes down or resistance goes up, PIP
increases
As compliance goes up or resistance goes down, PIP
decreases
Factors that impact PIP during VC ventilation
- Peak inspiratory flow setting
- Inspiratory flow pattern
- Auto-PEEP
- Tidal Volume
- Resistance
- Compliance
Peak Inspiratory flow setting impacts PIP in VC ventilation
The peak inspiratory flow rate can be set and changed based on pts needs. A higher set peak inspiratory flow results in higher PIP
Inspiratory flow pattern impacts PIP in VC
(the pattern with which the inspiratory flow is delivered can also be changed by operator)
- In VC, a square or decelerating flow pattern are available choices
- The decelerating flow pattern is associated with lower PIP
PEEP impacts PIP
Baseline pressure at the end of exhalation
-Any pressure or volume support used during mech ventilation occurs above the baseline pressure, so increases in PEEP result in increases in PIP
Auto-PEEP impacts PIP
Due to air trapping raises the PEEP pressure, thereby elevating the PIP
increases in the set VT will result in what to PIP
higher PIP
Resistance to PIP
Increases in airway resistance result in increases in PIP.
-Common cause of increased resistance are secretions in the airway or bronchospasm of the smooth muscle lining the airway
Decreased compliance of the lung or chest wall will result in what PIP during VC
Result in elevated PIP during VC ventilation
-Decreased compliance could be due to a worsening of the patients pulmonary condition
During PCV
the airway pressure is set and remains constant during changes in compliance or resistance
-BC PIP is constant during PCV, changes in resistance and compliance will result in changes in delivered tidal volume
Increased airway resistance or decreased compliance will
decrease Vt
Decreased airway resistance and increased compliance will
increase VT
Factors affecting tidal voume during PCV
- Driving pressure increases, so does Vt
- AutoPEEP, decreases Vt
- Inspiratory time, increase Vt if Inspiratory flow is present
- compliance decreases, descrease Vt
- resistance, decrease Vt
- Pt effort, increases Vt
Driving pressure
difference between PIP and PEEP
Decreases in compliance will result in decreased volume during PCV, potentially causing
hypoventilation and resp acidosis
Mode of ventilation
simply an option for how breath delivery will be provided
Major modes of ventilation common to all vents include
- CMV (AC)
- SIMV
- CPAP with or without PSV
Both CMV and SIMV modes can be either
volume or pressure controlled
CMV can deliver
either a set tidal volume or a set inspiratory pressure, along with a set minimum respiratory rate
What is constant during CMV
Volume or the pressure depending on which control method was selected. Patient can trigger or initiate a breath above the set RR.
SIMV can provide
either pressure-controlled or volume controlled mandatory breaths while allowing spontaneous breaths that may be above or below the set control variable