Test 3 Study Guide Flashcards
Methods to reduce Ventilator Induced Lung Injury (VILI)
Use of positive end expiratory pressure (PEEP)◦
Lung recruitment strategies◦
Permissive hypercapnia
◦Pressure limited modes
◦Noninvasive ventilation (NIV).
Tidal volume range of 4-8 mL
Most airway complications are associated with _______
Endotracheal tube
Purposes of ET cuff (2)
To seal the airway for optimal delivery of mechanical ventilation.
2.To prevent aspiration and reduce incidence of VAP.
Recommended cuff pressure
20-30
a _____ with a (PEEP) valve should be available at the bedside for unforeseen events.
bag-valve-mask
the primary driver of (VILI)
Alveolar overdistention
difference between plateau pressure and pleural pressure, determines the degree of alveolar distention.
transpulmonary pressure
As plateau pressure rises, so does the transpulmonary pressure, which can result in ____ or lung injury related to high lung volumes
Volutrauma
refers to injuries caused by high ventilation pressure, resulting in alveolar rupture and release of gas
Barotrauma
Gas embolism occurs in the ____
Pulmonary veins
Pneumothorax occurs in the ____
Pleural Cavity
Mediastinal emphysema and subcutaneous emphysema occur in the _____
Mediastinum
Ventilation at low tidal volumes can induce _____ the repeated collapse and opening of the alveoli with each breath
atelectrauma
(use of optimal PEEP)
Optimal PEEP range
6-8
Pneumonia that develops after (48 hours) of being placed on mechanical ventilation
Ventilator induced pneumonia
The ventilator ____ itself provides an environment for bacterial growth and biofilm production.
circuit
Formation of _____ implementing these strategies has been associated with a significant reduction in development of (VAP).
(VAP) bundle protocols
Prevention strategies for VAP
Avoiding invasive mechanical ventilation when possible.
◦Minimizing time on mechanical ventilation by minimizing sedation and implementing weaning protocols early.
◦Elevating the head of bed to (30 to 45 degrees).
◦Removal of subglottic secretions.
Airway lining and alveoli are most exposed to ____ and are at the highest risk for cellular injury.
inspired oxygen
Clinical consequences of oxygen toxicity
Absorption atelectasis
◦Worsening hypercapnia
◦Airway and parenchymal damage
High levels of inspired oxygen result in ______ and ultimately alveolar closure, or atelectasis
alveolar nitrogen washout
_____ results from the Haldane effect and increased dead space ventilation
Hyperoxic hypercarbia
Certain drugs, such as _____ may increase the sensitivity of the lungs to oxygen.
bleomycin (Blenoxane)
FiO2 should be ___ whenever possible
<60%
____ is most significant condition associated with prolonged mechanical ventilation, increased sedation, and even death in the (ICU)
Patient-ventilator asynchrony
ny single variable displayed against time on the ventilator is known as
Scaler
Types of scalers
Flow-time (F-T),
volume-time (V-T),
and pressure-time (P-T)
formed by plotting inspiratory and expiratory curves of two of the three following variables; pressure, flow, volume
Loops
(Pressure-volume loop
Flow - volume loop)
Pressure-volume loop = _____
Compliance
Constant flow pattern is used with _____ targeted ventilation.
volume
Peak flow rate maintained at set value.
I-time varies with changes in compliance and resistance.
Expiration is generally passive
Volume targeted ventilation
Descending flow pattern is used with ____ targeted ventilation.
Pressure
Flow rate decays during inspiration
Pressure-targeted ventilation
Inspiratory flow is above the isoflow line.
Inspiratory flow resembles a sine wave.
Spontaneous breath
the time it takes for airway pressure to reach a preset maximum value
Rise time
Allows instantaneous delivery of flow at the start of the breath.
Immediate rise in pressure to the preset level.
When rise is set to fast, turbulence can result in a higher than preset airway pressure (PIP).
Rapid rise time
Delays initial flow delivery.
Delays the rise in pressure to the preset level.
Slow rise time
Causes of airway obstruction
Bronchospasm
Inflammation
Secretions
Characteristics of airway obstruction
Decreased peak expiratory flow.
Prolonged expiratory time
Airway obstructions response to bronchodilators
Increased peak expiratory flow.
Shorter expiratory time
Causes of air trapping
The presence of air trapping can result from inadequate alveolar emptying as a result of increased airway obstruction
.May result from short expiratory time.
High respiratory rates.
Excessively long I-time.
Inspiratory tidal volume is the _____
Expiratory tidal volume is the _____
Inspiratory tidal volume the upstroke
Expiratory tidal volume is downstroke
The ____ waveform is useful in detecting air leaks as a result of volume loss through the circuit, a chest tube, bronchopulmonary fistula, or around the cuff of the endotracheal tube (ETT).
V-T waveform
The volume of the leak can be easily estimated by measuring the distance from the ____ to the end of the expiratory tracing.
plateau
In any situation in which the ventilator does not appear to be functioning correctly, immediately _____
Disconnect the patient
Tidal Volume range to prevent VILI
4 to 8 mL
Most common airway complications
Laryngeal and tracheal injuries, including laryngeal edema, vocal cord injury, and tracheal stenosis,
Normal adult urine output
60 mL/hr
1500 mL/day
Amount for polyuria
> 3L/25 hours
Diabetes mellitus
◦Diabetes insipidus
◦Excessive fluid intake
◦Diuretics
Amount for oliguria
<500 mL/24 hours
Acute nephritis
◦Hypotension
◦Hypovolemia
◦Renal failure
Xray shot from back to front. Clearer than AP xrays
Posteroanterior (PA)
Xray used in ICU. Shot from front to back. Can see scapula. Heart appears larger
Anterior posterior (AP)
Know xrays: Atelectasis v. Pneumothorax and tubes
Normal range for BUN
3-20 mg/day
Normal range for Creatinine
(0.5 to 1.2 mg/dL) males
(0.4 to 1.1 mg/dL) females.
Normal range for Glomerular filtration rate (GFR)
(90 to 120 mL/min)
Normal range for BNP
<100 pg/mL)
Increased in heart failure
Normal Troponin
<0.01%
Draw and trend serial numbers
Complications of PEEP
Barotrauma by overdistention
Compromises cardiac output and blood pressure.
May reduce cerebral venous outflow
Absolute contraindication of PEEP
Tension pneumothorax
May be beneficial for patients with severe ARDS, refractory hypoxemia.
Prone positioning
Should be initiated within the first 36 hours
18-20 hours consecutively
CPAP mode for recruitment maneuvers
“30 for 30” or “40 for 40”
30 of PEEP for 30 seconds
Bronchial hygiene techniques to improve oxygenation
Suctioning
Airway care
Humidification
Bronchodilators
Inhaled corticosteroids
Formula for dead space to tidal volume ratio
VD/VT = (PaCO2 - PCO2) ÷ PaCO2
Normal is 0.30 but range is 0.20 - 0.40
Certain patients with dangerously elevated (ICP) may be briefly _____ to achieve a (PaCO2) between (26- and 30-mm Hg) for (6 to 12 hours).
hyperventilated
ventilatory strategy which decreases tidal volume and associated delivery pressures to reduce alveolar pressures and minimize alveolar over distention.
Permissive hypercapnia
(PaCO2) rises and (pH) falls resulting in a respiratory acidosis
Ventilator adjustments that will decrease (PaCO2) include
Increased tidal volume
Increased frequency
Decreased mechanical dead space (if present)
Ventilator adjustments that will increase (PaCO2) include
Decreased tidal volume
Decreased frequency
Addition of mechanical dead space
