Troubleshooting

Question 1

Define liberation

Answer 1

Most patients do not need gradual reduction of vent support

Drug O.D

Surgery

Question 2

Who is able to quickly removed from vent

Answer 2

Those ventilated <72 hrs once primary problem has been resolved

Question 3

What is successful discontinuation of vent support dependent upon

Answer 3

Improvement or resolve of disease

Adequate O2

Ventilation

Circulation

Question 4

What is the goal of O2 SBT

Answer 4

Confirm that any existing hypoxia can be treated with non-invasive supplementation

Question 5

What settings during SBT indicate extubation

Answer 5

40-50% FiO2

PEEP of 5-8cmH2O or less

Question 6

How do you decrease ventilator support from CMV to IMV

Answer 6

Reduce mandatory rate at a pace that matches patients improvement

Steps of 1 or 2 breathes/min

Question 7

What is starting PEEP

Answer 7

2-6

Question 8

What is VT range

Answer 8

5-10mL/kg

Question 9

What is a normal adults Resp. Rate

Answer 9

12-18 breathes/min

Question 10

How is PSV cycled

Answer 10

Flow cycled

Question 11

What does the patient control in PSV

Answer 11

Rate
Depth
Timing

Question 12

What is the ideal PSV when weaning

Answer 12

5-8 cmH2O

Question 13

A SBT with a PS of 5 and a CPAp of 5 is equivalent to what BiPAP setting

Answer 13

10/5

Question 14

What B/P precludes SBT

Answer 14

Very high

Very low

Question 15

Describe automatic tube compensation

Answer 15

Closed loop

Designed to reduce WOB and associated with increased ET resistance

Question 16

How does automatic tube compensation work

Answer 16

Target pressure at the tracheal

Tracheal pressure = proximal airway pressure (tube coefficient flow^2)

Select the ATC function and enter type of tube

Select tube

Question 17

Can you use volume-targeted pressure-support ventilation to wean

Answer 17

Value in weaning has not been established

Question 18

Other name for volume targeted pressure support ventilation

Answer 18

Volume support

Question 19

Describe the artificial intelligence system

Answer 19

Uses predetermined range for V,f, and PetCO2 to automatically adjust IP and maintain “comfort zone”

One lowest IP is achieved monitor period is initiated

If they pass to modified SBT message comes up to separate the patient

Question 20

Describe mandatory minute ventilation mode (MVV)

Answer 20

Adjust pressure, f, or Vt to maintain VE

Question 21

Advantages of MVV

Answer 21

Greater control of PaCO2

Acute hypovent or apnea does not cause sudden hypercapnia

Smooth transition from MV to SBT for patients recovering form O.D. Or anesthesia

Question 22

Disadvantages of MVV

Answer 22

Rapid, shallow Resp. Patterns may provide preset VE

Auto-PEEP, high VT, increase dead space ventilation, inappropriate settings in mode not understood

Question 23

What HR indicates a stop to SBT

Answer 23

> 120-140 beats/min or > 20% increase from baseline

Question 24

What systolic pressure indicates termination of SBT

Answer 24

> 180 or a decline by 20% from baseline

Question 25

If a patient fails SBT, how long do we wait before we attempt it again

Answer 25

24 hours Multiple trials a day has not been found to reduce days on the ventilator

Question 27

What is the formula for RSBI

Answer 27

f/VT (put it in L)

Question 28

What is a normal RSBI

Answer 28

<50

Question 29

What is a bad RSBI value

Answer 29

>105

Question 30

What might increase RSBI

Answer 30

Fever Sepsis Anxiety Recent suction Small diameter of ET

Question 31

What does RSBI tell us

Answer 31

<105 isn’t a predictor of success >105 predictor for weaning failure

Question 32

Who is RSBI not a good predictor for

Answer 32

Patients over 65 years old MV > 7 days

Question 33

What MIP and VC is associated with impending or actual ventilatory failure

Answer 33

> -20 to -30cmH2O VC <15-20 mL/kg VC < 1L

Question 34

What MEP indicates a strong cough

Answer 34

MEP > 60cmH2O

Question 35

What pH is adequate for ventilator discontinuation

Answer 35

> 7.25

Question 36

For patients intubates for less than 24 hrs and without comorbidities how long should they be monitored

Answer 36

6 hrs

Question 37

Patients with higher risk and were intubates for longer than 24 hrs, how long should they be monitored

Answer 37

12-24 hrs

Question 38

What should a patient who has been ventilated for longer than 24 hrs be extubated to

Answer 38

NIV

Question 39

If a patient might be severely hypoxic what should you extubate to

Answer 39

HFNC

Question 40

What patients are at the greatest risk for re-intubation

Answer 40

Weak cough Requiring frequent suction

Question 41

What do you not reintubate a patient that self extubated

Answer 41

Clinically stable Patent AW Can clear secretions Good oxygenation Spontaneous vent

Question 42

Hazard associated with re-intubation

Answer 42

PNA (8x) Morbidity (12x)

Question 43

Hazards of delirium

Answer 43

Longer MV Longer ICU stay Increased cost Long-term cognitive impairment Increased mortality