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MVI > Vent Comp > Flashcards

Vent Comp Flashcards

1
Q

what is the standard criteria for instituting mechanical ventilation

A
  1. apnea or absence of breathing
  2. acute ventilatory failure
  3. impending ventilatory failure
  4. refractory hypoxemia with increase work of breathing
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2
Q

what are possible complications associated with mechanical ventilation

A
  1. self-extubation
  2. mechanical failure
  3. atelectasis
  4. pneumonia
  5. massive gastric distension
  6. hypotension
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3
Q

identify the following as either mandatory breath, spontaneous breath, or assisted breath:

flow triggered, pressure targeted, time cycled

A

assisted

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4
Q

identify the following as either mandatory breath, spontaneous breath, or assisted breath:

time triggered, volume targeted, volume cycled

A

assist

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5
Q

identify the following as either mandatory breath, spontaneous breath, or assisted breath:

pressure triggered, pressure targeted, time cycled

A

mandatory

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6
Q

identify the following as either mandatory breath, spontaneous breath, or assisted breath:

flow triggered, pressure targeted, flow cycled

A

spontaneous

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7
Q

if a patients ventilatory drive increases during the use of VC-CMV, what change will occur to the patients acid base balance

A

the patients assist rate will increase

Since every breath will be a machine breath at the set volume, this can easily lead to a decreased PaCO2 or respiratory alkalosis.

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8
Q

what can be done to fix the acid base problem of a patient whos ventilatory drive has increased on VC-CMV

A

identification of the source of the increased drive (i.e., fever, sepsis, etc.) and correction of this are the best ways to control the respiratory alkalosis

However, since this may take some time, sedatives, paralytic agents, or switching to SIMV with similar settings may be tried

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9
Q

a patient is being mechanically ventilated with 50% FiO2. His PaO2 is 60 mmHg. The physician orders are to titrate FiO2 to maintain PaO2 90 mmHg. Recommend the most appropriate FiO2 to use at this time

A

Desired FiO2 = (desired PaO2 + know FiO2) / know PaO2

(90 + 0.5) / 60 = 1.5
1.5 x 50 = 75

Desired FiO2 = 75%

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10
Q

list 2 diagnostic procedures the RT should recommend after placing a patient on mechanical ventilation

A 
121?
CBC
ABG
Blood Chem
PT/PTT/INR
Blood, urine, sputum culture
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11
Q

how is a trigger set

A

machine dettects variable when to begin breath

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12
Q

how is a limit set

A

machine measures limit variable not allowing maximum to be exceeded

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13
Q

how is a cycle set

A

machine measures cycle variable to govern when ventilator will end gas flow

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14
Q

what type triggers are there

A

time: when set time has elapsed to give breath
patient: when patient effort is detected to give breath
flow: when drop in flow is detected to give breath

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15
Q

what type limits are there

A

pressure: rise to certain value without exceeding it
volume: set volume value without exceeding it
flow: set flow value without exceeding it

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16
Q

what type cycles are there

A

volume: when set volume is delivered
time: when predetermined time has elapsed
flow: when flow decreases to predetermined value
pressure: when set pressure threshold is reached

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17
Q

what is compliance

A

the relative ease with which the structure distends the opposite or inverse of elastance

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18
Q

what is airway resistance (Raw)

A

frictional forces that must be overcome during breathing

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19
Q

what is the formula for static compliance

A

CS = VT / (Pplat - PEEP)

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20
Q

what is the formula for dynamic compliance

A

CD = VT / (PIP -PEEP)

21
Q

what is the formula for airway resistance

A

Raw = (PIP-Pplat) / inspiratory flow

22
Q

how does static compliance affect the breath delivery and mode PC-CMV

A

pressure remains constant
delivered Vt decreases

pressure must increase when compliance decreases to maintain adequate Vt

23
Q

how does dynamic compliance affect the breath delivery and mode VC-CMV

A

volume delivery constant
high pressures

regardless of change in CD

24
Q

how do you recognize changes in compliance on the ventilator

A
25
Q

review modes:

what are they
what type breath is delivered/given
when are they used
what things can be added to modes

A
26
Q

what is the purpose of setting PEEP

A

used to prevent alveolar collapse and recruit alveoli

27
Q

what is the purpose of setting PS

A
28
Q

what is the purpose of setting I-time

A

normally patient will have low lung compliance and normal Raw so I time must be short

29
Q

what is the purpose of setting flow

A

rapid inspiratory flows increase PIP, but higher inspiratory flows allow for Vt delivery in short time which produces lower Paw

three points to note when using high flow:

  1. more pressure will lost to patient circuit with high PIP
  2. more pressure required to overcome Raw
  3. uneven ventilation is likely to occur
30
Q

what is the purpose of setting I:E ratio

A

shorter inspiratory time (Ti) and longer expiratory time (Te) lead to fewer harmful effects of positive pressure

values of 1:1 and 2:1 or higher may result in increase Paw, airtrapping, and significant hemodynamic complications

31
Q

review alarms:

corrective actions (high pressure obstruction, low pressure/volume leaks)

A
32
Q

how do you set low volume alarms

A

5 to 10 below PIP

33
Q

how do you set high volume alarms

A

10 above PIP

34
Q

what do low volume alarms mean

A

useful for detecting patient disconnections and leaks in the system

35
Q

what do high volume alarms mean

A

indication of patient coughing, increased secretions, compliance decrease, or kinks in ETT or circuit tubing

36
Q

how do you set low PEEP alarms

A

2 to 5 below PEEP

37
Q

what do low PEEP alarms mean

A

indication of leak in patient-ventilator circuit

38
Q

how do you set low exhaled Vt alarm

A

10% to 15% below set Vt

39
Q

how do you set low exhaled minute volume

A

10% to 15% below average minute volume

40
Q

what problems can occur from decreased static compliance

A 
air trapping
pulmonary edema
atelectasis
consolidation
pneumonia
pneumothorax
pleural effusion
41
Q

how does static compliance affect the breath delivery and mode VC-CMV

A

PIP and Pplat increase

delivered Vt remains constant

42
Q

dynamic compliance will decrease if ____ decreases and _____ increases

A

static compliance decrease

airway resistance increase

43
Q

how does dynamic compliance affect the breath delivery and mode PC-CMV

A

decreased CD will:

delivered Vt will decrease
pressures increase

44
Q

how does decreased CD during PC-CMV affect PIP and Vt

A

PIP remain constant

Vt decreased

45
Q

how does decreased CD during VC-CMV affect PIP and Vt

A

PIP increase

Vt constant

46
Q

how does decreased CS and CD with constant Raw during VC-CMV affect PIP, Pplat, Pta, and Vt

A

PIP increase
Pplat increase
Pta constant
Vt constant

47
Q

how does decreased CD with constant CS and increased Raw during VC-CMV affect PIP, Pplat, Pta, and Vt

A

PIP increase
Pplat constant
Pta increase
Vt constant

48
Q

how does improving CD and CS during VC-CMV affect PIP, Pplat, Pta and Vt

A

PIP increase
Pplat decrease
Pta constant
Vt constant

MVI (6 decks)

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