Vent material Flashcards by Elisabeth Tribeck

restriction

How well did you know this?

Not at all

Perfectly

airway obstruction

How well did you know this?

Not at all

Perfectly

fixed obstruction

How well did you know this?

Not at all

Perfectly

variable intra thoracic obstruction

How well did you know this?

Not at all

Perfectly

early airflow obstruction

How well did you know this?

Not at all

Perfectly

variable extra thoracic obstruction

How well did you know this?

Not at all

Perfectly

normal flow volume loop

How well did you know this?

Not at all

Perfectly

spirogram

How well did you know this?

Not at all

Perfectly

wright respirometer

How well did you know this?

Not at all

Perfectly

3 types of dead space

How well did you know this?

Not at all

Perfectly

what is I TIME

amount of time spent in inspiration

How well did you know this?

Not at all

Perfectly

what is E time

amount of time spent in expiration

How well did you know this?

Not at all

Perfectly

what is volume

the amount of tidal volume a patient recieves

How well did you know this?

Not at all

Perfectly

what is pressure

measure of impedence to gas flow rate

How well did you know this?

Not at all

Perfectly

what is flow

measure of rate at which gas is delivered

How well did you know this?

Not at all

Perfectly

what is the ideal amount of tidal volume

6-8ml/kg of ideal body weight

How well did you know this?

Not at all

Perfectly

when do you give lower TVs

ARDS or COPD or ASTHMA

How well did you know this?

Not at all

Perfectly

what is PIP

peak inspiratory pressure
the highest level of pressure aplied to lungs in cm H2O

How well did you know this?

Not at all

Perfectly

what is PIP limit

40 cmH2O

How well did you know this?

Not at all

Perfectly

when can PIP be higher

ARDS

How well did you know this?

Not at all

Perfectly

what should PIP be in masked or LMA patient

20 cmH2O

bc lower esophageal sphincter opens at >20cmH20

How well did you know this?

Not at all

Perfectly

what triggers a ventilator to cycle inspiration

time
pressure
volume
flow

How well did you know this?

Not at all

Perfectly

what is a normal peep level

5-8 cm h2o

How well did you know this?

Not at all

Perfectly

what conditions require higher peep of 8-12 or 20 cm H2O

ARDS

How well did you know this?

Not at all

Perfectly

what happens if PEEP exceeds 20 cm H20

severe lung damage
barotrauma
subq emphysema
pneumo

How well did you know this?

Not at all

Perfectly

slope is a measure of

time

How well did you know this?

Not at all

Perfectly

slope is how long it takes to reach a set

pressure

How well did you know this?

Not at all

Perfectly

what is range of slope

0-2 seconds

How well did you know this?

Not at all

Perfectly

a higher number slope is a more (gradual/steep) slope

gradual

How well did you know this?

Not at all

Perfectly

what mode is slope important in

pressure support

How well did you know this?

Not at all

Perfectly

if slope is longer than inspiratory time what is comprimised

How well did you know this?

Not at all

Perfectly

what is PIP- PEEP

delta P

How well did you know this?

Not at all

Perfectly

pressure control is

preset pressure
delivered Vt changes according to lung compliance
when the patient is spontaneously breathing, as the PIP is fixed, reduces pt discomfort

How well did you know this?

Not at all

Perfectly

volume control is

volume is preset

delivered PIP varies based on pulm compliance and airway resistance

pt spontaneously breathing, PIP is variable, it will deliver a breath during asynchrony leading to increased work of breathing and discomfort

How well did you know this?

Not at all

Perfectly

pressure vs volume waveforms

How well did you know this?

Not at all

Perfectly

which vent mode provides guaranteed MV and is more comfortable for patients

volume control

How well did you know this?

Not at all

Perfectly

which vent mode is not optimal for poorly compliant lungs

volume

How well did you know this?

Not at all

Perfectly

which vent mode provides more support at lower PIP for poorly compliant lungs

pressure

How well did you know this?

Not at all

Perfectly

which vent mode does not have a guaranteed MV

pressure

How well did you know this?

Not at all

Perfectly

which vent mode do we use right before extubation

pressure support

How well did you know this?

Not at all

Perfectly

which vent mode is pressure support but with a BACKUP rate

PSV-pro

How well did you know this?

Not at all

Perfectly

which vent mode has madatory breaths (synchronized) and pressure support for spontaneous breaths

SIMV

How well did you know this?

Not at all

Perfectly

what flow is diminished in COPD

expiratory
FEV1 is low

How well did you know this?

Not at all

Perfectly

normal flow volume loop

How well did you know this?

Not at all

Perfectly

COPD flow-volume loop

How well did you know this?

Not at all

Perfectly

how does restrictive lung disease affect volume loop

residual volume is low
inspiratory volume (TLC)
FEV1 normal
peak exp flow normal

How well did you know this?

Not at all

Perfectly

restrictive flow-volume loop

How well did you know this?

Not at all

Perfectly

flow volume loop comparison

How well did you know this?

Not at all

Perfectly

what would cause a pattern of expiratory flow-volume curve to be normal, but have a low inspiratory value

upper airway obstruction

How well did you know this?

Not at all

Perfectly

what causes upper airway obstruction

paralysis of vocal cords
laryngospasms
Thyromegaly
tracheomalacia

How well did you know this?

Not at all

Perfectly

what complication obstructs both inspiration and expiration

fixed intrathoracic or extrathoracic airway obstuctions
EX. tracheal stenosis, foregn body, neoplasm

How well did you know this?

Not at all

Perfectly

what is a cause of post op bradypnea

opioid overdose

How well did you know this?

Not at all

Perfectly

what is a cause of post op tachypnea

pain

How well did you know this?

Not at all

Perfectly

as TV decreases, dead space____

increases

How well did you know this?

Not at all

Perfectly

what must be set in VCV mode

TV
RR
I:E ratio

How well did you know this?

Not at all

Perfectly

PIP is ____ related to lung compliance

inversely

How well did you know this?

Not at all

Perfectly

what is set in PCV

peak airway pressure
RR
I:E ratio

How well did you know this?

Not at all

Perfectly

what must be monitored closely in PCV

tidal volume
CO2

How well did you know this?

Not at all

Perfectly

what is the amount of gas inspired or expired with each normal breath

Tidal Volume (TV)

How well did you know this?

Not at all

Perfectly

what is the maximum amount of additional air that can be inspired from the end of a normal inspiration

inspiratory reserve volume

How well did you know this?

Not at all

Perfectly

what is the maximum volume of additional air that can be expired from the end of a normal expiration

expiratory reserve volume

How well did you know this?

Not at all

Perfectly

what is the volume of air remaining in the lung after a maximal expiration

residual volume

How well did you know this?

Not at all

Perfectly

what s the only lung volume which cannot be measured with a spirometer

residual volume

How well did you know this?

Not at all

Perfectly

what is the volume of air contained in the lungs at the end of a maximal inspiration

total lung capacity

How well did you know this?

Not at all

Perfectly

what is the sum of the 4 basic lung volumes

TLC

IRV+TV+ERV+RV

How well did you know this?

Not at all

Perfectly

what is the maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration

vital capacity

How well did you know this?

Not at all

Perfectly

what is the sum of inspiratory reserve volume, tidal volume and expiratory reserve volume

vital capacity

How well did you know this?

Not at all

Perfectly

what is the formula for VC

IRV+TV+ERV= TLC-RV

How well did you know this?

Not at all

Perfectly

what are some factors that decrease FRC

obesity
pregnancy
upright position
supine position
anesthetic induction
neuromuscular blockers
surgical displacement

How well did you know this?

Not at all

Perfectly

what is the reservoir of oxygen that prevents hypoxemia during apnea

functional residual capacity

How well did you know this?

Not at all

Perfectly

what is the volume of air remaining in the lung at the end of a normal expiration

functional residual capacity

How well did you know this?

Not at all

Perfectly

what is the residual volume plus the expiratory reserve volume

FRC

How well did you know this?

Not at all

Perfectly

what is the fomula for FRC

RV + ERV

How well did you know this?

Not at all

Perfectly

how does GA affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does obesity affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does pregnancy affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how is FRC in neonates

decreased

How well did you know this?

Not at all

Perfectly

how does advanced age affect FRC

increases

How well did you know this?

Not at all

Perfectly

how does supine position affect FRC

decreased

How well did you know this?

Not at all

Perfectly

how does lithotomy affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does trendelenburg affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does prone affect FRC

increases

How well did you know this?

Not at all

Perfectly

how does sitting affect FRC

increases

How well did you know this?

Not at all

Perfectly

how does lateral position affect FRC

no change or increases

How well did you know this?

Not at all

Perfectly

how does paralysis affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does inadequate anesthesia affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does excessive IV fluids affects FRC

decreases

How well did you know this?

Not at all

Perfectly

how does high FI02 affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does reduced pulmonary compliance affect FRC

decreases

How well did you know this?

Not at all

Perfectly

how does obstructive lung disease affect FRC

increased

How well did you know this?

Not at all

Perfectly

how does PEEP affect FRC

increased

How well did you know this?

Not at all

Perfectly

how do sigh breaths affect FRC

increased

How well did you know this?

Not at all

Perfectly

what is the maximum volume of air that can be inspired from end expiratory position

inspired capacity

How well did you know this?

Not at all

Perfectly

what is the sum of tidal volume and inspiratory reserve volume

inspired capacity

How well did you know this?

Not at all

Perfectly

what is the formula for IC

tidal vol + inspiratory reserve volume

How well did you know this?

Not at all

Perfectly

which lung zone has no blood flow

zone 1, pathological zone

How well did you know this?

Not at all

Perfectly

in what lung zone does pulmonary pressure exceed alveolar pressure. blood flow here is pulmonary artery pressure-alveolar pressure

zone 2

How well did you know this?

Not at all

Perfectly

what lung zone is blood flow proportional to PAP- pulmonary vein pressure

zone 3

How well did you know this?

Not at all

Perfectly

where should Swan be

zone 3

How well did you know this?

Not at all

Perfectly

which zone is present in pulmonary edema

zone 4

How well did you know this?

Not at all

Perfectly

blood flow in zone 4 is PAP- ___________

pulmonary interstitial fluid pressure gradient

How well did you know this?

Not at all

Perfectly

which lung zone is:
PA(alveolar)>Pa>Pv

zone 1

How well did you know this?

Not at all

Perfectly

which lung zone is:
Pa>PA>pv

zone 2

How well did you know this?

Not at all

Perfectly

which lung zone is:
Pa>Pv>PA

zone 3

How well did you know this?

Not at all

Perfectly

which lung zone is:
Pa>Pi (interstitial pressure)> Pv>PA

zone 4

How well did you know this?

Not at all

Perfectly

what is normal Va (alveolar ventilation)

4 L/ min

How well did you know this?

Not at all

Perfectly

what is normal pulmonary capillary perfusion (Q)

5 L/min

How well did you know this?

Not at all

Perfectly

what is normal V/Q ratio

0.8

How well did you know this?

Not at all

Perfectly

what is normal V/Q range

0.3-3.0

How well did you know this?

Not at all

Perfectly

what causes a low V/Q ratio

LUNG PROBLEM
shunt
airway obstruction to area

How well did you know this?

Not at all

Perfectly

what causes a high V/Q ratio

BLOOD PROBLEM
deadspace
blood flow problem
pulmonary emoboli

How well did you know this?

Not at all

Perfectly

low v/q

How well did you know this?

Not at all

Perfectly

high V/Q

How well did you know this?

Not at all

Perfectly

what is the affect of shunt/low V/Q

hypoxia

How well did you know this?

Not at all

Perfectly

what is the affect of deadspace high V/Q

hypercapnea
hypoxia

How well did you know this?

Not at all

Perfectly

shunt

How well did you know this?

Not at all

Perfectly

dead space

How well did you know this?

Not at all

Perfectly

in shunt:
PaO2 is __________
PaCO2 is ___________

Low
High

How well did you know this?

Not at all

Perfectly

in pulmonary embolism (dead space):
PAO2 is_________
PACO2 is _________

higher
low

How well did you know this?

Not at all

Perfectly

mapleson circuits

How well did you know this?

Not at all

Perfectly

bain circuit

How well did you know this?

Not at all

Perfectly

at what flow do you not need a CO2 absorber on circuit

> 5L

How well did you know this?

Not at all

Perfectly

where is dead space on a circle cicuit

distal to Y piece

How well did you know this?

Not at all

Perfectly

what gives lungs their elasticity

collagen and elastin fibers

How well did you know this?

Not at all

Perfectly

lungs with low compliance require (less/more) pressure to inflate

How well did you know this?

Not at all

Perfectly

what is the elastance formula

How well did you know this?

Not at all

Perfectly

what is compliance formula

How well did you know this?

Not at all

Perfectly

what causes resistance in the lungs

tissue resistance and airway resistance

How well did you know this?

Not at all

Perfectly

what law gives us the formula for resistance

poiseuilles law

How well did you know this?

Not at all

Perfectly

poiseuilles law pressure formula

How well did you know this?

Not at all

Perfectly

what does an increased alfa angle suggest

expiratory airway obstruction
-copd, bronchospasm, kinked et tube

How well did you know this?

Not at all

Perfectly

what can cause increased dead space causing low etco2

pulm embolism

How well did you know this?

Not at all

Perfectly

what does an increased beta angle suggest

rebreathing due to faulty inspiration valve
soda lime

How well did you know this?

Not at all

Perfectly

what needs to be monitored when giving neuromuscular blocking agents

neuromuscular function and status

How well did you know this?

Not at all

Perfectly

what are advantages of side stream sampling

lightweight,
less chance of disconnect,
accurate <40 breaths/min,
no dead space

How well did you know this?

Not at all

Perfectly

what are disadvantages of side stream monitoring

water/secretions may clog line,
flexible tube easily obstructed,
inaccurate >40 breath so no peds

How well did you know this?

Not at all

Perfectly

describe side stream sampling

pump in monitor aspirates sample of gas trhough thin/flexible sampling line

How well did you know this?

Not at all

Perfectly

what monitoring sampling measures gas directly in breathing system

mainstream aka non diverting

How well did you know this?

Not at all

Perfectly

what are advantages of mainstream sampling aka non diverting

fast,
good fidelity,
water and secretions not an issue

How well did you know this?

Not at all

Perfectly

which sampling method can increase etco2

mainstream sampling by increasing dead space

How well did you know this?

Not at all

Perfectly

what are disadvantages of mainstream sampling aka non diverting

heavy in circuit,
increases dead space,
greater opportunity for disconnect,
gas options limited

How well did you know this?

Not at all

Perfectly

what is the measurement and numerical display of co2 concentrations during respiratory cycle

capnography

How well did you know this?

Not at all

Perfectly

what is a graphic record of co2 concntratino on screen or paper

capnography

How well did you know this?

Not at all

Perfectly

what is the actual waveform genered by capnometer

capnogram

How well did you know this?

Not at all

Perfectly

what may be detected due to abnormalities in capnography

airway obstruction

How well did you know this?

Not at all

Perfectly

what is produced by cells of body during metabolism into circulatory system and then is diffused into lungs

CO2

How well did you know this?

Not at all

Perfectly

what is a better indicator of rosc during resuscitation

exhaled CO2

How well did you know this?

Not at all

Perfectly

what cardiac changes can etco2 aid in detecting

decreased cardiac output,
pulmonary embolism,
reduced blood flow to lungs

How well did you know this?

Not at all

Perfectly

what guides ventilator changes and can give a trend of anesthesia depth

CO2

How well did you know this?

Not at all

Perfectly

what could a sudden increase in co2 represent during code

spontaneous cardiac function/output

How well did you know this?

Not at all

Perfectly

what is difference between etco2 on monitor and blood

blood is usually 5 higher than monitor

How well did you know this?

Not at all

Perfectly

What are some complications that can happen that etco2 can help alert to

esophageal intubation,
apnea,
extubation,
disconnection,
ventilator malfunction,
ett partial obstruction,
compliance vs resistance changes,
spontaneous resp w/muscle relaxant use,
poor lma fit,
leaking ett cuff

How well did you know this?

Not at all

Perfectly

what is phase 1 in capnography (A)

inspiratory baseline- 0- low valley

How well did you know this?

Not at all

Perfectly

what could be a problem if your co2 isn’t reading 0 during phase 1

co2 canister needs to be changed out

How well did you know this?

Not at all

Perfectly

what is phase 2 in capnography and what letters are in it

initiating exhale- b- c

How well did you know this?

Not at all

Perfectly

what is phase 3 in capnography and what letters are in it

plateau c-d
no plateau= not reading correctly

How well did you know this?

Not at all

Perfectly

how is slope of phase 3 increased

kink, ventilation perfusion status,

How well did you know this?

Not at all

Perfectly

what is phase iv in capnography and what letters are in it

end tidal point down to zero (inhalation)
d-e

How well did you know this?

Not at all

Perfectly

what is the letter with the highest co2 number on capnography

d- 35-40 torr

How well did you know this?

Not at all

Perfectly

what could cause no co2 in gas line

obstruction,
disconnection,
esophageal intubation,
no blood circulation to lungs

How well did you know this?

Not at all

Perfectly

what uses each anesthetic gas’s ability to absorb specific frequencies of emr in the infrared spectrum

infrared absorption analysis

How well did you know this?

Not at all

Perfectly

what anesthesia gas monitoring has advantages of being fast, reliable, low cost, multiagent/multigas

mass spectrometry

How well did you know this?

Not at all

Perfectly

what anesthesia gas monitoring has disadvantages of warm up time, space, must be scavenged, and measures only preprogrammed gases

mass spectrometry

How well did you know this?

Not at all

Perfectly

what has a laser that interacts with gas molecule and measures the fraction of energy absorbed at different live wavelengths called scattering

raman spectrometry

How well did you know this?

Not at all

Perfectly

what anesthesia gas monitoring is less accurate with pediatric cases, since they use high carrier gas flow rates and small tidal volumes

raman spectrometry

How well did you know this?

Not at all

Perfectly

what are disadvantages of raman spectrometry

costly, less accurate in pediatrics

How well did you know this?

Not at all

Perfectly

what are advantages of raman spectrometry

no scavenging,
accurate,
fast multi-gas/agent

How well did you know this?

Not at all

Perfectly

what do you need to do with o2 flow sensor (galvanic cell)

calibrate to room air, degrade in 30 days

How well did you know this?

Not at all

Perfectly

what does vaporizer output assess

detects incorrect agents
detect vaporizer turned off/empty
provides info on uptake and elim of agent in pt

How well did you know this?

Not at all

Perfectly

what should baseline be on capnography

zero

How well did you know this?

Not at all

Perfectly

what can interfere with bis

shivering, electrocautery, forced air warmer, cardiac pacemaker spikes

How well did you know this?

Not at all

Perfectly

how does electrocautery interupt bis

unipolar cautery overloads bis signal transmission

How well did you know this?

Not at all

Perfectly

how can you reduce exposure to unheated gases and aid in volatile agent sparing

low FGF

How well did you know this?

Not at all

Perfectly

t or f- the icu ventilator breathing circuit is typically a closed system

f- typically open system, does not have gas recirculated through

How well did you know this?

Not at all

Perfectly

t or f- modern anesthesia machines are typically closed system

f- semi closed systems

How well did you know this?

Not at all

Perfectly

why are modern anesthesia machines considered semi closed systems

removal of co2
conservation of volatile agents

How well did you know this?

Not at all

Perfectly

what are the two major functions of the lung

ventilation
oxygenation

How well did you know this?

Not at all

Perfectly

what is the term for elimination of co2

ventilation

How well did you know this?

Not at all

Perfectly

what is the term for intake of oxygen

oxygenation

How well did you know this?

Not at all

Perfectly

what determines the partial pressure of co2 in the arterialized blood

alveolar ventilation

How well did you know this?

Not at all

Perfectly

what is the best indicator for oxygenation

PaO2

How well did you know this?

Not at all

Perfectly

t or f- PAco2 is best estimated from Paco2

TRUE

How well did you know this?

Not at all

Perfectly

the quantity of ___________ ________________ produced normally dictates minute ventilation

carbon dioxide

How well did you know this?

Not at all

Perfectly

normally dead space minute ventilation makes up _______ of the minute volume

1/3

How well did you know this?

Not at all

Perfectly

what is the normal oxygen consumption of an average 70kg adult human

250 ml/min

How well did you know this?

Not at all

Perfectly

what is the ratio between co2 production and oxygen consumption

respiratory quotient

How well did you know this?

Not at all

Perfectly

what is normal respiratory quotient

200/250

How well did you know this?

Not at all

Perfectly

what is the energy expended to move the gas into and out of the lungs

work of breathing

How well did you know this?

Not at all

Perfectly

work of breathing is measured by the work needed to overcome what two things

elastic properties of lung/chest wall
resistance aspects of circuit

How well did you know this?

Not at all

Perfectly

what parts of circuit provide resistance

et tube
large and small airways

How well did you know this?

Not at all

Perfectly

what does change of airway pressure/change in volume

elastance

How well did you know this?

Not at all

Perfectly

under normal circumstances, the work of breathing is mostly overcoming what:

elastance of lung and chest wall

How well did you know this?

Not at all

Perfectly

t or f- mechanical ventilation exhalation is passive

true

How well did you know this?

Not at all

Perfectly

what is the formula for compliance

change in volume/change in pressure

How well did you know this?

Not at all

Perfectly

what two pressures must the ventilator overcome during inspiration

compliance and resistance

How well did you know this?

Not at all

Perfectly

changes in inspiratory pressure result in changes in what two variables

tidal volume
inspiratory flow

How well did you know this?

Not at all

Perfectly

what does the symbol PI stand for

inspired pressure

How well did you know this?

Not at all

Perfectly

what does the symbol PIMAX stand for

peak inspiratory pressure

How well did you know this?

Not at all

Perfectly

what does the symbol VT stand for

tidal volume

How well did you know this?

Not at all

Perfectly

what does the symbol mv mean

minute volume

How well did you know this?

Not at all

Perfectly

what does the symbol QI stand for

inspiratory flow

How well did you know this?

Not at all

Perfectly

what does the symbol f stand for

frequency

what does the symbol TC stand for

resp cycle time

what does the symbol Tplat stand for

inspiratory pause time

what does the symbol TI stand for

inspiratory time

what does the symbol TE stand for

expiratory time

what does the symbol I:E stand for

inspiratory/expiratory ratio

t or f- inspiratory pause (tplat) is not a part of the inspiratory time

false

what determines the duration of the respiratory cycle

frequency

in the I:E ratio, which is generally the bigger number

expiratory- need more time to exhale

what does intermittent positive pressure ventilation or PEEP do to cardiac output and how

decreases- pressure increases intrathoracic pressure, which decreases blood flow to heart, which decreases cardiac output

when does intrathoracic pressure increase during IPPV vs PEEP

IPPV: inspiration
PEEP: expiration

what are two possible negative effects of peep

increased dead space
reduced cardiac output

why is someone with pneumonia or ards at an increased risk for further lung damage

the good lung segments receive more tidal volume and peep, which can cause further damage

t or f- maintain large tidal volume (15-20ml/kg) to maintain alveolar distention and prevent atelectasis

f- may cause barotrauma

what can overdistention of health alveoli cause

pulmonary interstitial emphysema
pneumothorax

what is the recommended tidal volume

6-8 ml/kg

peep maximizes what lung volume measurement

functional residual capacity

what kind of ventilation is the goal to increase mean airway pressure and minimize peak pressure

inverse ratio ventilation

what kind of ventilation seeks to recruit alveoli without overdistention

inverse ratio ventilation

which bellows rises during exhalation

ascending- standing

which bellows falls during exhalation

descending- hanging

which type of bellows may inflate with room air even during circuit disconnect or leak

descending- hanging

what can a hole in a bellows lead to

barotrauma

does bellows driven or piston driven ventilator have more accurate tidal volumes

piston drive

which type of ventilator relies on a spinning fan to produce a drive gas pressure

turbine

t or f- exhalation is typically a passive event

true

how do you manipulate exhalation pressures

peep

what can high pressure ventilation lead to with blood pressure

hypotension

t or f- extending an inspiratory plateau may improve gas exchange by keeping alveoli expanded for a longer period

true

when is the relief valve to the scavenging system sealed

during inspiration
beginning of exhalation

t or f- relief valve to scavenging system is closed during the beginning of exhalation until the ascending bellows has been refilled

true

what provides the constant 2-3 cm h2o of peep even when peep hasn’t been manually turned on

relief valve

t or f- there is alway 2-3 of peep on ventilator even when peep hasn’t been manually turned on

true

why is it important to check adjustable relief valve on machines that have it

if it is improperly adjusted, it can result in too high of peep which can cause barotrauma or hypotension

what are the 3 ventilator modes of breathing

controlled breathing
assisted/supported
spontaneous

t or f- in controlled breathing mode, the patient can contribute effort toward work of breathing

f- cannot contribute any

what is set parameter in volume control ventialtion

volume

when needs to be closely monitored during volume control ventilation

Peak airway pressure- because airway pressure can get really high to hit specified volume in those with poor lung compliance

what is fixed parameter in pressure control ventilation

pressure

when are high flows delivered during pressure control ventilation

start of inspiration

what should be monitored with pressure control ventilation

CO2
tidal volume

which ventilator setting is the patient’s effort to breath manifested by negative deflection in airway pressure, and a predetermined negative pressure triggers the vent to deliver a set tidal volume

assisted ventilation

which vent setting will a control breath not be delivered as long as the patient triggers ventilator more than the interval defined by set control rate

assist control ventilation

what are the characteristics of acv

-set control rate: patient triggers ventilator, but if less than interval defined, vent initiates breath
-volume is also set on machine

what is set by clinician in pressure support ventilation

peak airway pressure,
i time,
trigger

which mode does clinician set mandatory vent breaths by either volume or pressure at a defined rate and i time

intermittent mandatory ventilation

what is patient at risk for with intermittent mandatory ventilation

breath stacking–>barotrauma

t or f- breath stacking is a common problem with SIMV mode

false
rarely occurs

what does the cpap number represent on vent

airway pressure between exhalation and inhalation

the gas flow in the airway is always __ between exhalation and inhalation

which mode has t-slope, simv or psv pro

psv pro

what should you make sure to monitor with pressure control ventilation

CO2
tidal volume

if lung perfusion/cardiac output decreases, what will happen to amount of dead space ventilation

increases

what modes are commonly used with lma

SIMV
pressure support

how is incoming gas warmed in the bain circuit

exhaled gas

which mapleson is best for spontaneous ventilation

mapleson a
worst= B

which mapleson is best for controlled ventilation

d
worst= A

what is an example of a surgery where patient will have decreased compliance

laparoscopy

what is the maximum amount of additional air that can be inspired from the end of normal inspiration

inspiratory reserve volume

which volume keeps alveoli open during exhalation

residual volume

what is the maximum volume of additional air that can be expired from end of normal expiration

expiratory reserve volume

what is the volume of air remaining in lung after a maximal expiration

residual volume

what is fev1

forced expiratory volume in 1 sec

t or f- you can breath all of the air out in your lungs

false
always a residual volume

what is the only lung volume that cannot be measured with a spirometer

residual volume

what is the volume of air contained in lungs at end of maximal inspiration

total lung capacity

what is the term for the sum of the 4 basic lung volumes

total lung capacity

what is the equation for tlc

residual volume + inspiratory reserve volume+ tidal volume + expiratory reserve volume

what is vital capacity

max volume of air that can be forcefully expelled from lungs following a maximal inspiration

what are the two formulas for vital capacity

tlc- residual volume
or
inspiratory reserve+tidal volume+ expiratory reserve

what is functional residual capacity

amount of air left in lung at end of normal expiration

residual volume + expiratory volume

functional residual capacity

what is the reservoir that prevents hypoxemia during apnea

functional residual capacity

what is approximate normal frc

35 ml/kg

what are some factors that decrease functional residual capacity

general/inadequate anesthesia
obesity
pregnancy
neonates
certain positions
paralysis
excess iv lfuids
high fio2
reduce pulm compliance

which positions decrease frc

supine
lithotomy
trendelenburg

what are some factors that increase functional residual capacity

advanced age
certain positions
obstructive lung disease
peep
sigh breaths

which positions increase frc

prone
sitting
lateral

how does position increase or decrease frc

changes position of diaphragm
gravity alters distribution of pulmonary blood flow

how does advanced age increase frc

decreased elastic lung tissue= air trapping= increased residual volume

why do neonates have decreased frc

less alveoli= less lung compliance
ribcage is cartilaginous, prone to collapse

why does pregnancy decrease frc

-diaphragm shifts cephalad as a result of uterus
-restrictive lung disease

why does obesity decrease frc

decrease chest wall compliance
increased airway collapsibility

how does general anesthesia cause decreased frc

diaphragm shifts 4cm cephalad as a result of decreased inspiratory muscle tone and increased expiratory muscle tone

how does sigh breaths increase frc

recruits collapsed alveoli

how does obstructive lung disease increase frc

air trapping= increased residual volume= increased frc

how does high fio2 decrease frc

absorption atelectasis= conversion of low v/q unit= shunt unit

how does peep increase frc

prevents alveoli from collapsing
partially overcomes general anesthesia effects
decreases venous blood admixture= increased pao2

t or f- peep pops open alveoli aka alveolar recruitment

f- maintains open alveoli from collapsing

how do you pop open more alveoli

alveolar recruitment mechanism
-forceful breath for long period=high peak

how does excessive iv fluids decrease frc

fluid accumulation in dependent lung favors zone 3

how does inadequate anesthesia decrease frc

straining= forceful expiration= decreased lung volumes

how does paralysis decrease frc

diaphgram moves cephalad= decreased lung volumes

what are some disease that decreases frc/pulmonary compliance

acute lung injury
pulmonary edema
pulmonary fibrosis
atelectasis
pleural effusion

what conditions cause diaphragm to shift cephalad causing decreased frc

general anesthesia
pregnancy
paralysis

what lung capacity is of less clinical significance

inspiratory capacity

what is the max volume of air that can be inspired from normal-end expiratory position

inspiratory capacity

what is the formula for inspiratory capacity

tidal volume + inspiratory reserve

what are the names of the 4 lung zones

collapse
waterfall
distention
interstitial pressure

which lung zone is only present with pathology

1 and 4

which lung zone is pulmonary artery pressure negligible

zone 1

after blood passes through alveoli of zone 2, where does it go

falls into pulmonary venous system

what is blood flow proportional to in zone 2

Pa-PA

what is blood flow proportional to in zone 3

Pa-pv

pressure is reflected from ____________ ventricle back through zone ____ to site where swan is wedged

left, 3

what is blood flow proportional to in zone 4

Pa-Pi

which zone is present with pulmonary edema

zone 4

what is normal alveolar ventilation (V)

4L/min

what is normal capillary perfusion (q)

5L/min

what is normal vq range

0.3-3.0

what are the 4 components of a mapleson circuits

breathing tube
fresh gas inlet
apl valve
reservoir

which mapleson is considered a bain circuit

mapleson d

what are the advantages and disadvantages to bain circuit

advantages: fgf flows through center, helps prevent heat loss
disadvantages: fgf may be kinked without you knowing it

which mapleson is a jackson rees circuit

mapleson f

which mapleson is used for peds laryngospasm

mapleson f- jackson rees

what is decreased in circle system

dead space

what breathing test is severe copd defined by

fev1 <30% predicted

what is vq of an absolute intrapulmonary shunt

vq is 0

what is vq of a relative intrapulmonary shunt

low v/q ratio

what is a shunt

airway obstruction to area= low v/q
-low oxygenated blood leaving alveoli

what is a shunt

airway obstruction to area= low v/q
-low oxygenated blood leaving alveoli

what is deadspace

blood flow problem- high v/q ratio
high oxygen, but no blood flow

what can be a cause of deadspace

what mismatch does dead space cause

high v/q

what mismatch does shunt cause

low v/q

what is predominant effect of low v/q

hypoxia (shunt)

what is predominant effect of high v/q

hypercapnia (dead space)
-also hypoxia

which v/q is perfusion to nearby segment of alveoli increase and ventilation to diseased segment is wasted

high v/q

which v/q is ventilation increased to nearby segments–hypoxic vasoconstriction

low v/q (shunt)

which v/q ratio will you have hypoxic vasoconstriction

low v/q ratio- shunt

what is v/q defect when v/q values is 0.8

normal

what is v/q defect when v/q value is 0

airway obstruction - shunt

what is v/q defect when v/q value is infinity

pulmonary embolus- dead space

what is v/q defect when pAo2 is 150 mmhg

pulmonary embolus-dead space

what is v/q defect when pAco2 is 0

pulmonary embolus- dead space

what is v/q defect when pao2 is 40

airway obstruction- shunt

what is v/q defect when paco2 is 46 mmhg

airway obstruction- shunt

what are normal values of pa/pA o2/co2

pAo2= 100
pAco2= 40mmhg
pa02- 100mmhg
paco2= 40 mmhg

any process that decreases ______________ ______________ and ____________ ________________ will lead to a relative increase in dead space ventilation

cardiac output
lung perfusion

what are some causes of decreased cardiac output and lung perfusion leading to increased dead space

hypovolemia
shock
pulmonary embolism
reverse trendelenburg
increased intraabdominal pressure

where is dead space in circle system

distal to y piece

what are causes of resistance in circle system

valves and absorbers

when a patient is in lateral position, which side gets more air

independent

what is the independent zone of lung in lateral position

zone1

when a patient is in lateral position, which side gets more blood

dependent

what provides heat/moisture in circle system

granules

what decreases moisture in circle system

high flow

how do you adjust i:e ratio for copd

lengthen e time so they have longer to get air out

how long will each breath take if freq is set to 12

5 sec

if I:E ratio is 1:1, how long will inspiration take if freq is set to 12

2.5 seconds

what can high volumes cause in ards or acute copd exacerbation cause

barotrauma

t or f- co2 absorber prevents rebreathing of co2 in closed system

true

what does fgf need to be below to make it a closed system

<1 L/min

at what fgf do you not need co2 absorber

> 5L/min

during inspiration gas flow into alveoli until what?

until alveolar pressure reaches upper airway pressure

t or f- during expiration, positive pressure is removed

t- it decreases

what is the process of providing positive airway pressure at upper airway

mechanical ventilation

why is the lung elastic

elastic and collagen fibers in parenchyma

what is the formula for elastance

Change in pressure (cmH20) / change in volume (L).

what is the opposite of elastance

compliance

what do lungs with low compliance need to infalte

more pressure

what is the equation for compliance

change in volume (L)/
change in pressure (cmH2O)

what are the two types of lung resistance

tissue resistance
airway resistance

tissue resistance accounts for ___ of total resistance

20%

what kind of resistance is impedance to motion caused by moving organs and chest wall during resp cycle

tissue resistance

what does resistance depend on

type of flow- turbulent/laminar
geometry of tube
viscosity of gas
flow rate of gas

what is formula for resistance derived from by

poiseuilles law

how is resistance calculated via poiseuilles law

r= 8NL/pi (r^4)

what is amount of tidal volume that a patient receives

volume

what is the term for measure of impedance to gas flow rate

impedence

what is the measure of rate at which gas is delivered

flow

what setting refers to number of breathers per minute that the ventilator delivers

frequency

what is typical freq

8-12 bpm

t or f- ventilator always provides all of patient’s ventilation

f- can also breath spontaneously between vent breaths

how do you calculate tidal volume

6-8 ml/kg ideal body weight

what disease may require lower tidal volume

ards
acute copd exacerbation
asthma

what patient may benefit from higher tidal volumes that prevent atelectasis

neuromuscular disease

what is highest level of pressure applied to lungs during inhalation

pip (cmh2o)

what should pip never be higher than

40 cm h2o
unless patient has ards

what should pip be limited to in masked/LMA patient

20 cm h2o

what causes ventilator to cycle to inspiration

trigger
-time, pressure, volume, flow

what kind of trigger does vent cycle at a frequency as determined by controlled rate

time trigger

what kind of trigger does vent sense patient’s inspiratory effort by way of a decrease in baseline pressure

pressure trigger

what is trigger in most modern vents

flow trigger

how does flow trigger work

deliver constant flow around circuit through resp cycle, deflection in this flow by patient inspiration is monitored by vent and it delivers a breath

which requires less work by patient, pressure or flow trigger

flow trigger

what can be used to increase oxygenation by maintaining alveoli

peep

what is peep most patients are started on

5 cm h2o

who requires higher level of peep

stiff lungs- ards

what does peep help prevent with ards

intrapulmonar shunting

what should peep not exceed

20 cm h2o

what does high peep settings increase risk of

subq emphysema
pneumothorax

how is t slope measured

seconds

what controls how long it takes to reach set pressure

t slope (sec)

what is range of t slope

0-2 seconds

what mode is t slope most important in

pressure support modes

what t slope is set longer than inspiratory time, what can happen to tidal volume

shortened tidal volume

what does a higher t slope mean for the slope

more gradual slope

how do calculate delta p

PIP-PEEP

during pressure limited ventilation the delivered tidal volume is determined by the pressure level above ____________

peep

what type of ventilation is not optimal for poorly compliant lungs

volume control

what does ventilator determine in volume control

pressure required

what are advantages of volume control

guaranteed minute vent
more comfortable for patient-if-not-spontaneously-breathing

what type of ventilation is more comfortable for patient if they are not spontaneously breathing

volume control

is volume control a controlled mechanical ventilation mode or an assisted mechanical ventilation

controlled

what is typical fio2 during a case

40-50%

what typical fio2 during extubation

50-80%

what type of ventilation has guaranteed minute ventilation

volume control

what are presets on volume ventilation

volume
peep
rate
i time
fio2

what type of ventilation does vent determine tidal volume

pressure control

what type of ventilation is minute ventilation not guaranteed

pressure control

what type of ventilation provides more support at lower pip for poorly compliant lungs

pressure ventilation

what are presets of pressure ventilation

pip
peep
rate
i time
fio2

in pressure control what changes according to lung compliance

tidal volume

in volume control, what varies based on pulmonary compliance/airway resistance

delivered peak inspiratory pressure

what happens when patient is spontaneously breathing during pressure control

pip is fixed, mode reduces discomfort

which ventilation method is better for spontaneously breathing patient, volume or pressure

pressure
volume control will give asynchronous breaths

what happens when patient is spontaneously breathing during volume control

pip is variable, delivers breath during asynchrony leading to increased work of breathing and discomfort

what mode can cause asynchrony during spontaneous breathing

volume control

how many breaths does pressure support give

none

what parameters are set during pressure support

pressure support
fio2

what is purpose of pressure support

final step prior to extubation
assist spontaneous breath

what is final mode before extubation

pressure support

what mode are patient’s spontaneous breaths supported by a set pressure

pressure support

what does simv mode stand for

Synchronized Intermittent Mandatory Ventilation

what is simv mode

mandatory breaths-synchronized
pressure support for spontaneous breaths

will inspiratory and expiratory flow on copd flow volume loop be low or high

low

which flow volume loop has low residual volume

restrictive flow volume floop

which flow volume loop is inspiratory volume diminished

restrictive flow volume

what is your ventilator mode if you set your freq at 12 but the patient can still initiate spontaneous breaths where vent provides pressure supoort

simv

what is psv-pro mode

pressure support with a backup rate

what are differences between psv-pro-and simv

psv has: t slope, ps with backup rate

what is diminished on copd flow volume loop

expiratory flow

why is expiratory flow loop diminished in copd

resistance due to airway collapse

which flow volume loop has normal amount of volume exhaled in three seconds, but forced exp volume in one second is low

copd

t or f- residual volume is high in copd

true

are inspiratory/expiratory flow low or high in copd

low

residual volume is low in the ________________ flow volume loop

restrictive

what happens to inspiratory volume in restrictive flow loop

diminished

t or f- peak expiratory flow and one second expiratory flow is normal copd flow loop

f- restrictive flow volume loop

what are examples of variable extrathoracic obstruction

paralysis of vocal cords
laryngospasm
thyromegaly
tracheomalacia

which obstruction is indicative of upper airway obstruction- extrathoracic or intrathoracic

extrathoracic

what does flow volume loop of extra-thoracic obstruction indicate

upper airway obstruction

t or f- extrathoracic obstructions have normal inspiration but abnormal exhalation

f- abnormal inspiration, normal exhalation

which obstruction does inspiratory plateau reach a low value-extrathoracic or intrathoracic

extrathoracic

what kind-of-obstruction does inspiratory plateau reach a low value

variable extrathoracic obstruction

what would cause a fixed intrathoracic obstruction flow volume loop

fixed large airway obstruction
tracheal stenosis
foreign body/neoplasm

what obstruction effects both inspiration and expiration-extrathoracic or intrathoracic

fixed intrathoracic obstruction

what’s the difference between variable extrathoracic vs variable intrathoracic obstruction

extra: inspiration obstruction
intra: expiration obstruction
fixed-intra: effects both

what is A

liters

what is B

L/sec

what is C

expiration

what is D

inspiration

what is E

obstruction

what is F

normal

what is G

restrictive

what is H

fixed

what is A (x axis)

volume

what is B

vital capacity

what is C (y axis)

flow

what is D

peak expiratory flow rate

what is E

normal

what is G

obstruction

what is A

what is B

expiration

what is C

L/sec

what is D

total lung capacity

what is E

residual volume

what is F

functional residual capacity

what is G

vital capacity

what circuit is this

mapleson A

what circuit is this

mapleson D

what circuit is this

mapleson B

what circuit is this

mapleson E
ayres piece

what circuit is this

mapleson C

what circuit is this

mapleson F
jackson-Rees

which is the only circuit where the fresh gas inlet is near the bag

mapleson A

which is the only circuit with no corrugated tubing

Mapleson C

which is the only circuit with the APL valve away from the patient

Mapleson D

which is the only circuit without a reservoir bag

Mapleson E

which circuit does not have an APL valve anywhere

Mapleson E

which circuit can have either an APL valve or a small hole at the tail of the bag that is manipulated to control pressure like an APL valve

Mapleson F

which circuit is best for a spontaneous ventilation patient

Mapleson A

A>DFE>CB

which circuit is the worst for spontaneous ventilation patient

Mapleson B

which circuit is best for the controlled ventilation patient

Mapleson D

DFE>BC>A

which circuit is the worst for controlled ventilation patients

Mapleson A

acronym for best circuits for spontaneous ventilation patients

All Dogs Bite

A>DEF>CB

acronym for circuits for controlled ventilation patients

DFE>BC>A

Dont Be Arrogant

which system is a modified Mapleson D design

Bain system

what is the Pethick test

used to test circuit integrity during pre-anesthetic checkout procedure

what does this show

esophageal intubation

what does this show

incompetent expiratory valve
incompetent inspiratory valve
exhausted soda lime canister

what does this show

prolonged upstroke and expiratory plateau

what does this show

incompetent inspiratory valve
-not returning to zero axis
-inspiratory limb prolonged

what is this

hyperventilation
-less amplitude
-ventilation is increased

what does this show

hypoventilation: rate
-y axis scale large
-slow down in RR
-probably chronic condition

what does this show

inspiratory effort
-lack of adequate paralysis
-alveolar plateau is key

what does this show

cardiogenic oscillations

what does this show

external chest compressions

what does this show

incompetent inspiratory valve take off angle

what is this

malignant hyperthermia
-very rapid increase in CO2

what does this show

hypoventilation
-wave does not reflect hypercarbia
-acute hypoventilation

what does this show

pulmonary embolus2 is down (low)
-alveolar plateau is angled
rate is increased

Brainscape's Knowledge GenomeTM

Vent material Flashcards

Brainscape's Knowledge Genome^TM