Ventilation Flashcards
Setting for Oscillator
MAP, Amplitude, Hertz, iTime
Amplitude on Oscillator
-What generates the wiggle
-the delta P
-determines the volume of gas that is pushed in/out of the airway during each ventilated breath
-higher Amp oscillating outsides of MAP->stretching lung too much
-1:2-3 ratio of MAP and amplitude?
-Once get to high 40’s consider adjust Hz
Hertz on Oscilator
-Start at 8-12 (smaller patient higher the hertz)
-ventilator rate is expressed in hertz -1Hz=60breaths/min = 1/ wavelength (distance between each wave, if increase distance between peaks then shorter hertz/frequency)
-By decreasing the frequency the lungs see high tidal volume due to less resistance to the pressures that are being delivered–>improve ventilation and MAP
-higher hertz: decrease ability to remove CO2
-increase wavelength: increase tidal volume
iTime Oscillator
0.33
HFJV setting
PIP, MAP, ITIME, RR
benefit of longer iTIME
more flow, more volume with longer inspiration time, getting bigger breaths
rate on HFJV for PIE
360
NAVA-EDI min description and range
-what the diaphragm is doing at rest
-2-5
NAVA EDI min changes to make
If <2 and FiO2 is <0.3 or at baseline–> decrease PEEP 1
If >5 and FiO2 is >0.3 or >baseline–> increase PEEP 1 (max 8)
NAVA EDI peak description and range
-Start NAVA level at 1
-10-15
NAVA EDI peak changes to make if elevated
> 15 (Acidotic, tachypneic, increase WOB, increase O2)
-If mostly in back up w/ A/B/D increase back up rate, increase back up PIP, decrease apnea time by 1sec (min 3sec)
-If mostly in NAVA–> Increase NAVA level by 0.2 every 3-5 min until PIP is no longer increases and EDI peak decrease
NAVA EDI peak changes to make if low
<10 (acceptable pH, CO2, FiO2)
-Mostly in NAVA–> Decrease NAVA by 0.2, increase apnea time, consider CPAP
-If mostly in backup–> decrease sedation, decrease back up, decrease back up PIP, increase apnea time
settings to consider CPAP vs NINAVA
NAVA level <2
PEEP <7
FiO2<.0
pH> 7.25
CO2<55
Apnea time 5-8 sec
want FiO2 to be <60% before consider weaning the MAP
Will take several hours before seeing the effects of decreasing MAP
High PIPs on HFJV are commonly used with the expectation that alveolar pressures will not be correspondingly high because of the short I-time.
Higher the MAP the closer approximation of alveolar to blood and improving V/Q
High frequency= high rates +low tidal volumes
gentle ventilation to minimize trauma keeping airway stable
dead space=anatomical +alveolar is ~3ml/kg
anatomical= conduits for air entry (trachea, bronchi ETT)
alveolar= alveolar not being perfused/participating in gas exchange
oscillator active exhalation: electrical magnet positive/negative waves results in pushing air into the lung and pulling air out of the lungs
jet dilation passive exhalation: flow interruptor that stops the flow in which is allows passive exhalation
passive exhalation may be better for PIE to allow time for air in the interstitial (surrounding airways) to get into alveolar for removal
relaxation of the thoraic allow air to be removed from ventilation
