Ventilation

Question 1

Setting for Oscillator

Answer 1

MAP, Amplitude, Hertz, iTime

Question 2

Amplitude on Oscillator

Answer 2

-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

Question 3

Hertz on Oscilator

Answer 3

-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

Question 4

iTime Oscillator

Answer 4

0.33

Question 5

HFJV setting

Answer 5

PIP, MAP, ITIME, RR

Question 6

benefit of longer iTIME

Answer 6

more flow, more volume with longer inspiration time, getting bigger breaths

Question 7

rate on HFJV for PIE

Answer 7

360

Question 8

NAVA-EDI min description and range

Answer 8

-what the diaphragm is doing at rest
-2-5

Question 9

NAVA EDI min changes to make

Answer 9

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)

Question 10

NAVA EDI peak description and range

Answer 10

-Start NAVA level at 1
-10-15

Question 11

NAVA EDI peak changes to make if elevated

Answer 11

> 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

Question 12

NAVA EDI peak changes to make if low

Answer 12

<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

Question 13

settings to consider CPAP vs NINAVA

Answer 13

NAVA level <2
PEEP <7
FiO2<.0
pH> 7.25
CO2<55
Apnea time 5-8 sec

Question 14

want FiO2 to be <60% before consider weaning the MAP

Question 15

Will take several hours before seeing the effects of decreasing MAP

Question 16

High PIPs on HFJV are commonly used with the expectation that alveolar pressures will not be correspondingly high because of the short I-time.

Question 17

Higher the MAP the closer approximation of alveolar to blood and improving V/Q

Question 18

High frequency= high rates +low tidal volumes

Answer 18

gentle ventilation to minimize trauma keeping airway stable

Question 19

dead space=anatomical +alveolar is ~3ml/kg

Answer 19

anatomical= conduits for air entry (trachea, bronchi ETT)
alveolar= alveolar not being perfused/participating in gas exchange

Question 20

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

Answer 20

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