Ventilation

Question 1

Type 1 RF

Answer 1

Hypoxaemic

Question 2

Type 2 RF

Answer 2

Hypoxia and hypercapnia

Question 3

Type 3 RF

Answer 3

Perioperative

Question 4

Type 4 RF

Answer 4

Shock

Question 5

Indications for CPAP

Answer 5

Neonates
OSA
Obesity
Extubation
Heart failure (pulm oedema)

Question 6

Physiological effects of CPAP

Answer 6

Reduces pulmonary vascular resistance
Reduce LV preload
Reduce venous return
Improved FRC
Reduces atelectasis
Improve VQ mismatch
Improve surface area

Question 7

Indications for BIPAP

Answer 7

T2RF / COPD
Asthma (controversial)
Cardiogenic pulm oedema (not routine)
Post intubation
Chest wall trauma
Neuromuscular diseases

Question 8

Contraindications for NIV/bipap

Answer 8

Facial trauma
#BOS (pneumocephalus)
Airway protection needed
Makes tolerability
Apnoea

Question 9

Benefits of NIV. V Invasise

Answer 9

Avoids intubation
Quick and easy
Lower infection risks
Less drugs
Easier to wean
Allows communication
Eating and drinking

Question 10

Lung protective ventilation considerations

Answer 10

Mode irrelevant
Minimise volume and pressure
Tv 6-8ml / kg
Optimise PEEP
Plateau pressures below 30

Question 11

Ventilator basics

Answer 11

Control - volume, pressure, dual
Trigger - machine or pt
Cycling - how vent switches to exp
(Time, flow, pressure)

Question 12

SIMV

Answer 12

Synchronised intermittent mandatory ventilation
Volume or pressure control
Cycled time or pt
Permits along breathing

Question 13

CIMV

Answer 13

Continuous mandatory ventilation
Volume or pressure
Cycled time
Prevents spont breathing

Question 14

APRV

Answer 14

Airway pressure release ventilation
High levels of peep with times cycle releases
Maintains recruitment
Encourages spont breathing

Question 15

P high
T high

Answer 15

P-high = highest level of pressure
T-high = time in seconds spent at pressure

Question 16

HFOV

Answer 16

High frequency oscillation ventilation
Increases mortality

Question 17

Dysynchrony

Answer 17

Pts demand not met by ventilator
Fighting the ventilator
Causes? Pain? Anxiety? Awareness?

Question 18

Double triggering

Answer 18

Reflects inadequate machine support:
Increase inspiratory time or convert to pressure support

Question 19

ARDS statistics

Answer 19

17-34 per 100,000
10-15% of ITU admissions
Mortality 40%

Question 20

Describe ARDS

Answer 20

Spectrum of poorly understood conditions
Acute (<1 week from insult) diffuse, imagine bilateral opacities not explained by effusion or HF, mild moderate severe

Question 21

ARDS risk factors

Answer 21

Pneumonia
Aspiration
Drowning
Inhalation injury

Indirect: Sepsis, trauma, pancreatitis, burns

Question 22

ARDS pathophysiological consequences

Answer 22

VQ mismatch
Reduced lung compliance
Pulmonary hypertension

Question 23

ARDS treatment

Answer 23

Treat underlying cause
Protective strategy
General ITU care

Question 24

ARDS General points for management

Answer 24

Deceleration flow (VC auto flow)
Optimum peep
Low tv
Plat pressure <30
Permissive hypercapnia (ph > 7.2)

Refractory hypoxia: prone, NMB, ECMO

Question 25

Asthma immediate treatment

Answer 25

Oxygen, salbutamol, atrovent, steroids, magnesium, rule out TPx, intubation

Question 26

Features of severe asthma

Answer 26

Peak exp flow <33-50%
Can’t complete sentences
Resps > 25/min
Hypoxia
Normal paco2
Silent chest
Hotn
Exhaustion or low gcs

Question 27

Considerations when intubating asthmatics

Answer 27

Relative hypovolaemia
Anticipate CVS collapse (neg v pos pres)
Ketamine
Avoid opioids

Question 28

How to assess intrinsic peep

Answer 28

Auto peep
(Bronchospasm)

Question 29

How to asses intrinsic peep

Answer 29

Expiratory hold on vent

Question 30

Extremists asthma management

Answer 30

ECMO
Ket infusion
Disconnect from vent manually decompress
Thoracostomies