Ventilation Flashcards

1
Q

What is ventilation?

A

Ventilation is the process of exchanging air between the lungs and the ambient air. Gas exchange occurs at the alveoli, where oxygen (O₂) and carbon dioxide (CO₂) are transferred across cell membranes.

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2
Q

What is mechanical ventilation?

A

Mechanical ventilation is ventilation delivered by a machine/ventilator. Invasive ventilation is provided via an Endotracheal Tube (ETT), which can be oral, nasal, or through a tracheostomy.

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3
Q

What is respiratory failure?

A

Respiratory failure is the inability to maintain adequate gas exchange, characterized by abnormal arterial blood gas (ABG) levels.

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4
Q

What are the types of respiratory failure?

A
  • Type I: Hypoxia (PaO₂ <8 kPa) with normal or low CO₂, caused by V/Q mismatch.
  • Type II: Hypoxia (PaO₂ <8 kPa) and hypercapnia (PaCO₂ >6 kPa), caused by ventilatory failure.
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5
Q

What is Type II Respiratory Failure?

A
  • Acute: ↑PaCO₂, ↓pH, ↔HCO₃
  • Chronic: ↑PaCO₂, ↔pH, ↑HCO₃
  • Acute on Chronic: ↑PaCO₂, ↓pH, ↑HCO₃
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6
Q

What causes respiratory failure?

A
  • Disease affecting ventilatory control or respiratory muscles (brain injury, neuromuscular disorders).
  • Increased respiratory load exceeding muscle capacity (e.g., COPD, reduced lung compliance).
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7
Q

What are the indications for mechanical ventilation?

A
  • invasive: Organ failure, airway protection, sedation, trauma, post-surgery, pH <7.35 & PaCO₂ >6 kPa.

  • Non-Invasive (NIV): To avoid intubation, weaning from ventilation, long-term support, pH <7.35 but >7.1 & PaCO₂ >6 kPa.
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8
Q

What are the aims of invasive mechanical ventilation?

A
  • Reduce work of breathing (support mode)
  • Take over ventilation completely (controlled mode)
  • Maintain PaO₂, reduce PaCO₂, normalize pH
  • Allow medical management time for recovery
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9
Q

How does mechanical ventilation work?

A
  • Volume/pressure modes: Adjust tidal volume for effective ventilation.
  • PEEP: Keeps airways open for gas exchange and CO₂ clearance.
  • Pressure control: Increases pressure to improve CO₂ washout
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10
Q

What is tidal volume augmentation?

A
  • Set based on ideal body weight (6–8 mL/kg IBW).
  • Adjust pressure levels in pressure-controlled modes to reach target volume.
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11
Q

What are comfort parameters in ventilation?

A
  • Respiratory rate (RR): Set rate for assisted/control mode.
  • Ti ratio: Inspiration time (1:2, 1:3, etc.).
  • Flow/Ramp: Gradual increase to peak inspiration.
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12
Q

What are mixed ventilation modes?

A
  • PRVC: Pressure-regulated volume control
  • SIMV: Synchronized Intermittent Mandatory Ventilation
  • Bi-level ventilation: Controlled, assisted, or support mode.
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13
Q

What is Non-Invasive Ventilation (NIV)?

A

Ventilation provided via a mask, nasal pillow, or mouthpiece, delivering positive pressure during inhalation/exhalation.

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14
Q

What are the types of NIV?

A
  • CPAP (Continuous Positive Airway Pressure): Splints open airway during breathing, used in OSA and cardiac failure.
  • BiPAP (Bi-level Positive Airway Pressure): Flow-triggered with backup rate, useful in Type II respiratory failure.
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15
Q

What are the key parameters in NIV?

A
  • IPAP: Inspiratory Positive Airway Pressure
  • EPAP: Expiratory Positive Airway Pressure
  • Pressure Support: Difference between IPAP and EPAP
  • Tidal Volume (TV): Volume of air delivered per breath
  • Respiratory Rate (RR): Number of breaths per minute
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16
Q

What are the indications for NIV?

A
  • Acute: Respiratory acidosis (pH <7.35 but >7.1, PaCO₂ >6 kPa), avoiding intubation, weaning from ventilation.

  • Chronic: Compensated respiratory failure, nocturnal hypoventilation, spirometry abnormalities, sleep-disordered breathing (SDB), transplant bridging.
17
Q

What are the contraindications for NIV?

A
  • Absolute: Pneumothorax, severe hypotension, severe lung disease, cardiac arrhythmias, neurological instability, recent surgery, facial trauma.
  • Relative: Anxiety, excess secretions, need for continuous ventilatory assistance.
18
Q

What are the complications of NIV?

A
  • Skin breakdown (especially over the nose)
  • Secretion retention
  • Gastric distension
  • Air leaks and discomfort
  • Claustrophobia
  • Sleep fragmentation
19
Q

What are the interface options for NIV?

A
  • Nasal masks
  • Full-face masks
  • Nasal pillows
  • Mouthpieces
  • Tracheostomy