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Respiratory > Ventilation > Flashcards

Ventilation Flashcards

1
Q

What is the VC level of patients with neuromuscular disorders (e.g. Myasthenia Gravis) that indicates the need for mechanical ventilation?

A

10-15 cc/kg

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2
Q

True or false: mechanical ventilation can be a diagnostic tool

A

True

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3
Q

Normal spontaneous breathing is better at aerating what parts of the lung?

A

Posterior and inferior

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4
Q

What areas of the lung are commonly damaged with mechanical ventilation? Why?

A
  • Anterior/superior

- Where gas accumulates when supine

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5
Q

What is the MOA of the iron lung? What is the major issue with this?

A

Decreases pressure surrounding chest

No diaphragm movement

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6
Q

What are the three T’s for volumes and pressure targets?

A
  • Target volume/pressure
  • Trigger (signal to initiate the breath)
  • Termination
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7
Q

What are the two types of triggers for positive pressure ventilation?

A

Flow or pressure

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8
Q

What are mandatory breaths?

A

The guaranteed number of breaths that a ventilator will give no matter what

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9
Q

What is a controlled breath?

A

Breath initiated by the ventilator

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10
Q

What is an assisted breath?

A

Effort can initiate the breath, but ventilatory provides the pressure

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11
Q

What are the two characteristics of assisted breaths that the patient determines?

A

Initiation

Duration

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12
Q

The airway pressure is dependent on what two variables?

A

Ventilatory settings

Mechanics of lung and chest wall

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13
Q

What is the most common type of target for a ventilator?

A

Volume

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14
Q

What is the typical inspiratory flow rate?

A

30-80 L/min

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15
Q

What are the three patterns of delivery?

A
  • Square wave
  • Sine
  • decelerating/ramp pattern
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16
Q

Vt with a ventilatory is determined by what?

A

Inspiration pressure and time

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17
Q

True or false: Vt is variable, and not guaranteed. Why or why not?

A

True–changes in lung mechanics can have significant impacts

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18
Q

What is the most common mode used for a ventilator? What is involved with this mode?

A

Assist control mode

Breaths are assisted with a either a volume or pressure target

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19
Q

What are the four variables that determine the frequency of ventilations?

A
  • signals to initiate breaths
  • Mode of ventilation
  • Min set rate
  • pt effort
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20
Q

What are the disadvantages of assist control mode?

A
  • Respiratory Alkalosis

- Hyperinflation

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21
Q

How is VACV used as a diagnostic tool? (2)

A
  • If pressures needed to get a given volume in are high, it may point to a restrictive lung disease
  • If there is a large gap between park and plateau pressure, may point to bronchospasm
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22
Q

What is intermittent mandatory ventilation (IMV)?

A

Effort beyond set rate delivers spontaneous breath from a reservoir bag that contains gas with the same FiO2

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23
Q

What are the downsides of intermittent mandatory ventilation?

A
  • Uncomfortable

- Inferior for weaning patients

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24
Q

What is spontaneous ventilation (PSV)?

A

Initiation and duration of breath are patient determined

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25
Q

What is the most comfortable mode for the alert patient?

A

PSV

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26
Q

What are the ways to improve oxygenation with a ventilator?

A
  • Increase FiO2

- Adjust airway pressure of the ventilator

27
Q

What is PEEP? What is the use of this?

A

Positive end expiratory pressure

Adding 5-20 cm H2O to keep alveoli open

28
Q

What are the drawbacks to increased airway pressure? (3)

A
  • Overdistention of the alveoli
  • Decreases venous return
  • Increased dead space from over distending functional alveoli
29
Q

What determines the PCO2? What is the equation for this value?

A

Minute ventilation (=TVxRR)

30
Q

What are the two variables of pressure control/assist?

A

RR

Pressure target

31
Q

What are the two variables of volume cycled ventilation?

A

RR

TV

32
Q

What is the optimal tidal volume for ARDS? Everyone else?

A
  • ARDS = 4-6 cc/kg/IBW

- Everyone else= 6-8 cc/kg/IBW

33
Q

What is the ideal body weight equation?

A

50 kg for 5 foot males
45 kg for 5 feet

2.3 kg for every inch above

34
Q

Why are targeted tidal volumes important?

A

Prevent hyperinflation of the lung

35
Q

What is the target of the plateau pressure?

A

Less than 30 cm H2O

36
Q

What is the pH goal for ventilation?

A

Greater than 7.1

37
Q

What is the TV goal for ventilation?

A

Less than 8 cc/kg/IBW

38
Q

True or false: the longer someone is on the ventilator, the worse the survival

A

True

39
Q

What are the three oxygen requirements for ventilator weaning (PEEP, FiO2, and PF values)?

A
  • PEEP 5-8 cm H2O
  • FiO2 less than 50%
  • PF greater than 150
40
Q

What is the cutoff for the rapid shallow breathing index for weaning?

A

f/VT less than 105

41
Q

What fraction of extubations will fail?

A

1 in 5

42
Q

Who usually fails extubation?

A

age greater than 65

43
Q

What are the criteria for “difficult” extubation patient?

A

Fails 1-3 trials up to 7 days

44
Q

What are the criteria for “prolonged” extubation patient?

A

Greater than 7 days

45
Q

What is BiPAP?

A

Positive pressure through a mask

46
Q

True or false: NIVs after extubation can help people get off of a ventilator

A

True

47
Q

True or false AECOPD is appropriate for NIMV

A

True

48
Q

True or false: comatose pts is appropriate for NIMV

A

False

49
Q

True or false: Acute cardiogenic pulmonary edema is appropriate for NIMV

A

True

50
Q

True or false: pts with excess secretions are appropriate for NIMV

A

False

51
Q

True or false: pts with bleeding are appropriate for NIMV

A

False

52
Q

True or false: pts with vomiting are appropriate for NIMV

A

False

53
Q

True or false: pts with neuromuscular failure are appropriate for NIMV

A

True

54
Q

True or false: pts with immunocompromised pneumonia are appropriate for NIMV

A

True

55
Q

True or false: pts with hemodynamic instabilityare appropriate for NIMV

A

False

56
Q

What are the benefits of NIV in AECOPD?

A
  • Improves hospital mortality
  • Decreased LOS
  • Decreases risk of intubation
57
Q

What is high flow nasal cannula oxygen?

A

Humidified air via NC

58
Q

True or false: HFNCO is appropriate for shock

A

False

59
Q

True or false: HFNCO is appropriate for hypercapnia

A

False

60
Q

True or false: HFNCO is appropriate for Neuromuscular respiratory failure

A

False

61
Q

True or false: HFNCO is appropriate for tachypnea

A

False

62
Q

What are the three determinants of weaning off of a ventilator?

A

Pain
Agitation
Delirium

63
Q

When is ECMO used?

A

-PaO2/FiO2 less than 150

64
Q

What is the difference between ECMO and CBP?

A
  • Closed chest cannulation
  • Less anticoag
  • Anesthetized, not sedated

Respiratory (34 decks)

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