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Ornge > Ventilation201 > Flashcards

Ventilation201 Flashcards

1
Q

Respiratory Failure Type 1

A

Hypoxemia
-Sp02 <90%
-Pa02 <60mmHg
-PaC02 normal or below normal

-Most common

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2
Q

Respiratory Failure Type 2

A

Hypoxemia + Hypercapnia
-PaC02 >45mmHg
-Sp02 <90%, Pa02 <60mmHg

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3
Q

Hypercapnic Respiratory Failure Examples

A

Medulla dysfunction
Tox
Neuromuscular disease (Guillain-Barre, Myasthenia Graves, Polio, Spinal Injuries)
Chest wall/Pleural Diseases
Upper Airway Obstructions
Peripheral Airway Disorder (asthma, COPD)

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4
Q

Respiratory Failure Management

A
  1. Reverse & prevent hypoxemia
  2. Control PaC02 & acidosis
  3. Treat underlying disease
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5
Q

Calculate Complaince

A

Cstat= Vt
——————–
Plateau-PEEP
-Normal 50-7ml/cmH20
-Compliance describes the elastic property of the respiratory system

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6
Q

Calculate Resistance

A

RAW= PIP-plateau
——————- x60
VI

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7
Q

C02 Management Equation

A

RR = known EtC02 x known RR
————————————
desired EtC02

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8
Q

Factors effecting rate of diffusion

A

Pressure gradient
Solubility coefficient
Membrane permeability
Membrane thickness
Surface area

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9
Q

Factors that increase PIP

A

Increased inspiratory flow
Increased set Vt
Increased airway resistance
Decreased lung compliance
Increased PEEP
Kinged, obstructed or misplaced ETT
Patient ‘fighting’ the ventilator
Coughing

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10
Q

If PIP >30

A
  1. Dope
  2. Ventilator Dysynchrony
  3. Inspiratory hold
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11
Q

What is PIP

A

Measure of resistive + elastic forces
Measured at the mouth
Reflects the amount of PRESSURE required to overcome airway resistance

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12
Q

What is an Inspiratory Hold

A

Assists in understanding why PIPs are elevated.
May be the result of an increase in airway resistance or a decrease in lung compliance.

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12
Q

What is an Inspiratory Hold

A

Assists in understanding why PIPs are elevated.
May be the result of an increase in airway resistance or a decrease in lung compliance.

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13
Q

Permissive Hypercapnea Indications

A

Patients with ARDS managed with low tidal volume.
Patients ventilated for exacerbations of asthma or chronic lung disease who require low tidal volume and/or a low respiratory rate to minimize intrinsic PEEP.

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14
Q

Permissive Hypercapnea Contraindications

A

-Cerebral Disease
-CAD, Heart Failure, Cardiac Arrhythmias, Pulmonary HTN, Right Ventricular Disfunction (increases sympathomimetic output which would be poorly tolerated by patients who have cardiac disease)
-Hypovolemia (can induce systemic vasodilation)

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15
Q

Permissive Hypercapnea Adverse Effects

A

Increased HR, arrhythmias, BP
Exacerbation of right heart dysfunction
Increased ICP
Worsening of hypoxemia & lung injury

16
Q

VALI/VILI

A

Ventilator Associated/Induced Lung Injury - cellular level lung injury that occurs as a result of PPV. Presents like ARDS

17
Q

Prevention of VALI

A

-Limit plateau aureate pressure to under 30cmH20
-Limit tidal volumes to 6ml/kg
-Aim for lower oxygen levels, tolerate Sp02 88-90%
Use high PEEP (15) to prevent cyclic atelectasis
-Use neuromuscular function blockers
-Consider prone ventilation

18
Q

‘Baby Lung’

A

The fraction of lung that still maintains normal inflation with near normal mechanical characteristics. The baby lung is not anatomical but a functional entity which changes dimensions and location with prone position and PEEP application.

19
Q

Ventilating ARDS Patient

A

-Pressure Control
-Lung Protective Ventilation (low tidal volumes)
-Use a higher PEEP with a lower plateau pressure
-Accept a level of permissive hypercapnia.
-I:E 1:1, manipulating does not help patient
-Neuromuscular blockade
-Inhaled pulmonary vasodilators

20
Q

Ventilating Asthma Patient

A

-Use volume-control
-Largest Tube Possible
-Sp02 90-92%
-10-12 breaths/minute or less
-Long expiratory time (1:3/1:4)
-Heavy sedation & neuromuscular blockade
-Minimal PEEP
-Keep pplat below 25

21
Q

Asthma Ventilated Patient Therapies

A

Humidified O2
Nebulized beta-agonists & anticholinergic drugs
Hydrocortisone or prednisone
Magnesium

22
Q

Mechanical ventilation can _____ ICP and _____ CPP.

A

Increase ICP
Decrease CPP

23
Q

Increases in PaCO2 and decreases in PaO2 do what to ICP?

A

Increase it

24
Q

Examples of Obstructive Lung/Airway Disease

A

Asthma
Bronchitis
Emphysema
Bronchiectasis
Cystic FIbrosis

25
Q

Examples of Restrictive Lung Disease

A

Pneumonia
PE
Pleural Effusion
Pneumothorax
Obesity
Scoliosis
Myasthenia Gravis
Guiliian-Barre
ALS, Polio
ARDS

26
Q

Obstructive Diseases..

A

Experience during exhalation.
3 common diseases
-Asthma
-Bronchitis
-Emphysema

27
Q

Obstructive Ventilation Stategy

A

Low (4-6ml/kg) & Slow (RR8-10)

28
Q

Mechanical Ventilation & Increased ICP

A

HOB Elevated 30’
MAP >80
EtC02 33-38
Sp02 94-98%

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