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Principles I -- Exam 3 > Ventilator as told Dr. Ford > Flashcards

Ventilator as told Dr. Ford Flashcards

1
Q

What leads to derecruitment? (2 things he listed)

A

low tidal volumes
NO PEEP

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2
Q

What leads to overdistention? (3 things)

A

high Vt
high PIP
no recruitment

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3
Q

What preserves lung mechanics? 1 answer.

A

Spontaneous ventilation

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4
Q

Complaince is a change in ____ for a given change in ____?

A

a change in volume for a given change in pressure

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5
Q

Flow affects ____ and pressure from _____ affects flow.

A

pressure, compliance

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6
Q

Lung compliance is lower when?

A

Near the end of inspiration/when lungs are fully expanded

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7
Q

If a variable flow ventilator slows down flow as it nears the end of expiration, what is this called?

A

decelerating flow pattern

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8
Q

what happens to compliance is lungs are compressed by the abdomen?

A

Reduced compliance

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9
Q

What compliance-dependent factor will vary when a ventilator delivers a volume?

A

inspiratory pressure

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10
Q

If compliance is reduced, what is plateau pressure?

A

Higher

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11
Q

If compliance is higher, what is plateau pressure?

A

Lower

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12
Q

How to calculate driving pressure?

A

Plateau pressure - PEEP

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12
Q

A high plateau pressure equates to a ____ driving pressure

A

Higher driving pressure

More is necessary to achieve desired Vt

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13
Q

At a set Vt, the lower the driving pressure, the ____ the pulmonary compliance.

A

higher/greater

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14
Q

How can we reduce driving pressure?

A

add PEEP

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15
Q

What driving pressure is SUGGESTED from studies that David mentions?

A

<15 cmH2O

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16
Q

During PPV, chest movement is _________.

A

uncoordinated and asynchronous

d/t paralytics and deepened anesthetic state

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17
Q

What makes PPV unnatural? (3 answers)

A

-Cyclic recruitment and de-recruitment of collapsed lung units

-Repetitive shear stress is shown to destroy cellular structures

-Inspiratory flow is directed to less resistant areas or areas that remain open resulting in overinflated alveoli

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18
Q

During PPV, intrathoracic pressures and pulmonary vascular resistance can cause….

A

impeded venous return, leading to decreased cardiac output

This related to vena cava compression

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19
Q

A decreased CO due to PPV does what to renal function?

A

Decreases function, leading to decreased urine volume and sodium excretion

Additonally….liver receives less perfusion and gastric mucosa may also be subject to low perfusion and subsequently ischemia

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20
Q

Distended lungs and cardiac septal shifts can be caused by what?

A

PPV

▪ Alveolar distention may occur as well as air trapping
▪ Surfactant production may be impaired

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21
Q

What type of VILI is overdistention of alveoli?

A

Volutrauma

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22
Q

Barotrauma is….

A

Excessive pulmonary pressures

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23
Q

Repeated opening and collapse of atelectatic lung units is…..

A

Atelectrauma

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24
Inflammatory mediator release into alveoli and surrounding bronchiole spaces is...
Biotrauma
25
Lung protective strategies in summary:
Large Vt cannot prevent atelectasis or improve gas exchange, but it can cause acute lung injury. High FiO2 can accelerate atelectasis formation and it does not improve gas exchange. Mild hypercarbia is ok.
26
What maintains an open lung?
PEEP
27
STIFF lungs equals... (3 components)
decreased compliance high plateau pressure high driving pressure
28
When is inspiration terminated with volume control?
when preset volume is reached
29
When is inspiration terminated with pressure control?
when preset pressure is reached
30
FGF (air, O2, N2O) affects ____ if using fresh gas flow compensators.
Tidal volume
31
Driving gas for outside of bellows...
O2
32
Volatile inhalation agents and fresh gas flow are _____ the bellows.
inside
33
Ventilator moves volume of gas from ____ to the _____.
bellows to the patient's lungs
34
Ascending bellows ascend during _____.
Expiration
35
Bellow descend during ____.
Inspiration
36
Bellow add how much of PEEP?
2-3 cmH20
37
if your vent is on and bellows fall flat, what does this mean?
There is a disconnect somewhere.
38
Bellow may GRADUALLY descend all the way to flat if...
there is a small circuit leak -- think: improperly inflated ETT cuff that might let tidal volumes leak with each cycle
39
Vt setting
6-8 mL/kg of ideal body weight
40
PIP > ____ can lead to barotrauma and volutrauma
30 cmH2O
41
____ airway pressure helps preserve cardiac output and minimize ventilation perfusion
Lower
42
Ventilator sigh breaths are...
Not available Different than when awake -- sign breaths are effective then
43
Keep FiO2 around ___ to ___ %
40-50% 100% can accelerate atelectasis.
44
Normal I:E ratio
1:2 (or 1:1.5) allows time for passive expiration, while also not allowing breaths to stack.
45
What standard amount of PEEP helps recruit alveoli?
5 cmH20
46
What are two goals of tidal volumes?
-Keep alveoli open, expanded, recruited -Control ETCO2 (a measure of ventilation)
47
What is PiP affected by? (2 things)
flow rate and inspiratory time
48
Which is the more EFFICIENT way to increase minute ventilation?
Increase Vt
49
Which is the SAFEST way to increase minute ventilation?
Increase RR
50
Circuit compliance (expandability)
2 mL/cmH20
51
Normal circuit compliance
0.5-2.0 mL/cmH2O
52
Gas sampling
150 mL/min (2.5 mL/second)
53
Gas compression
3%
54
You are using a ventilator that only has rate and minute ventilation. Turning the rate up and leaving the minute ventilation unchanged will affect the tidal volume how?
Tidal volume will decrease
55
The smaller the I:E ratio, the _____ ETCO2
lower
56
The higher the I:E ratio, the ____ the inspiratory time.
greater
57
The higher the I:E ratio the _____ the inspiratory pressures since the breath is delivered over a longer amount of time.
lower
58
_________ has been utilized to allow longer inspiratory times under lower pressures in order for inspired volume to reach & recruit collapsed alveoli.
Inverse ratio ventilation (IVR)
59
What can occur is PiP is too high?
Barotrauma
60
Which I:E Ratio is higher? a.) 1:4, b) 1:6, c.) 1:2
c.) 1:2
61
With constant tidal vol. and rate, the expiratory time and ETCO2 are ____ related
Inversely -- the shorter the E time then the higher the CO2 will climb d/t shorter time to exhale and eliminate it
62
What leads to turbulent flow in lungs? (3 things)
1.) Bronchospasm 2.) Airway edema 3.) Airway mucosa and secretions
63
____ flow is not smooth, swirls and eddies.
Turbulent
64
____ flow is smooth layers in a smooth straight channel with no turbulence or eddie
Laminar
65
Short I:E effect (like 1:4) & expiratory time effect
Longer expiratory time, better CO2 elimination
66
Long I:E effect (like 2:1) and inspiratory time effect
Longer inspiratory time, better oxygenation
67
Long or short I:E: obstructive lung disease
Short; think longer E time so more CO2 elimination
68
SHORT I:E and PiP relationship
Higher PiP d/t rapid breath delivery
69
Long I:E and PiP relationship
Lower PiP d/t slower breath delivery
70
If PiP is too high, ____ing I:E can help lower it by slowing respirations.
increasing (maybe going from 1:4 to 1:2)
71
Short I:E and flow type
more turbulent flow due to fast inspiration
72
Long I:E and flow type
more laminar flow d/t slower inspiration
73
High RR effects on flow and pressure
Shortens inspiratory time, therefore increases PiP and flow rate
74
Low RR effects on flow and pressure
Lengthens inspiration time , decreases flow rate and PIP
75
Determinant for adjusting RR
pt needs; more CO2 elimination or greater oxygenation?
76
How does FGF on tidal volumes, minute ventilation, and PIP?
Really no effects unless extreme if extreme --> increases everything MV = put at hyperventilation risk TV = Increased; excessive vol delivery PIP = r/t inc vol delivered
77
Set parameter of volume control
Volume
78
If you are using pressure control ventilation and compliance changes from low to high how will volume change?
Volume will increase
79
Main advantage of volume control
Tidal volume is set and kept constant and delivered each breath
80
How would you change Vm on volume control?
RR (this is in his notes but I mean you could always increase the set volume too, I guess RR is just the safer option)
81
If increased PiP results from set volume, then what type of injury can occur?
Barotrauma
82
Indication for VC
Best for patients with no respiratory effort and little expected change in airway resistance and intra-thoracic pressure.
83
Increasing the the inspiratory flow (IF) ______ the I:E ratio.
DECREASES
84
Pressure control set parameter
Pressure (I guess technically rate and inspiration time also)
85
Advantages of Pressure Control (4)
1. Decelerating flow pattern 2. Mandatory rate and inspiration are set 3. Tidal vol based on desired pressure -- whatever vol they achieve while hitting set pressure 4. Longer inspiration time = delivered vol can reach and recruit collapsed airways
86
Disadvantages of pressure control (3)
1. -Inc tidal volume (volutrauma) can result if a drop in PiP occurs, e.g. laparoscopy 2. -Tidal volumes are NOT guaranteed 3. -Flow varies with each breath delivered
87
Indications for Pressure Control (2)
-Useful when high PIPs are not appropriate: LMA, emphysema, neonates and children -Useful when low compliance is present: laparotomy, pregnancy, morbid obesity, and ARDS.
88
In pressure control, expiration occurs when the ____ time and ___ pressures are reached.
inspiratory; airway
89
In pressure control, inspiratory time is longer as the ____ _____ delivered may take up much of the ventilatory cycle.
tidal volume
90
What is an "add on" to pressure control?
Volume guarantee --> 1. ensures set TV 2. delivered vol may not exactly match the set volume 3. enhances lung safety by adjusting to compliance changes Common in newer vent models
91
Pressure support set parameters
Inspiratory pressure and breath trigger are set
92
PSV sensitivity settings (breath trigger)
Based on inspiratory flow 200ml/min = more sensitive, trigger w very little mvmt = ideal for after deep anesthesia and paralytic reversal 2000ml/min = less sensitive = must have significant chest mvmt to trigger
93
Advantages of PSV (6)
1. Dec WOB and inc pt comfort 2. Augments TV in spon breathing pt 3. Overcomes neg resistance of ETT, LMA, filters, and circuit (around 5-10 cmH20) 4. Supports weak inspiratory (e.g. deep anesthesia, residual muscle paralysis) 5. Allows pt-determined RR 6. Can be used alone or combined with SMV
94
Disadvantage of PSV (3)
-Pt reliance -Risk of hypoventilation if settings are inadequate -Asynchrony if sensitivity settings are not optimized
95
Indications of Pressure Control (5)
-To augment tidal vol in spon. breathing pt -To dec WOB and improve pt comfort -Weak inspiratory effort d/t deep anesthesia or residual paralysis -Obstructed airway breathing -To use alone or in combo with SIMV
96
When is expiration triggered in PSV?
When inspiratory flow decreases
97
Advantages of SIMV (4)
-Functions as a “backup” ventilation when a patient’s own respiratory rate decreases -Allows spontaneous over-breathing patient breaths -Can help patient’s effort with pressure support -More patient control over their own ventilation
98
SIMV set parameter
-Delivers breath if no inspiration within the sync window -Ensures mandatory breaths if effort fails outside the timeframe
99
Disadvantage of SIMV (1)
Increased WOB and pt fatigue if not adequately supported
100
Indication for SIMV
-Pt who requires partial vent support but can initiate some breaths -weaning from mechanical ventilation -Ideal when a spon ventilating pt is breathing too shallow to maintain normocarbia
101
SIMV -- Senses ___ _______ inside the chest cavity created by diaphragm and knows the patient initiated a patient-driven breath
negative pressure
102
SIMV - synchronizes pt effort with the _________
ventilator
103
SIMV -- does pt breath compete or not compete with ventilator?
DOES NOT COMPETE!

Principles I -- Exam 3 (1 decks)

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