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Ventilator CBE > Ventilator CBE > Flashcards

Ventilator CBE Flashcards

1
Q

What is FiO2? What is the goal?

A

Fraction of inspired oxygen. Goal = < 50%.

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2
Q

What is Tidal Volume (Vt) What is it set at? What is the setting for lung protective ventilation? What patients do you use lung protective ventilation for?

[this is a ventilator SETTING]

A

Vt= Volume of air delivered by ventilator.
Setting= 10cc/kilogram
Lung protective ventilation= 4-6cc/kilogram
Lung protective ventilation is used for pts. with acute lung injury or ARDS

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3
Q

What is Peak Flow? What is a normal rate?

[this is a venitlator SETTING]

A

How fast the ventilator delivers a set volume to the patient (velocity)
Normal rate is 40-60 liters/minute
Example: 800cc of air (Vt) will get into the patient faster going 60 liters/minute than 40 liters per minute.

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4
Q

PEEP
What does it stand for and how does it help a patient? What is the typical setting? Does it help with ventilation? Does it improve pCO2 levels? What is physiologic PEEP? When do you use a PEEP valve Ambu Bag? What are the disadvantages of PEEP.

[this is a ventilator SETTING]

A

PEEP= Positive End Expiratory Pressure
Opens alveoli pushes out fluid, improves oxygenation (ex. cardiogenic pulmonary edema)
Typical Setting is +5 – +20 cm/H20
Physiologic PEEP is +5cm/H20
Use PEEP Valve AMbu Bag is >7.5 PEEP
Does not help with ventilation/Does not improve pCO2 Levels
Disadvantages of PEEP
Head- Increased ICP, Decreased CPP (CPP- MAP-ICP)
(Avoid PEEP in Neuro/TBI patients)
Heart- Decrease cardiac output, decreased BP, decreased UOP
Lungs- Barotrauma (subQ emphysema, pneumothorax)

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5
Q

Peak Inspiratory Pressure/Peak Pressure
What is the normal level?
What can cause a low peak pressure alarm?
What can cause a peak pressure to go up quickly?
What makes peak pressure go up slowly over time?
How do you decrease peak pressure?
What is the peak pressure alarm limit?
[this is something you MONITOR on the ventilator]

A

Amount of resistance to the delivery of the vent breath.
Normal is 20-30 cm/H20
Low peak pressure alarm: disconnected/dislodged tube, cuff leak, air hunger
To go up quickly: Biting/kinking, coughing, secretions, PENUMOTHROAX
To go up slowly over time: atelectasis, pneumonia, pulmonary edema, ARDS
To decrease peak pressure: suction, sedation, decrease tidal volume, neuromuscular blockade
Peak pressure alarm limit is the level at which vent will alarm. RT determines this setting based on pt.’s average peak pressure.

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6
Q

PaO2/sat to assess for ____ Normal =?

PaCO2 to assess for _____ Normal =?

A

Oxygenation, Normal= 80-100

Ventilation, Normal= 35-45

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7
Q

AC/CMV
What does this mode mean, and what do you monitor?
What happens when pt. attempts to take their own breath?
What does sensitivity mean here?

A

Assist control/controlled mandatory ventilation

Every breath is a volume controlled vent breath. Vent gives the same volume (ex. set Vt of 800cc) no matter how fast patient is breathing. When pt. attempts to take their own breath, it triggers the vent to give a breath.

Set rate and Vt

Sensitivity= how easily a pt. can trigger a breath. If sensitivity is high vent may give a breath if anything barely triggers it (hiccups, bounding heart beat, etc.) If pt. is paralyzed and still appears to be triggering vent, sensitivity may be too high.

Monitor
1.) O2 & CO2
2.) Total Rate
3.) Peak Pressure (Resistance to every vent breath)
When we control volume, we monitor pressure.

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8
Q

SIMV

What does this mode mean, and what do you monitor?

A

Synchronized intermittent mandatory ventilation

Partial support.

You can still set rate (ex. 10) and Vt (800cc)

The patient may initiate their own spontaneous breath at their own depth between the vent breaths.

A weaning mode for ventilation. Rarely used anymore.

Monitor

  1. ) O2 + CO2
  2. ) Total Rate
  3. ) Peak Pressure (Resistance to every vent breath)
  4. ) Tidal volume of PATIENT’s BREATH (if spontaneous breath is not large enough, pressure support can be added)
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9
Q

CPAP

A

Continuous Positive Airway Pressure
For SPONTANEOUSLY BREATHING PATIENTS
NO mandatory breaths are given by the vent.

Monitor

  1. ) O2/CO2
  2. ) Total Rate
  3. ) Spontaneous Tidal Volume of the PATIENT”s BREATH
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10
Q

PRVC

What is it??

To use this what do you set on the Vent?

What do you monitor?

A

Pressure Regulated Volume Control

Sets a target tidal volume, delivers pressure to get there. More natural way to breathe. Weaning is tricky.

To use this you set:

  1. ) Minimum RR
  2. ) Target VT
  3. ) FiO2
  4. ) I:E ratio (normal is 1:2, you exhale longer than you inhale, this mimics normal breathing, 1:3 or 1:4 I:E ratio is used for COPD
  5. ) PEEP

Monitor
1.) O2 and CO2
2.) Total RATE
3.) Inspiratory Pressure/Peak PRessure
Basically: how much inspiratory pressure did it take to deliver target volume
4.) Exhaled VT to determine what was actually delivered.

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11
Q

Assessment Parameters for Newly Intubated patients

A
  1. ) Absence of Gastric Sounds
  2. ) Bilat Breath Sounds (assures that tube is not in R. Mainstem or Esophagus
  3. ) EtCo2 sensor (purple=no CO2, Yellow=CO2, 6 breaths before you believe it)
  4. ) ETT Position and size- Document placement at tube at lips or teeth, diameter (size) of tube and cm markings
  5. ) CXR= best parameter for placement
  6. ) MD should confirm that ETT is going through cords on CMAC or Glidoscope
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12
Q

What if there is low exhaled tidal volume?

A

Disconnected tubing or circuit.
Disolodgement of ETT
Cuff leak
Water in tubing or in exhaled volume sensor.
Pt. is too weak to take a deep breath ++ Add pressure support to allow for better spontaneous tidal volumes

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13
Q

What to do if ventilator malfunctions? / Inoperative Vent Alarm

A

Call respiratory therapy for another vent and ambu bag the patient.

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14
Q

How to Secure ETT for the neuro patient?

A

No velcro, head gear or tape around the back of th eneck, decreases JVD outflow

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15
Q
  1. ) Name some clues for suctioning a patient without a gag reflex/cough?
  2. ) Always suction after ______
  3. ) When PEEP is greater than 7.5 use ____ suction
  4. ) Always wait 30 minutes after suctioning and ventilator changes before obtaining ______
A

1.)
Elevation in peak pressure
Ronchi
Increase in RR/Agitation
Feel vibration of secretions when pt. inhales on chest
2.)
Always suction after CPT
Preoxygenate with Vent before suctioning
3.)
In line suction should be used when PEEP >7.5 is being used
4.)
Always wait 30 minutes after suctioning/vent changes before obtaining an ABG

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16
Q

RVR stands for…/what is it?

RVR Parameters for Extubation

A 
RVR= Respirator Ventilation Ratio
Respiration Rate % Tidal Volume (Vt)
Parameters 
0-80= extubate
80-100= consider extubation, sit em up, sedation off, listen to lungs, suction, lasix, etc.
100+= Probably gonna fail
17
Q

When going on a road trip, always bring…

If patient is on PEEP > 7.5 also bring a…

A

An AMBU BAG WITH MASK

A PEEP Valve

Ventilator CBE (1 decks)

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