Ventilator Patient Management

Question 1

Tidal Volume (Vt)

Answer 1

Normal inhalation amount
4-8 ml/kg IBW

Question 2

Inspiratory Reserve Volume (IRV)

Answer 2

total forced inhalation in addition to Vt

Question 3

Expiratory Reserve Volume (ERV)

Answer 3

total forced exhalation after Vt

Question 4

Residual Volume (RV)

Answer 4

amount of air left in airway after forceful exhalation

Question 5

Total lung capacity (TLC)

Answer 5

IRV+Vt+ERV+RV

Question 6

Dead Space

Answer 6

surface of airway not involved in gaseous exchange
2ml/kg

Question 7

Chemoreceptors

Answer 7

Central: located in Pons, and Medulla
driven by CO2 and H+ levels in CSF
slow to respond
Peripheral: Located in aortic arch/carotid bodies
driven by O2, CO2, and H+
body’s pulse ox

Question 8

Apneustic

Answer 8

Deep gasping inspiration with pause and insufficient release
Decerebrate posturing

Question 9

Ataxic

Answer 9

irregular
increasing periods of apnea
caused by damage to medulla
V-fib of breathing

Question 10

Biot’s

Answer 10

quick shallow respirations, followed by periods of apnea

Question 11

Cheyne-Stokes

Answer 11

progressively deeper then shallower, followed by periods of apnea
Decorticate posturing

Question 12

Kussmaul’s

Answer 12

Deep, Labored
DKA

Question 13

Gold standard of oxygenation

Answer 13

SPO2

Question 14

Gold standard of Ventilation

Answer 14

EtCO2

Question 15

Hypoxic Respiratory Failure

Answer 15

Inability to diffuse O2
ARDS, Pneumonia, CHF
Low PaO2 <60mmHg
Tx: O2 and PEEP

Question 16

Hypercarbic Respiratory Failure

Answer 16

Inability to remove CO2
damage to Pons or Medulla
evidenced by respiratory acidosis (high EtCO2)
Tx: Increase Vt (Pplat), then Increase rate

Question 17

Rate (F)

Answer 17

12-20 BPM
respiratory rate

Question 18

Minute Volume (Ve)

Answer 18

Vt X F

Question 19

Inspiratory: Expiratory Ratio (I:E)

Answer 19

Ratio of Inspiration to expiration
Normal 1:2

Question 20

Fraction of Inspired Oxygen (FIO2)

Answer 20

0.21-1.0 or 21% -100%
much more accurate than LPM

Question 21

Positive End Expiratory Pressure (PEEP)

Answer 21

0-20 cm H2O
prevents atelectasis
increases PaO2

Question 22

Peak Inspiratory Pressure (PIP)

Answer 22

<35cmH2O
Max pressure on inhalation

Question 23

Plateau Pressure (Pplat)

Answer 23

<30cmH2O
Pressure after lungs relax

Question 24

Controlled Mandatory Ventilation (CMV)

Answer 24

Breath completely controlled
Use on apneic, sedated, or paralyzed Pts

Question 25

Assist-Control Ventilation (AC)

Answer 25

Breath triggered by ventilator or Pt Pt gets full Vt either way Can cause breath stacking and barotrauma Indicated for ARDS, paralyzed, or sedated Pt

Question 26

Synchronized Intermittent Mandatory Ventilation (SIMV)

Answer 26

If Pt fails to take a breath the vent will provide one If the Pt initiates breath then vent provides a preset amount of pressure. (assisted pull-up)

Question 27

Pressure Support Ventilation (PSV)

Answer 27

Requires Pt to initiate breath Every breath is assisted with pressure

Question 28

Continuous Positive Airway Pressure (CPAP)

Answer 28

One continuous pressure increases PEEP

Question 29

Bi-Level Continuous Positive Airway Pressure (BiPAP)

Answer 29

Uses alternate levels of PEEP during inhalation and exhalation

Question 30

DOPES

Answer 30

Vent alarm pneumonic Dislodged: Low pressure alarm Obstructed: High pressure alarm Pneumothorax: High pressure alarm Equipment: machine failure, dead batteries Stacked breaths: High pressure alarm

Question 31

Low Pressure Alarm

Answer 31

Disconnection from machine (most common) Chest tube leak Circuit leak Airway leak Hypovolemia

Question 32

High Pressure Alarm

Answer 32

Kinked line coughing secretions in airway Pt biting tube Reduced lung compliance (Pneumothorax, ARDS) Increased airway resistance

Question 33

Waveform indicating bucking the tube

Answer 33

Curare Cleft

Question 34

PIP Decreased causes

Answer 34

Air leak Hypoventilation Hyperventilation

Question 35

PIP Increased/ Pplat increases causes

Answer 35

Decreased compliance Abdominal distension Asynchronous Breathing Atelectasis Pleural effusion Endobronchial Intubation Auto PEEP Pneumothorax Pulmonary Edema

Question 36

PIP Increased/ Pplat unchanged causes

Answer 36

Obstruction Foreign body Bronchospasm Kinked tube