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Principles > Ventilators > Flashcards

Ventilators Flashcards

1
Q

Ventilator definition

A

Automatic device designed to provide/augment
Patient ventilation
Patient oxygenation

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2
Q

Ventilation

A

volume; air, pressure, oxygen

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3
Q

Oxygenation

A

oxygen

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4
Q

On anesthesia workstations,
Ventilator replaces ……..

A

The reservoir bag

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5
Q

Older ventilators had what features (3)

A

Couldn’t provide high enough inspiratory pressure

Couldn’t provide PEEP

Offered only volume control ventilation

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6
Q

injury resulting from high airway pressures

A

Barotrauma

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7
Q

ratio of a change in volume to a change in pressure

A

Compliance

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8
Q

valve that opens to allow driving gas to exit the bellows housing

A

Exhaust valve

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9
Q

fresh gas compensation

A

a means to prevent FGF from affecting Vt by measuring Vt and adjusting volume of gas delivered by the ventilator

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10
Q

Inspiratory pause time

A

time during which lungs are held inflated at a fixed volume/pressure…..inspiratory plateau

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11
Q

I:E ratio

A

ratio of the inspiratory phase time to the expiratory phase time

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12
Q

Inverse ratio ventilation

A

inspiratory phase time is longer than expiratory phase time

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13
Q

normal IE ratio

A

1:2

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14
Q

Minute volume

A

sum of all tidal volumes in one minute

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15
Q

maximum pressure during the inspiratory phase time

A

Peak pressure

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16
Q

Spill valve

A

the valve in the ventilator that allows excess gases to be sent to scavenging system during exhalation

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17
Q

energy expended by the patient/ventilator to move gas in and out of lungs.

A

Work of breathing

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18
Q

energy expended by the patient/ventilator to move gas in and out of lungs.

A

Work of breathing

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19
Q

Factors that affect delivered VT (3)

A

FGF
compliance
leaks

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20
Q

On older vents, as FGF increased ______

A

On older vents, as FGF increased so did Vt

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21
Q

FGF is supposed to be ______ during inspiration

A

excess FGF diverted during inspiration

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22
Q

Compliances effect on delivered VT

A

Decreases in compliance in breathing system causes decrease in Vt as volume is used to expand system
Newer vents alters volume delivered to compensate for system compliance (pressure controlled)

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23
Q

How to detect a leak

A

Exhaled volume is not reaching the set amount.

a decrease Vt that can’t be compensated by the ventilator

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24
Q

driving gas

A

Driving gas stays in bellows housing -> helps compress bellows

Either oxygen, air, or mix

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25
Q

Usual inspiratory pressure set at

A

A good set-point is 10cm H2O above peak pressure with desired Vt

Limits inspiratory pressure. If you set inspiratory pressures (usually preset), start at 10.

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26
Q

accordion-like device

A

Bellows assembly

27
Q

clear plastic cylinder

A

Housing

28
Q

Allows driving gas to be vented to atmosphere on exhalation

A

Exhaust Valve

Communicates with inside of housing

29
Q

Ascending bellows

A

standing
Descends on inspiration

30
Q

Descending bellows

A

(hanging)
Rises on inspiration
Exhalation and gravity cause bellow to fall
Continues to descend d/t gravity even if disconnected

31
Q

Most commonly used mode

A

Volume control

32
Q

Preset tidal volume is delivered (fixed parameter)

A

Volume control

Set Vt, RR, I:E ratio

Additional breaths at machine preset Vt

33
Q

What can Volume control lead to? (2)

A

May cause excessive inspiratory pressure
Additional breaths at machine preset Vt

34
Q

When is volume control not good? (5)

A

Trendelenburg
obese,
pregnant
lithotomy

spont vent

35
Q

Ways to fix high inpiratory pressure with VC

A

decrease the volume-
switch to pressure control
change positions
are they paralyzed?

36
Q

High VT for too long leads to…

A

resp alkalosis

37
Q

Preset pressure is quickly achieved during inspiration (fixed parameter)

A

Pressure control

38
Q

Pressure control sets….

A

Set PIP, RR and I:E ratio

39
Q

VT with Pressure control

A

Vt changes with resistance and compliance

40
Q

Maintains Vt by adjusting PIP over several breaths

A

Volume guarantee Pressure-Control
Prevents sudden Vt changes d/t compliance
Lost insufflation

41
Q

Predetermined negative pressure triggers breath

A

Assist control ventilation
Breath is set Vt

42
Q

Mandatory ventilator breaths are set
Additional native breaths at variable Vt

A

Intermittent mandatory ventilation

43
Q

What mode allows stacking

A

Intermittent mandatory ventilation

good for weaning.

44
Q

SIMV

A

measure to ventilator cycled breath so there is no stacking.
Synchronizes ventilatory driven breaths with spontaneous breaths
Provides backup to weaning ventilator

45
Q

PIP and inspiratory time set (3)

A

Pressure support
Vt equates to the native effort
Need apnea alarm

46
Q

What makes ventilators not work with MRI

A

Standard machines have variable amounts of ferromagnetic substances

47
Q

Solutions to MRI and ventilators (4)

A

MRI compatible machines
Anesthesia machine kept outside in hallway
Machine bolted to wall
Aluminum (not steel) tanks or pipeline gas supply

48
Q

considerations for Ventilation failure (4)

A

Disconnection from power supply
Extremely high FGF
Fluid in electronic circuitry
Leaking bellows housing

49
Q

Considerations for Loss of breathing system gas (2)

A

Failure to occlude spill valve
Leak in system

50
Q

What kind of Incorrect settings can we have (4)

A

Inadvertent bumping
Not adjusted for new case
Not adjusted for position/pressure changes
Ventilator turned off for xrays

51
Q

Advantages of a ventilator (3)

A

Allows anesthesia provider to devote energy to other tasks

Decreases fatigue

Produces more regular rate, rhythm, and Vt

52
Q

Disadvantages of ventilator (6)

A

Loss of “feel”
Older versions may not have all the desired modes
Components are hard to clean or fix
Lack user-friendliness
Noisy or too quiet
May require high-flow driving gases…expensive

53
Q

Concentration of a gas far below that needed for anesthesia or detected by smell

A

Trace gas concentrations

54
Q

How are trace gasses written

A

Written in PPM (parts per million)
100% of a gas is 1,000,000ppm
1% is 10,000ppm

55
Q

High levels of trace gasses are seen in…..

A

Higher levels seen in pediatric anesthesia, dental surgeries and poorly ventilated PACU’s (expiration)

LMA cases

56
Q

Passive scavenging system

A

Attached to room ventilation system

Air flows through room after being filtered and adjusted for humidity and temperature
Entire volume is exhausted to atmosphere
Disposal tubing from the anesthesia machine is attached to the exhaust grill and removed with room air

consider grill location

57
Q

Active scavenging system

A

Attached to central vacuum system

Must be able to provide high volume (30L/min)

Need plenty of suction outlets and close to anesthesia machine

58
Q

How to Alte work practices with effects of scavenging (5)

A

Mask fit
Turn off gas flow (not vaporizer) during intubation
100% wash out at end of case
Prevent liquid spills
Place anesthesia machine as close to exhaust grill as possible

59
Q

How can hypoxic inspired gas mixtures develop.

A

Incorrect gas in the pipeline
Incorrectly installed outlets
Oxygen tubing or hoses attached to the incorrect flow meter
Incorrect cylinder attached to yoke
Incorrect cylinder…..around world O2 is green, white, blue, and black
Flow control malfunction
Leak in oxygen flow meter

60
Q

How can hypoventilation on ventilator develop

A

Insufficient gas
Switch from pipeline to cylinder
Replace cylinder
Obstruction
Leaks
Main machine power off
Breathing system leaks
Absorbent, connectors, gas sampling
Disconnect

61
Q

What can Block inspiratory/expiratory paths

A

Mask wrapping

Absorbent wrapping

62
Q

How can hypercapnia develop on on ventilator (4)

A

Hypoventilation
Absorbent failure
Excessive dead space
Defect coaxial system

63
Q

How to get anesthetic OD (5)

A

Tipped vaporizer
Vaporizer accidentally on
Incorrect agent in vaporizer
Interlock system failure
Overfilled vaporizer

64
Q

How to have Inadvertent exposure to volatiles

A

Change breathing system hoses and bag
Change fresh gas supply hose
Change absorbent
Use very high oxygen flows to flush machine
Remove vaporizers
Use axillary flowmeter for supplemental oxygen

Principles (34 decks)

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