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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
Usual inspiratory pressure set at
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.
26
accordion-like device
Bellows assembly
27
clear plastic cylinder
Housing
28
Allows driving gas to be vented to atmosphere on exhalation
Exhaust Valve Communicates with inside of housing
29
Ascending bellows
standing Descends on inspiration
30
Descending bellows
(hanging) Rises on inspiration Exhalation and gravity cause bellow to fall Continues to descend d/t gravity even if disconnected
31
Most commonly used mode
Volume control
32
Preset tidal volume is delivered (fixed parameter)
Volume control Set Vt, RR, I:E ratio Additional breaths at machine preset Vt
33
What can Volume control lead to? (2)
May cause excessive inspiratory pressure Additional breaths at machine preset Vt
34
When is volume control not good? (5)
Trendelenburg obese, pregnant lithotomy spont vent
35
Ways to fix high inpiratory pressure with VC
decrease the volume- switch to pressure control change positions are they paralyzed?
36
High VT for too long leads to...
resp alkalosis
37
Preset pressure is quickly achieved during inspiration (fixed parameter)
Pressure control
38
Pressure control sets....
Set PIP, RR and I:E ratio
39
VT with Pressure control
Vt changes with resistance and compliance
40
Maintains Vt by adjusting PIP over several breaths
Volume guarantee Pressure-Control Prevents sudden Vt changes d/t compliance Lost insufflation
41
Predetermined negative pressure triggers breath
Assist control ventilation Breath is set Vt
42
Mandatory ventilator breaths are set Additional native breaths at variable Vt
Intermittent mandatory ventilation
43
What mode allows stacking
Intermittent mandatory ventilation good for weaning.
44
SIMV
measure to ventilator cycled breath so there is no stacking. Synchronizes ventilatory driven breaths with spontaneous breaths Provides backup to weaning ventilator
45
PIP and inspiratory time set (3)
Pressure support Vt equates to the native effort Need apnea alarm
46
What makes ventilators not work with MRI
Standard machines have variable amounts of ferromagnetic substances
47
Solutions to MRI and ventilators (4)
MRI compatible machines Anesthesia machine kept outside in hallway Machine bolted to wall Aluminum (not steel) tanks or pipeline gas supply
48
considerations for Ventilation failure (4)
Disconnection from power supply Extremely high FGF Fluid in electronic circuitry Leaking bellows housing
49
Considerations for Loss of breathing system gas (2)
Failure to occlude spill valve Leak in system
50
What kind of Incorrect settings can we have (4)
Inadvertent bumping Not adjusted for new case Not adjusted for position/pressure changes Ventilator turned off for xrays
51
Advantages of a ventilator (3)
Allows anesthesia provider to devote energy to other tasks Decreases fatigue Produces more regular rate, rhythm, and Vt
52
Disadvantages of ventilator (6)
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
Concentration of a gas far below that needed for anesthesia or detected by smell
Trace gas concentrations
54
How are trace gasses written
Written in PPM (parts per million) 100% of a gas is 1,000,000ppm 1% is 10,000ppm
55
High levels of trace gasses are seen in.....
Higher levels seen in pediatric anesthesia, dental surgeries and poorly ventilated PACU’s (expiration) LMA cases
56
Passive scavenging system
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
Active scavenging system
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
How to Alte work practices with effects of scavenging (5)
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
How can hypoxic inspired gas mixtures develop.
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
How can hypoventilation on ventilator develop
Insufficient gas Switch from pipeline to cylinder Replace cylinder Obstruction Leaks Main machine power off Breathing system leaks Absorbent, connectors, gas sampling Disconnect
61
What can Block inspiratory/expiratory paths
Mask wrapping Absorbent wrapping
62
How can hypercapnia develop on on ventilator (4)
Hypoventilation Absorbent failure Excessive dead space Defect coaxial system
63
How to get anesthetic OD (5)
Tipped vaporizer Vaporizer accidentally on Incorrect agent in vaporizer Interlock system failure Overfilled vaporizer
64
How to have Inadvertent exposure to volatiles
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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