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Anesthesia Concepts Final > ventilators and airway monitors > Flashcards

ventilators and airway monitors Flashcards

1
Q

stages of ventilation cycle

A

1 - inspiration
2 - transition from inspiration to expiration
3 - expiration
4 - transition from expiration to inspiration

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2
Q

constant flow

A
  • deliver constant insp gas flow regardless of a/w circuit pressure
  • hi pressure gas source (5-50) allow stay sam regardless of changes in a/w resistance or compliance
  • lo pressure (venturi) gas source varies to some degree w a/w pressure
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3
Q

non constant flow

A

consistently vary flow w each insp cycle

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4
Q

constant pressure generators

A

maintains constant a/w pressure throughout insp, irrespective of insp gas flow
gas flow ceases when a/w pressure equals the set insp pressure

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5
Q

time cycled

A
  • cycle tot the exp phase once predetermined interval elapses from start of insp
  • TV product of set insp time and insp flow rate
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6
Q

vol cycled

A
  • terminate insp when preselected TV delivered (most are V cycled bu thane second limit on insp, pressure to guard against barotrauma)
  • percentage of TV always lost to compliance of the system, 4-5cc
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7
Q

pressure cycled

A

cycle into exp phase when a/w pressure reaches a predetermined level
TV & insp time vary

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8
Q

flow cycled

A

BOTH pressure sand flow sensors that plow the vent to monitor insp flow at preselected fixed insp pressure
when flow reachers predetermined level, vent cycles from insp to exp

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9
Q

power source

A

1 - compressed gas-gas only
2 - piston - power only (quiet, can’t hear things change)
3 - compressible bellows - gas & power ( most)

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10
Q

drive mechanism

A
  • double circuit bellows compressed by driving gas and pneumatically driven
  • piston bellows comprised by electricity
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11
Q

cycling mechanism in older machines

A

most vents are time cycled, electronically controlled w lvl limiting aspect

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12
Q

bellows

A

direction of bellows movement during EXPIRATION determined classification

1 - ascending, ascend during exp
2 - descending, descend during expiration (gravity)

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13
Q

pressure

A

impedance to gas flow rate
1 - breathing circuit
2 - pt airway and lungs

amt back pressure generated as result of airway resistance and lung thorax compliance (tube, elasticity)

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14
Q

flow rate

A

rate at which gas vol delivered to pt, from pt connection of breathing system to pt,

vol change/time

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15
Q

during expiration

A
  • drive gas exits bellows chamber, pressure in bellows and pillot drop to zero, vent relief (ball) open
  • exhaped pt gas fills bellows before any scavenging occurs (ball 2-3cm H2O), which occurs only after bellows filled completely
  • relief valve only open during exp
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16
Q

TV

A

10-15ml/kg

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17
Q

RR

A

8-12

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18
Q

flow rate

A

4-6/min vent

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19
Q

MV

A

TV X RR

20
Q

I:E

A
  • physiologic 1:2
21
Q

TI

A

TV/flow rate

500ml/30,000ml/min = .0167 X 60sec = 1 sec

22
Q

TE

A

determined by flow rate and RR/min
first figure out total tim elf ea vent for 1 min cycle…

60sec/12bpm = 5sec
exp time = 5-1 1:E = 1:4

23
Q

inspiratory pause

A
  • inhalation time increased by 25%
  • drive gas flow stops
  • gas pressure in bellow housing system stays the same
  • col of gas to pt is held inputs lungs until exhalation begins
  • changes ratio to get exp you want (shorter exp)
24
Q

FiO2

A

delivery - COxO2 content

content - (hgb x %sat x 1.39) + (PaO2 x .0031)

25
Q

how much O2 to give?

A
  • ## hypoventilation reduces PaO2 except when subject breathes enriched O2 mix
26
Q

PaO2

A

PiO2 - PaCO2/ R+F

R = extraction ratio (0.8)
F = correction factory (negligible)

each time you increase FiO2 by 10%, increase PaO2 by 50mmHg

27
Q

low pressure alarm

A

“disconnect alarm”

detected by drop in peak circuit pressure

28
Q

sub atm pressure alarm

A

pressure =/< -10

pt starting to breath on mating, creating neg pressure

29
Q

sustained/continuing pressure alarm

A

15 for more than 10 sec

30
Q

high peak airway pressure alarm

A

normal 35-40

detects excess pressure in system activated at 60 (or set by practitioner)

31
Q

vent setting alarm

A

vent inability to deliver desired MV set

32
Q

ETCO2 monitor

A

capnography is best for revealing disconnect

33
Q

O2 analyzers

A

most important monitor on machine
calibrate at 21% in ambient air
determine how much you’re giving pt

34
Q

respirometer

A

vent setting, PAP monitors
keep from delivering too much pressure

  • transducer cartrige and TV sensor clip
  • gas flow converted to electrical pulses
  • cartridge in exp limb
  • sensor clip snaps ionto transducer cartrige
  • exhaled vt expect to measure is…
    Vt = Vt set on vent + Vt fresh gas flow - Vt lost in system
35
Q

exhaled vol monitor

A

activated automatically once breaths are sensed and always active during mechanical vent

36
Q

reverse flow

A

alarm in flow toward patient

37
Q

apnea

A

if insufficient breath, based on TV setting, not achieved w/in 30sec

38
Q

ICU vs

A
  • ICU vent more powerful, greater insp pressure & TV
  • CO2 absorber (pt rebreathing in OR)
  • ICU vent support more modes of vent
  • gas in ICU vent directly vent patient (OR, driving gas)
39
Q

CV

A

controlled ventilation by vent

40
Q

IMV

A

vent delivers preset vol at specific interval, while also providing cont flow of gas for spontaneous vent

pt breaths spontaneously, while the vent delivers preset TV at predetermined interval through parallel vent circuit

use as weaning technique
fixed rate, NOT synch w pt

41
Q

SIMV

A

IMV, but synch w pts effort
pt breaths spontaneously and at a predetermined interval the spontaneous breath is assisted by machine
it times mechanical breath w the BEGINNING of spontaneous effort
waking pt up in OR

generates rest of breath for patient as soon as it detects pt breathing

42
Q

AC

A

intermittent mode of pos pressure vent
pts insp effort creates sub baseline pressur ein insp limb of vent circuit that then triggers vent to deliver predetermined TV

if pt rate drops below ppeset min rate, machine takes over w controlled vent mode
all breaths pt takes are full assisted vent breaths
can be pressure controlled or vol controlled

43
Q

pressure support

A

aid in normal breathing w predetermined level pos a/w pressure
similar to IMV except than a/w pressure held constant throughout insp
objective is to increase pt spon TV by delivering a/w pressure to achieve vol = 10-12

1- decrease work of breathing
2 - delay muscle fatigue

44
Q

high frequency vent

A

low total vol, less than dead space w high rate (60-300)

typical settings 100-200bpm, IT 33%, drive pressure 15-30psi
goal to maintain plum gas exchange at lower mean a/w pressures
used in ESWL, ARDS

must allow for exhalation

45
Q

pressure control

A

pt or time triggered pressure limited, time-ccyled mode of vent support
gas flow decreases as a/w pressure rises and ceases when a/w pressure equals the set peak inflation pressure

  • TV not fixed
  • used in situation where pressure can be high
  • useful in neonates/premies
46
Q

CPAP

A

continuous pos pressure
maintained during both insp & exp, only when pt is spent breathing
can be provided w mask
caution - if pressure > 15 can cause regurgitation & aspiration.

Anesthesia Concepts Final (6 decks)

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