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Applied Clinical Veterinary Nursing > Ventilators and Ventilation > Flashcards

Ventilators and Ventilation Flashcards

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1
Q

how is air drawn into the lungs during spontaneous ventilation?

A

via negative pressure ventilation

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2
Q

what type of ventilation occurs via negative pressure ventilation?

A

spontaneous breathing

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3
Q

how does the air move into the lungs during manual/mechanical ventilation?

A

via positive pressure ventilation

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4
Q

during which type of ventilation is air pushed into the lungs via positive pressure?

A

manual or mechanical ventilation

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5
Q

which physical factors can affect spontaneous ventilation?

A

airway obstruction
stenotic nares
excess tissue around airway
hypoplastic trachea
obesity (pressure on diaphragm)

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6
Q

which external factors can affect spontaneous ventilation?

A

ET tube size
external restriction e.g. sandbags, surgeons hands

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7
Q

what could act as internal restriction against spontaneous breathing?

A

effusions

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8
Q

what are the indications for assisted ventilation?

A

reduced drive to ventilate

inability to ventilate/ventilate effectively

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9
Q

why might a patient have decreased ventilatory drive?

A

anaesthetic drugs (respiratory depression)

CNS disease (raised ICP, encephalopathy)

hypothermia

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10
Q

why might a patient have an inability to ventilate?

A

open thoracic cavity

muscle failure (NMBAs, myasthenia gravis)

nerve failure

external factors affecting lung inflation (sandbags, surgeons hands)

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11
Q

failure of which nerves might results in an inability to ventilate?

A

intercostal

diaphragmatic

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12
Q

how might we recognise the need to ventilate our patient?

A

ventilatory pattern - watch chest movements

tidal/minute volume (spirometry)

blood gases

end tidal CO2

pulse oximetry

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13
Q

what are the advantages of manual ventilation?

A

easy to perform

cheap - doesn’t require much equipment

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14
Q

what are the disadvantages of manual ventilation?

A

dependent on the operator

poor control of airway pressures

each breath may be different

operator fatigue

boring and time consuming

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15
Q

what are the advantages of mechanical ventilation?

A

allows a hands-free anaesthetic

ensures appropriate volumes of gas are administered

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16
Q

what are the disadvantages of mechanical ventilation?

A

not always available

expensive - initial financial outlay

requires skill

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17
Q

what happens to the large veins of the vena cava during IPPV?

A

positive pressure in the thoracic cavity exerts pressure on the veins and compresses them

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18
Q

why is cardiac output reduced during mechanical ventilation?

A

pressure exerted in the thoracic cavity compresses the large veins of the vena cava

results in reduced venous return to the heart and in turn reduced CO

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19
Q

when might cardiac output be even further reduced during mechanical ventilation?

A

if the patient is hypovolaemic

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20
Q

what are the cardiovascular side effects of IPPV?

A

decreased venous return and CO

reduced stroke volume, pre-load

reduced BP

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21
Q

what are the other main side effects of IPPV (not directly CVS related)?

A

reduced hepatic/renal perfusion

possible barotrauma and volutrauma

oxygen toxicity

22
Q

how can oxygen toxicity due to mechanical ventilation be avoided?

A

ideally shouldn’t be on 100% oxygen for more than 6 hours

23
Q

how does extended time on 100% O2 cause damage?

A

forms damaging free radicals

24
Q

how can we monitor the efficacy of ventilation?

A

observation of thoracic movements

auscultation - should hear sounds/air entering both lungs at all areas

capnography

pulse ox

arterial blood gases

25
Q

what should be considered if we cannot hear sounds/air entering both lungs at all areas during mechanical ventilation?

A

bronchial intubation
atelectasis
mass affecting lung expansion
fluid/material in pleural space

26
Q

why doesn’t pulse ox indicate efficacy of ventilation?

A

only tells you how perfused that specific area is e.g. tongue, toe

27
Q

what is PaO2?

A

partial pressure of oxygen in the arterial circulation

28
Q

what is PaCO2 comparable with?

A

etCO2 - very close, may be slight difference

29
Q

what might be happening if there is a large difference between PaCO2 and etCO2?

A

shunting of blood in the lungs

30
Q

what might indicate that there is shunting of blood in the lungs?

A

large difference between etCO2 and PaCO2

31
Q

what might affect the relationship between PaCO2 and etCO2?

A

chest cavity open

32
Q

what might we need to do if the PaCO2 is high?

A

increase minute volume (usually by changing rate)

33
Q

what might we need to do if the PaCO2 is low?

A

look at fresh inspired O2 and amend if necessary

start thinking about possibility of atelectasis

34
Q

what is peak inspiratory pressure (PIP)?

A

the highest pressure measured during the respiratory cycle

35
Q

what is the highest pressure measured during the respiratory cycle known as?

A

peak inspiratory pressure (PIP

36
Q

what is positive end pressure ventilation (PEEP)?

A

pressure applied by the ventilator at the end of each breath to ensure the alveoli are not prone to collapse

37
Q

what is cycling?

A

the change from inspiration to expiration

38
Q

what is the cycling variable?

A

the variable which determines when and how the ventilator moves from inspiration to expiration

39
Q

which variable determines when and how the ventilator moves from inspiration to expiration?

A

the cycling variable

40
Q

what are the 4 possible cycling variables?

A

pressure
volume
time
flow

41
Q

how does pressure controlled ventilation work?

A

the ventilator maintains a set airway pressure for a set inspiratory time until the max pressure is reached

42
Q

what can affect pressure controlled ventilation

A

if lung compliance changes (e.g. open chest) - larger volume of gas delivered before trigger is reached = over-inflation

43
Q

how does volume controlled ventilation work?

A

tidal volume, pressure limit, rate/inspiratory time/I:E ratio are all set
check expansion and CO2

44
Q

what is the advantage of volume controlled ventilation over pressure controlled?

A

doesn’t rely on airway compliance change - set volume given if chest open or closed

45
Q

how does time controlled ventilation work?

A

switches from insp to exp after a set time is reached

done by setting RR, inspiratory time or I:E ratio

46
Q

how does flow cycling work?

A

the ventilator delivers a set flow until the total volume has been delivered

useful in paediatrics

47
Q

what is assist control mode?

A

where the breath is initiated by the patient?

48
Q

what is control mode?

A

where the breath is controlled by the ventilator

49
Q

what is the standard I:E ratio?

A

1:2

50
Q

what types of ventilator are available?

A

bag squeezer (bellows)

mechanical thumb (similar to t piece)

intermittent blower

volume divider

51
Q

what should we consider in terms of patient care during long periods of ventilation?

A

mouth care e.g. rinses, eye care

humidification of gases

ET tube care - suction, deflate cuff and reposition

monitor efficacy of ventilation

physiotherapy, turning patient, limb mobilisation

52
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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