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ACVN - ANAESTHESIA > Ventilators and ventilation > Flashcards

Ventilators and ventilation Flashcards

1
Q

What is spontaneous ventilation?

A

air is drawn into the lungs under negative pressure

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2
Q

What is manual ventilation?

A

using a breathing system to deliver breaths to your patient

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3
Q

What type of ventilation is manual and mechanical ventilation?

A

positive pressure ventilation

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4
Q

What does manual and mechanical ventilation do?

A

forces air into the lungs and is no longer being drawn in under negative pressure, it is pushed in under positive pressure

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5
Q

What factors affect spontaneous ventilation?

A
  • anatomical/physiological such as airway obstruction stenotic nares, excess tissue around airway, hypoplastic trachea and obesity
  • external factors such as the ET tube and external restriction such as sandbags
  • effusions
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6
Q

What are the indications fo assisted ventilation?

A

reduced drive to ventilate and inability to ventilate or ventilate effectively

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7
Q

What can cause decreased ventilatory drive?

A
  • anaesthetic drugs
  • central nervous system disease such as raised ICP, encephalopathy and hypothermia
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8
Q

What causes the inability to ventilate?

A
  • open thoracic cavity
  • muscle failure (NMBAs peri and post, myasthenia gravis)
  • nerve failure - intercostal and diaphragmatic
  • external factors effecting lung inflation
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9
Q

How do you recongise the need to ventilate?

A
  • ventilatory pattern
  • tidal/minute volume - spirometry
  • blood gases
  • end tidal carbon dioxide
  • pulse oximetry
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10
Q

What are the advantages of manual ventilation?

A

easy to perfrom and cheap as it doesnt need much equipment

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11
Q

What are the disadvantages of manual ventilation?

A
  • dependant on the operator
  • poor control of airway pressures
  • each breath may be different
  • operator fatigue
  • can be boring as time consuming
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12
Q

What are the advantages of mechanical ventilation?

A

allows a hands-free anaesthetic and ensures appropriate volumes of gas are administered

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13
Q

What are the disadvantages of mechanical ventilation?

A
  • not always available
  • expensive
  • requires skill
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14
Q

What are the cardiovascular side effects of IPPV?

A
  • decreased cardiac output (due to increased pressure within thorax)
  • decreased venous return
  • reduced stroke volume
  • reduced pre-load
  • reduced BP
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15
Q

What effects on the lungs are there due to IPPV?

A

barotrauma

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16
Q

What other effects of IPPV are there?

A

sheer stress effect and oxygen toxicity

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17
Q

What is the renin angiotensin aldosterone system?

A
  • sympathetic nervous system notices decreased blood pressure
  • triggers increased heart rate
  • increased heart rate leads to increased cardiac work load
  • increased cardiac work load leads to increased oxygen requirement
  • RAA system kicks in leading to vasoconstriction/urine retention and ADH release
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18
Q

How can you monitor the efficacy of ventilation?

A
  • observation
  • auscultation
  • capnography
  • pulse oximetry
  • arterial blood gas
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19
Q

When observing efficaacy of ventilation, what are you observing?

A
  • thoracic movements
  • the way abdomen rises and falls
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20
Q

When observing efficaacy of ventilation, what are you auscultating?

A
  • can you hear air entering both lungs
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21
Q

What should you consider if you cannot hear sounds/air entering both lungs?

A
  • bronchial intubation
  • atelectasis
  • mass affecting lung expansion
  • fluid or other material in pleural space
22
Q

What should you do if there is high ETCO2?

A

increase minute volume

23
Q

What should you do if there is low ETCO2?

A

reduce minute volume

24
Q

What is a ventilator?

A

a medical ventilator is a machine designed to provide mechanical ventilation to a patient, by moving air into and out of the lungs

25
Q

Why might we need a ventilator?

A
  • apnoeic/poorly ventilated patient
  • neuromuscular blocking agents
  • thoractomy
  • diaphragmatic rupture
26
Q

What ventilator settings are there?

A
  • frequency of breathing
  • tidal volume/minute volume
  • I:E ratio
  • inspiratory flow rate
  • PIP (peak inspiatory pressure)
  • PEEP (positive end pressure ventilation)
27
Q

What is PIP / peak inspiratory pressure?

A

the highest pressure measured during the respiratory cycle

28
Q

What is PEEP / positive end pressure ventilation?

A

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

29
Q

What is ventilation cycling?

A

the change from inspiration to expiration

30
Q

What are the four variables used to determine when to cycle expiration?

A

1 - pressure
2 - volume
3 - time
4 - flow

31
Q

What is pressure controlled ventilation?

A
  • the ventilator maintains a set airway pressure for a set inspiratory time
  • inspiratory flow of gas is delivered until a trigger pressure is reached and this will cause insiratory cut off and will begin expiratory cycle
32
Q

When should you avoid pressure controlled ventilation?

A

thoractomy

33
Q

What is volume controlled ventilation?

A
  • set tidal volume
  • set pressure limit
  • set rate, inspiratory time or I:E ratio
34
Q

What does volume controlled ventilation not rely on?

A

airway compliance change

35
Q

What is time controlled ventilation?

A

time cycling indicated that the ventilator breath has switched from inspiration to expiration after a set time is reached

36
Q

How do you use time controlled ventilation?

A

set the rispiratory rate, inspiratory time, or ins:exp ratio

37
Q

What is flow cycling?

A

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

38
Q

What is assist control mode?

A

the breath is initiated by the patient

39
Q

What is control mdoe?

A

the breath is controlled by the machine

40
Q

What are inspiratory:expiratory ratios I:E?

A

refers to the ratio of inspiratory:expiratory time in normal spontaneous breathing

41
Q

What is the standard I:E ratio?

A

1:2

42
Q

How can you remember what the I:e is?

A

the expiratory time is usually approximately twice the inspiratory time

43
Q

What types of ventilators are there?

A
  • bag squeezer (ascending, descending and horizontal bellow)
  • mechanical thumn (like a t-piece)
  • intermittent blower
  • volume divider
44
Q

What is a bag squeezer ventilator?

A
  • sets volume, I:E time
  • pressure guage
  • can set tidal volume
  • connected to bag port
45
Q

What is a hallowell EMC 2000?

A

time cycle and pressure limited

46
Q

What is a JD medical bag squeezer?

A

pressure cycled and limited

47
Q

What is a mechanical thumb?

A

essentially a thumb on a t-piece and used in small anaesthesia

48
Q

What does an intermittent blower do?

A

takes the driving gas and divides it into smaller volumes and uses that to push the gas into the patient

49
Q

What is a merlin intermittent blower?

A

microprocessor - controlled precision pistol, time pressure or volume set

50
Q

How can you care for a patient during long periods of ventilation?

A
  • mouth care
  • humidification of gases
  • endotracheal tube care - suction, deflate cuff and reposition
  • monitoring efficacy of ventilation
  • periodic sigh?
  • physiotherpay
  • turning patient
  • eye care
  • limb mobilisation

ACVN - ANAESTHESIA (12 decks)

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