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Cardiopulm > Ventilators, Weaning, and Delirium > Flashcards

Ventilators, Weaning, and Delirium Flashcards

1
Q

Indications for mechanical ventilation

A

Hypoxemic respiratory failure

hypercarbia respiratory failure

other

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2
Q

Hypoxemic respiratory failure examples

A

(Arterial O2 saturation < 90% despite inspired O2 fraction > 0.6)

Severe pneumonia

Pulmonary edema

Pulmonary hemorrhage

Respiratory distress syndrome; COVID

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3
Q

Hypercarbic respiratory failure examples

A

(Arterial PCO2 > 50 mmHg and arterial pH < 7.3)

COPD

Restrictive lung disease

Asthma

Neuromuscular diseases

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4
Q

Other Examples indicating a mechanical ventilator

A

Protect the airway and lung parenchyma

Relieve upper airway obstruction

Improve pulmonary toilet

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5
Q

4 ways that tubes are placed for ventilation

A
  • Oral pharyngeal tube
  • nasal pharyngeal tube
  • oral endotracheal tube
  • tracheostomy tube
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6
Q

Main two types of ventilator settings

A
  • Mode
  • limiting factors
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7
Q

Mode (ventilator)

A

how the ventilator breaths are triggered, cycled, and limited

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8
Q

Limiting Factor

A

operator-specified values such as airway pressure

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9
Q

4 Common Types of Ventilator Modes

A

Assist Control Mode Ventilation (ACMV) Volume Control

Synchronized Intermittent Mandatory Ventilation (SIMV)

Pressure-Control Ventilation (PCV) Pressure Control

Pressure-Support Ventilation (PSV) Pressure Support

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10
Q

Assist Control Mode Ventilation (ACMV) Volume Control

A

Commonly used for initiation of mechanical ventilation

Initiated by patient or ventilator timer signal

Operator-specified minute ventilation

Problems sometimes with patient tachypnea (if minute ventilation is low)

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11
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

A
  • Like ACMV
  • Preset number of mandatory breaths and fixed tidal volume
  • Patient breathes spontaneously between mandatory breaths (usually lower rate than ACMV)
  • Allows exercise of inspiratory muscles if intact respiratory drive
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12
Q

Pressure-Control Ventilation (PCV) Pressure Control

A
  • Time triggered, time cycled, and pressure limited
  • Variable tidal volume and inspiratory flow rate; must be monitored
  • Preferred for barotrauma or postoperative thoracic surgery patients
  • PCV with inverse ventilation ratio (inspiratory to expiratory ratio > 1) APRV
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13
Q

Pressure-Support Ventilation (PSV) Pressure Support

A
  • Ventilator assist only when inspiratory effort detected
  • Inspiratory phase terminated airflow falls below a certain level
  • Provide fully or nearly fully support that can be withdrawn slowly gradually loading respiratory muscles
  • Useful and well tolerated for weaning with T-piece
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14
Q

Continuous Positive Airway Pressure (CPAP)

A
  • Not a true support mode of ventilation
  • All ventilation is thru patient’s spontaneous efforts
  • Ventilator provides fresh gas to circuit at constant operator-specified pressure
  • Assess for extubation or for patient with intact respiratory system function who needs trach tube for airway protection
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15
Q

Bilevel Positive Airway Pressure (BiPAP)

A

With this mode of ventilation, BiPAP cycles between two levels of continuous positive airway pressure.

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16
Q

Ventilator Parameters to Note

A
  • Mode of ventilation
  • Fraction of O2 in inspired air (FiO2)
  • Positive end-expiratory pressure (PEEP) (mm H2O)
  • Respiratory rate (breaths per minute)
  • Tidal volume (mL)
  • Minute volume (mL/min)
  • Alarm settings
17
Q

Positive End-Expiratory Pressure (PEEP)

A
  • Maintains patency of alveoli and small airways
  • Improves matching of ventilation and perfusion
  • Reverses hypoxemia and atelectasis
  • 0 - 10 cm H2O
18
Q

Ventilator General Support

A
  • Sedation and analgesia
  • DVT prophylaxis
  • GI mucosal injury prevention
  • Nutrition support
19
Q

Ventilator Complications

A
  • Barotrauma: > 50 cm H2O inspiratory pressure
  • Ventilator Acquired Pneumonia (VAP): especially if > 72 hours
  • O2 toxicity
  • Tracheal stenosis: inflammation/scarring from endotracheal tube
  • Deconditioning of respiratory muscles
  • Hypotension 2 degree/2 increased intrathoracic pressure
  • GI stress ulceration; cholestasis
  • Pupillary edema
20
Q

Examples of Barotrauma

A
  • Interstitial emphysema
  • Pneumomediastinum
  • Subcutaneous emphysema
  • Pneumothorax
21
Q

How does Prone Positioning help?

A
  • Recruitment of posterior lung - decrease shunt
  • Recruitment of posterior lung with continued perfusion -
    improved V/Q
  • Mediastinum supported by sternum
  • Less heterogeneous inflation
  • Improved oxygenation with less overdistension
22
Q

Absolute Contraindications for Prone Positioning

A

Unstable spine and/or sternum

23
Q

Relative Contraindications for prone positioning

A

lines

Severe hemodynamic instability

Acute dependence on vascular access catheters (risk/benefit)

PREGNANCY is not a contraindication

24
Q

Weaning Criteria - General

A
  • Resolution of event/disease leading to respiratory failure
  • Maximize status re: nutrition, metabolic stability, fluid &
    electrolyte balance, hemodynamic stability, cardiac function
  • Afebrile
  • Improving or stable chest x-ray
  • Manageable respiratory secretions (intact cough with suction)
  • Alert and cooperative
  • Initiating breaths spontaneously
  • Psychologically ready
25
Q

Weaning Criteria - Respiratory

A
  • Observe RR, tidal volume, inspiratory pressure (> - 30 mmH2O), and vital capacity (> 10 mL/kg) A 100kg pt would need 1000mL (or 1L) of vital capacity to wean
  • CO2 elimination maintains arterial pH 7.35-7.45
  • Arterial O2 saturation > 90% with FiO2 < 50% and
    PEEP ≤ 5 cm H2O
  • Weaning Index: RR/TV (breaths per minute/liter) < 105 and RR < 35 breaths/min
26
Q

Weaning Show Stoppers

A
  • RR > 35 breaths/minute
  • Paradoxical breathing pattern, use of accessory muscles,
    or dyspnea
  • Arterial O2 saturation < 90%
  • Any decrease in PaO2
  • Increase in PaCO2 5 mmHg, especially with pH < 7.3
  • Change in HR > 20 bpm, BP > 20 mmHg, angina, cyanosis
    or cardiac arrhythmias
  • Change in level of consciousness
27
Q

Delirium Definition

A

a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment.

The start of delirium is usually rapid — within hours or a few days.

Hyperactive, hypoactive, or mixed

28
Q

Delirium symptoms

A
  • Reduced awareness of the environment
  • Poor thinking skills (cognitive impairment)
  • Behavior changes
  • Emotional disturbances
29
Q

Two Scales to measure delirium

A

-Richmond Agitation & Sedation Scale (RASS)

-Confusion Assessment Method - ICU (CAM-ICU)

Cardiopulm (6 decks)

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