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vents TA 1 Flashcards

1
Q

What other names can APRV have ?

A

Bilevel
BiPAP
BiVENT
DuoPAP

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2
Q

What is the criteria for APRV ?

A
  • Fixed times at both high and low level pressures
  • inverse ratio ( I : E ) ventilation
  • must induce air-trapping
  • pt can theoretically breath spont at both pressure levels
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3
Q

advantages of Volume control

A
  • precise MV control
    guaranteed volume and rate
    -can be triggered with pt effort
    -can provide full support
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4
Q

Disadvantages of Volume control

A
  • pressures can vary ( high pressures) is a problem if high alarms are not set properly
  • Uncomfortable for awake pt
  • can cause Alkalosis if trigger is too sensitive ( increase in MV)
  • muscles atrophy if prolong use
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5
Q

Advantages of PC

A
  • precise control on pressure
  • less danger on over distending the lung due to excess pressure
    -pt can access flow by triggering
  • Improved WOB and is better tolerated in awake pts
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6
Q

Disadvantages of PCV

A
  • Risk of resp alkalosis with excessive pt triggering
  • Increase Volumes with increase in pt effort may cause injury due to excessive stretch
  • no CO2 control
  • muscle atrophy of prolonged use
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7
Q

when should we use SIMV ?

A
  • to facilitate weaning ( 1st by deacreasing RR and the decrease support)
  • for pts who have a variable drive to breath ( gives a minimum ventilation)
  • reduces breath stacking
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8
Q

disadvantages of SIMV

A

inferior to PSV
is no better than control modes for asychrony and may be worse in trauma patients

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9
Q

Advantages for SIMV

A
  • Mode use for weaning
  • provides a minimum minute ventilation
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10
Q

Advantages of pressure support

A

better synchrony btw pt and ventilator (more comfortable)
increase in work of breathing ( PS support)
training of muscles
decrease in oxygen cost of breathing

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11
Q

Disadvantages of PS

A

Need a drive to breath
can under or over ventilate pt
doesnt give you a fixed MV

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12
Q

PRVC advantages

A
  • ventilating pressures will be lower
  • more comfortable with pt
  • Vt is not exact but is relatively consistent
  • may decrease risk of overdistension
  • breath is more adaptive if the patient is interacting with it
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13
Q

Disadvantages of PRVC

A

As it works on a feedback mechanism if there are rapid changes, ventilator may struggle to determine next breath ( pt coughing, dramatic swings in effort to breath)
- If pt is triggering for more flow (Vt) the vent may reduce pressure getting less support, this may fatigue pt overtime.

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14
Q

What is MMV ?

A

MMV is an auto adjusting mode. (lets patient go back and forth from control to spontaneous mode)
like the name suggest it gives minimum minute ventilation even when the pt is not breathing.
mode is found only on evita vent

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15
Q

MMV disadvantages

A
  • only on Evita
  • when it cycles to control mode (VC) it may be uncomfortable for the patient
  • pt able to maintain MV above set MV even while tiring out ( it never cycles to a control breath unless your MV is less than what you had set)
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16
Q

Advantages of MMV

A
  • provides minimum minute ventilation
  • Good on patients that have an erratic drive to breath
  • prevents hypoventilation
17
Q

What is PC-PSV ?/

A

is an auto- adjusting mode that lets patients with an erratic drive to breath switch from a pressure support mode ( spontaneous) to a PC mode when they breath below the set RR.

18
Q

Advantages of PC-PSV ?

A

– prevents apnea and hypoventilation if the patient loses their drive to breath ( not all true because we dont what Vt is going to be once the patient is not making efforts)

19
Q

what is automode trigger timeout ?

A
  • the longest possible time for the pt to be apneic which is 12 seconds
20
Q

What is ASV ?

A

ASV is a mode only found in the Hamilton ventilator.
- It determines the pt MV by the clinician in putting the pt’s sex and height. Once it gets their Ideal MV it determines their ideal RR, Ti and driving pressures to keep the pt in the golden zone or their ideal MV

21
Q

Advantages of ASV

A
  • Easy to set up
    -requires minimal adjustment once started
    -safely guarantees minute ventilation
22
Q

Disadvantages of ASV

A
  • pt can tired out if they want a greater MV
  • can’t adjust to ABGs
  • doesn’t know what to do when people fall out of the golden zone
    -no ability to automatically wean pt
23
Q

Advantages of APRV

A
  • Improves time constant
  • may open atelactic alveoli by sustained pressures (Phigh 5-7 secs)
  • Allows for better gas mixing in the alveoli (increase aveolar surface are
  • high mean airway pressure, while controlling PIP
24
Q

In what mode is Pplat and PIP equal ?

A

Pplat and PIP are the same in APRV and that is because you are holding pressure constant almost like an inspiratory hold. (PIP is usually started btw 18-26 cmH2O) with a Pplat < 30

25
Q

How is Autopeep created in APRV ?

A
  • Because Thigh is so long (5-7 secs) and a Tlow very shot (0.5- 1.0 secs) we dont have enough time to exhale all that volume out. ( we cant never reach FRC and that creates Autopeep (air-trapping)
26
Q

Disadvantages of APRV

A
  • can be uncomfortable for the patient (sedation required)
  • High mean airway pressure can impact cardiac function (venous return)
  • difficult to set up
  • May not work on patients requiring high MV
  • bad for pts who have obstructive disease
27
Q

How is PAV determining elastance and Resistance ?

A
  • by doing a short insp pause randomly every 6-10 breaths. Volume and flow its determined by measuring circuit pressures. ( Once the ventilator knows the pts elastance and resistance it can calculate the pts effort and this is calculated 200 times per second during inspiration)
28
Q

what is PAV ?

A

Is a solely spontaneous mode that measure pt’s inspiratory effort in order to supply the correct support pressure or amplify pressure. The more effort you are making the more support your are getting.

29
Q

What is percent support ?

A

Is an amplification of the pt’s effort, this setting is used on PAV modes. It sets how do we want the vent to work for out patient
example 50% percent support means 50 of the work falls on the patient and the other 50 is provided on the vent

30
Q

Advantages of PAV

A
  • No free rides, pt always have to generate an effort to get the support from the ventilator
  • gives numerical estimate of the effort the pt is making
    -support changes in proportion to pt effort
  • improves synchrony
  • constantly measure compliance (elastance) and resistance ( volume)
31
Q

Disadvantages of PAV

A
  • purely spontaneous (back up apnea alarm, does’t give you exact MV)
  • must have a sealed circuit, can’t use for NIV or there is a leak
  • relies on accurately measures C and R if these are off then we can missed calculated and give the wrong support
  • We can give way more pressure than what the pt actually needs when percent support is at higher levels
32
Q

Explain what NAVA is

A

Neurology adjusted ventilatory assist is an advance support mode on servo that measures patients efforts based on the electrical signal from the phrenic nerve as it passes across the diaphragm using either an NG or OG.
Support is multiple !!! NAVA X EDI
the level of support is measured every 3 milliseconds— making support variable throughout the entire breath

33
Q

When is the pt considered Weaned on the NAVA mode ?

A
  • pt should have an EDI less than 10 on a NAVA level less than 1 cmH20/ uV
    *** Remember normal values for Edi on a healthy person are btw 3-8 uV
    and we start NAVA support at 1.0-1,2
34
Q

When to use NAVA ?

A
  • Difficult to wean pts even post extubated pts
    -COPD or Pts with AutoPEEP
  • NIV
    -PEDS with uncuff tubes
  • Better sleep quality ( increase REM)
35
Q

Disadvantages of NAVA

A

Must have an intact phrenic nerve and signal to the diaphragm
Spontaneous breathing only
Avoid in brainstem or phrenic nerve injury
Questionable for use with Sepsis or where drive to breathe is abnormal
Staff must get used to a different concept of normal
Doesn’t assess lung dynamics (Compliance and Resistance)

vents (5 decks)

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