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Sof Acute Assessment 2 > W7: Mechanical Ventilation > Flashcards

W7: Mechanical Ventilation Flashcards

1
Q

2 types of oxygen delivery systems

A

low-flow
high-flow

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2
Q

Low-flow oxygen delivery systems

A

Provide lower oxygen than the actual inspiratory flow (30 L/min-1)
Degree of dilution depends on inspiratory flows

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3
Q

High-flow oxygen delivery systems

A

provide higher oxygen flows and FiO2 is stable and is not affected by the patient’s type of breathing

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4
Q

Nasal Prongs

A

low flow oxygen

Should not exceed maximum oxygen flow of 4L/min

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5
Q

Simple face mask/Hudson mask

A

Delivers concentrations of 35-65% depending on patient’s respiratory rate and tidal volume

Should not be used at flow rates <5/6 L/min as rebreathing of CO2 may occur

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6
Q

Venturi Mask

A

suited for patients who require O2 concentrations between 24-50%

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7
Q

Which conditions cannot have high FiO2 and why

A

COPD and emphysema as it pushes them into type 2 respiratory failure

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8
Q

Non-rebreather mask/oxygen reservoir mask

A

delivers 90-100% O2
15L/min
precise method to deliver high concentrations of O2 for a short period

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9
Q

Oxygen delivery systems

A

Nasal prongs
Simple face mask/Hudson mask
Venturi mask
Non-rebreather mask/oxygen reservoir mask

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10
Q

How many puffs for manual ventilation

A

RR is 12-20 so one puff every 5s

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11
Q

Two types of ventilation therapy

A

Non-invasive: CPAP or BiPAP
Invasive: intubation

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12
Q

What is the aim of ventilation therapy?

A

provide positive pressure ventilation, which relates to gas flow along a pressure gradient between the upper airways and the alveoli

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13
Q

What does inspiratory pressure do

A

pressure support helps to get air in
- would increase if not enough oxygen is getting in

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14
Q

What is expiratory pressure

A

helps the air get out and PEEP doesn’t allow the lung to fully deflate

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15
Q

What is the difference between CPAP and BiPAP

A

CPAP is constantly blowing air into the lungs and the flow doesn’t change.
This is necessary for hypoxic patients as you need to get lots of oxygen in at a fast rate
Type 1 Respiratory patients

BiPAP has 2 pressures which allow you to breathe out as well.
Good for type 2 respiratory patients as they can blow off the CO2

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16
Q

When would you use CPAP

A

Type 1 respiratory patients

Hypoxic patients - need to get lots of oxygen in at a fast rate

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17
Q

When would you use BiPAP

A

Type 2 respiratory patients so they can blow off CO2

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18
Q

BiPAP

A

Assists both inspiratory and expiratory phases of breathing. It can actively assist respiration through augmentation of alveolar ventilation

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19
Q

Contraindications of manual hyperinflation

A
  • Undrained pneumothorax
  • Severe bronchospasm
  • Head injury
  • High PEEP
  • decreased lung compliance
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20
Q

What is the range for PEEP

A

5-10 cmH2O

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21
Q

A high peak inspiratory pressure may indicate what?

A

increased airway resistance
decreased lung compliance

22
Q

SIMV

A

This mode provides a set number of mandatory breaths with either a fixed tidal volume or inspiratory pressure. The patient can breathe spontaneously between these mandatory breaths, and the ventilator synchronizes with the patient’s effort​

23
Q

CMV

A

This mode does not allow spontaneous breathing from the patient. All breaths are controlled by the ventilator, delivering a preset tidal volume or pressure. This mode is generally used for sedated or paralyzed patients​

24
Q

PCV

A

In pressure control ventilation, a constant pressure is applied during inspiration, and the tidal volume varies depending on the patient’s lung compliance. Pressure support may be added to help the patient initiate breaths and decrease the work of breathing

25
Q

When would you use manual hyperinflation

A
  • Optimise alveolar ventilation
  • Mobilise pulmonary secretions
  • secretion clearance
  • Improve lung compliance
26
Q

For every litre increase of Oxygen - Fio2 will be increased by approximately ___%

A

4

27
Q

Different levels of ventilation based on heaviest to least support

A

CMV: heaviest support
SIMV: middle
PS: least support

28
Q

When would intubation be indicated

A

other methods unsuccessful in maintaining a patients airway or if the patient’s level of consciousness is compromised

29
Q

What is indicated for long term ventilation

A

Tracheostomy

30
Q

Medical management
for gas exchange

A
  • medications: bronchodilators, steroids, pain relief
  • oxygen therapy
  • airway management and ventilation
31
Q

Physiotherapy management

A
  • education
  • positioning
  • breathing exercise
  • mobilisation and exercise
32
Q

Types of positioning

A

General positioning
Specific positioning

33
Q

General positioning

A

Increase lung volumes
increase FRC above closing capacity (lung volume where small airways start to close)

34
Q

Specific positioning

A

Aim to re-expand areas of localised atelectasis

35
Q

When is positioning indicated

A

prolonged bed rest and supine positioning
reduces muscle strength and conditioning
decreased FRC
increased atelectasis

36
Q

What position has highest FRC

A

upright posture and standing

37
Q

What can positioning help

A

Increase oxygenation
increase lung volumes
decrease work of breathing
increases V/Q matching

Increase FRC (above CC) and increase V/Q matching and gas exchange

38
Q

What happens if FRC < CC

A

small airway closure during tidal breathing

results in reduced gas exchange and decreased PaO2 and SaO2

39
Q

When would you use general positioning

A

Upright positions increases FRC

So you would use general positioning in patients with generalised low lung volumes e.g. postop

40
Q

When would you use prone positioning

A

commonly used for ventilated patients

41
Q

When is lean forward position used

A

used as a strategy to help relieve acute dyspnea

aims to reduce respiratory effort by stabilising the thorax and accessory muscles and optimising function of the diaphragm

42
Q

When are deep breathing exercises indicated

A

patients with atelectasis/low lung volume

43
Q

when is deep breathing exercises NOT indicated

A

hyperinflated, breathless patients

44
Q

What do deep breathing exercises do

A

encourage lateral basal expansion
better distribution of ventilation (air flow) to the dependent regions of the lungs
reduces risk of pulmonary complications

45
Q

What does the position of Pursed lips breathing create

A

back pressure producing PEEP which increases CO2 removal, increases gas exchange and decreases workload of breathing

46
Q

How does early mobilisation help

A

reduced duration of mechanical ventilation
increased FRC
increased inspiratory flow rates
increased expiratory flows

47
Q

reasons to intubate

A

maintain a patient’s airway
means of supplying oxygen
protects from aspiration
enables paralysis and sedation
rest the respiratory muscles
facilitate secretion removal

48
Q

Common modes of ventilation

A

Controlled mechanical ventilation
Assist control ventilation
Synchronised intermittent mandatory ventilation
Pressure support ventilation

49
Q

Reasons for tracheostomy

A

bypass an obstructed upper airway
removing secretions from airways
prolonging mechanical ventilation > 2 weeks
more easily and usually more safely deliver oxygen to the lungs

50
Q

What is PEEP?

A

The positive pressure that remains in the airways at the end of a respiratory cycle that is greater than the atmospheric pressure in mechanically ventilated patients

51
Q

what does PEEP do for mechanically ventilated patients

A
  • For patients placed on mechanical ventilation, PEEP will be used to keep the airways & alveoli open to allow for adequate oxygenation – ultimately, increase FRC
52
Q

how much PEEP for mechanically ventilated patients

A

5-15cmH2O

Sof Acute Assessment 2 (3 decks)

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