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PNP 749 Assessment & Diagnostic > Week 2 - Mechanical Ventilation > Flashcards

Week 2 - Mechanical Ventilation Flashcards

1
Q

What are the 2 physiologic criteria for when you should be considering mechanical ventilation?

A
  1. Hypercarbia (PaCO2 > 50mmHg)

2. Hypoxemia (despite supplemental O2)

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2
Q

What are 4 causes of respiratory failure?

A
  1. Mechanical dysfunction of the lung
  2. Loss of respiratory control d/t impaired central respiratory drive
  3. Upper or lower airway obstruction
  4. Multisystem organ failure, cardiac arrest
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3
Q

What are 7 signs of impending respiratory failure?

A
  • Increased respiratory drive
  • Respiratory muscle fatigue
  • Hypoxemia or hypercapnia
  • Evidence of lung disease
  • Loss of cough or gag
  • Critical upper airway obstruction
  • Decreased respiratory drive - LATE sign
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4
Q

What are the 5 goals of mechanical ventilation?

A
  1. Protect the lung from iatrogenic injury
  2. Promptly and aggressively treat the illness or injury
  3. Proper nutrition
  4. Assess extubation readiness daily
  5. Mobility
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5
Q

What is tidal volume?

Common setting?

A

quantity of gas delivered w/ each breath

5-8 mL/kg
4-6 mL/kg in PARDS

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6
Q

What is PEEP?

Common setting?

A

airway pressure at end of expiration

Start at 5-8 cm H2O

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7
Q

What is PIP?

Common setting?

A

maximal airway pressure reached during delivered breath

PIP = pressure control + PEEP

Only a setting in PC/PS
Normal set at 16-25

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8
Q

What is I:E?

Common setting?

A

time for the vent to deliver the volume of pressure breath and allow for exhalation

1:2 or 1:3

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9
Q

What is rate?

Common setting?

A

number of breaths/min delivered by ventilator

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10
Q

What is pressure support ventilation (PSV)?

A

all breaths spontaneous (patient initiated) and ventilator augments patient effort w/ pressure or volume

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11
Q

What is assist control (A/C) ventilation?

A

A/C ventilation provides full respiratory support. It takes over WOB for the patient.

All programmed breaths delivered within fixed inspiratory time (I-time)

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12
Q

What is SIMV?

A

Synchronized intermittent mandatory ventilation - combo of mandatory and spontaneous breaths

Patient or ventilator can initiate breath; ventilator will deliver entire breath to support

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13
Q

What vent mode is often better for neonates and patients with uncuffed tubes?

A

SIMV + PS/PC

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14
Q

What is plateau peak pressure?

A

Alveolar pressure - the equilibrium of pressures in lung when flow is stopped

Normal difference peak-plateau < 5

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15
Q

What is part of the respiratory exam for a patient on a vent?

A
  • WOB (retractions, belly-breathing, nasal flaring, head bobbing)
  • Breath sounds
  • Waveforms on ventilator
  • Patient-ventilator “synchrony” (Trigger, flow, inspiratory time, mode of ventilation)
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16
Q

What is part of the non-respiratory exam for a patient on a vent?

A
  • Vital signs (HR, BP, SpO2)
  • Appearance (pallor, diaphoretic, mottling)
  • sedation/muscle relaxing
  • Discomfort
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17
Q

What’s the pneumonic for troubleshooting a distressed vent patient?

A 
DOPE
D - displacement of tube
O - obstruction
P - pneumothorax
E - equipment failure
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18
Q

What’s the pneumonic for troubleshooting decompensation during mechanical ventilation?

A 
DOPE
D - displacement of tube
O - obstruction
P - pneumothorax
E - equipment failure
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19
Q

Capnography - decreasing EtCO2

Meaning?

A

ET tube cuff leak

ET tube in hypopharynx

Partial obstruction

20
Q

Capnography - sudden increase in EtCO2

Meaning?

A

Return of spontaneous circulation (ROSC)

21
Q

Capnography - bronchospasm (shark-fin appearance)

A

Asthma

COPD

22
Q

Capnography - bronchospasm (shark-fin appearance)

Meaning?

A

Asthma

COPD

23
Q

Capnography - decreased EtCO2 (variable changes)

Meaning?

A

Apnea

Sedation

24
Q

What are some examples of restrictive lung disease (inadequate oxygenation)?

A

ARDS, aspiration pneumonitis, pneumonia, pulmonary fibrosis, pulmonary edema, alveolar hemorrhage, chest trauma

25
Q

What are some examples of obstructive lung disease (inadequate ventilation)?

A

Asthma, COPD

26
Q

What are some examples of severe metabolic acidosis?

A

Salicylate poisoning, septic shock, toxic exposures, acute renal failure, DKA

27
Q

What are complications for a patient on a vent?

A

Diminished cardiac output and hypotension

Pulmonary barotrauma (eg. pneumothorax)

Ventilator-associated lung injury

Auto-positive-end-expiratory pressure (ie. intrinsic PEEP)

Elevated intracranial pressure

28
Q

What is recommended vent mode and setting for inadequate oxygenation?

A

SIMV + PS

high PEEP (5-8)
low tidal volume (3-6 or 5-8 depending on lung compliance)
29
Q

Vent adjustment for a patient with persistent hypoxia despite increasing/max FiO2?

A

Increase PEEP

maybe increase I-time

30
Q

What is recommended vent mode and settings for inadequate ventilation?

A

Pressure or volume controlled (SIMV + PS or PS alone)

low RR (8-16), max expiratory time (prolonged I:E, low I-time; 1:3 or greater)

31
Q

Vent adjustments for dynamic hyperinflation and evidence of auto-PEEP?

A

lower RR (10-14)

shorten I-time (1:3 - 1:5)

Keep tidal volume 6-8

32
Q

High peak + high plateau pressure. Causes?

A

Low compliance from underlying disease

Pneumothorax, severe pulmonary edema, pulmonary effusion, hyperinflation, elevated intra-abdominal pressure from ascites or compartment syndrome

33
Q

High peak pressure + normal/low plateau pressure. Causes?

A

Obstruction of airflow within vent circuit (clogged ETT) or proximal airways (copious secretions, bronchospasm)

34
Q

Low peak pressure (change). Causes?

A

ETT cuff leak

Accidental extubation

35
Q

Low peak pressure (no change). Causes?

A

Consider pulmonary embolism

36
Q

What is the recommended vent mode and settings for restrictive lung dz?

A

A/C (either volume or pressure controlled)

Higher PEEP (5-10)
Lower tidal volume (4-6)
37
Q

What is the recommended vent mode and settings for obstructive lung dz?

A

A/C (prefer volume)

Lower RR (10-14)
Shorter I-time (to increase I:E ratio) 1:3 or higher
38
Q

What lung dz would you allow permissive hypoxemia? SpO2 range?

A

Obstructive lung dz

SpO2 88-92%

39
Q

What is the recommended vent mode and settings for severe metabolic acidosis?

A

Pressure support ventilation

PEEP 5-10
PS 10-15
Minute ventilation 18-25

40
Q

How to adjust vent if PaO2 too low?

A

inc FiO2, inc PEEP

41
Q

How to adjust vent if PaCO2 too high?

A

inc RR

inc tidal volume (volume controlled)
inc driving pressure (pressure controlled)

42
Q

How to adjust vent if PaCO2 too low?

A

dec RR

dec tidal volume (volume controlled)
dec driving pressure (pressure controlled)

43
Q

7 causes of hypoxemic respiratory failure?

A
  1. shunt
  2. VQ mismatch
  3. diffusion limitation
  4. dead space
  5. low FiO2
  6. low Pb (barometric pressure)
  7. alveolar hypoventilation
44
Q

Examples when VQ ratio < 0.8?

A

asthma, COPD, interstitial lung dz, tracheobronchitis, pneumonitis

45
Q

Examples when VQ ratio > 0.8?

A

thromboembolic disease, vasculitis, overdistension of alveoli during positive pressure ventilation

PNP 749 Assessment & Diagnostic (8 decks)

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