Week 3- Mechanical Ventilation Flashcards
What is the purpose of mechanical ventilation?
Maintain homeostasis between gas concentrations Oxygen and CO2.
Do all mechanical ventilation indications come from a pulmonary impairment?
No
What are (5) indications for mechanical ventilation?
- Airway protection (Preventive measure)
- Cardiac arrest (Life saving measure)
- Management of ICP (Creation of alkalosis ->vasoconstriction ->dec cerebral blood flow/dec ICP)
- Airway obstruction (Maintenance of patent airway)
- Surgery or trauma (General anesthesia)
Describe the mechanical ventilation vocabulary:
- FiO2
- Tidal Volume (TV)
- PEEP
- Flow
- Respiratory Rate
- FiO2: Fraction of inspired oxygen (%)
- Tidal Volume (TV): Normal amount of air ventilated at rest (mL)
- PEEP: Positive End Expiratory Pressure (cmH2O)
- Flow: L/min
- Respiratory Rate: breaths/min
What are the 2 types of mechanical ventilation?
- Invasive
- Non-invasive
With invasive mechanical ventilation, why would we use a nasotracheal tube instead of an endotracheal tube?
If someone has an obstruction in throat or swelling.
What is a tracheostomy?
Invasive mechanical ventilation where tube is inserted straight into trachea.
- What are 2 types of non-invasive mechanical ventilation?
- Often the last step before __________.
- BiPAP or CPAP
- intubation
What is the difference between BiPAP and CPAP?
BiPAP (Bi-Level Positive Airway Pressure)
- BiPAP blows higher pressure while you breathe in. BiPAP blows lower pressure while you breathe out.
- Used for patients who have trouble exhaling.
CPAP (Continuous Positive Airway Pressure)
-CPAP blows constant pressure while you breathe in and out.
Is BiPAP a contraindication to PT?
No. Need to know why, how much they are on, and are they medically stable on BiPAP.
Is CPAP a contraindication?
No
-With mechanical ventilation, there is a ______ at the end of the tube that helps to hold it in place.
What do we suspect if the patient is able to talk or audibe sounds are heard with a tube inserted?
- cuff
- cuff leak
-The average person can be orally ventilated for ____ weeks. Why?
2, respiratory infection risk rises and it is not temporary anyways.
- What is done if the patient is unable to be weaned from the ventilator after 2 weeks?
- What are some reasons a patient would go straight to a trachestomy?
- Tracheostomy
- Difficult intubation (severe morbid obesity), Airway blocked or obstructed (tumor, traumatic injury)
What is a Passy Muir valve?
Valve put on the end of the tracheostomy to make it easier to talk.
- Why do most rehab facilities not take people with tracheostomy?
- Where will most patients with a tracheostomy go?
- High level of care including cleaning tube, access to wall suction.
- Long term acute care
- What is a second discharge option other than long term acute care?
- What are the requirements for them to be admitted here?
- rehab facility
- if they can be put on a trach collar and the percentage of O2 is 28% or less.
MODES OF VENTILATION
MODES OF VENTILATION
What are the main (7) modes of ventilation seen?
-Volume Control (VC)
-Pressure Control (PC)
-Assist Control (AC)
-Pressure Regulated Volume Control (PRVC)
-Synchronous Intermittent Mandatory Ventilation
(SIMV)
-Pressure Support Ventilation
-Volume Support (VS)
-Continuous Positive Airway Pressure (CPAP)
Volume Control (VC):
- Preset _____ volume is delivered at a set ________ rate
- Used when patient has no __________ breathing
- Peak pressures can vary depending on patient’s lung __________ and ___________
- tidal, respiratory rate
- spontaneous
- compliance and resistance
With volume control, pressure from ventilator will ________ if patient’s lung compliance decreases.
increase (stiff lung = increased resistance)
Pressure Control (PC):
- Predetermined amount of _________ at a set rate
- Ventilator determines __________ time
- Patient has no __________ breathing
- ______ used to increase arterial oxygen, improve lung compliance (prevents collapse, makes lungs easier to inflate)
- pressure
- inspiratory
- spontaneous
- PEEP
Assist Control (AC):
- Delivers a specific amount of ______ volume
- Forces air down into lungs
- ________ or ventilator can trigger when breaths are taken
- _____ level of respiratory support
- tidal
- patient
- high
Pressure Regulated Volume Control (PRVC):
- Combines _______ and ______ controlled ventilation
- Preset tidal volume is delivered at set rate, but with ______ possible pressure
- Helps prevent __________
- pressure and volume
- lowest
- barotrauma
Synchronous Intermittent Mandatory Ventilation (SIMV):
- Used to assist patients who have some, but not sufficient breathing (Patients can breathe in between each machine assisted breath)
- Used for __________
- Delivers certain number of breaths in coordination with respiratory effort of patient
- Does have increased work of breathing
weaning
Pressure Support Ventilation:
- Small amount of pressure occurs on inspiration
- _________ initiates all breaths (Assists patient in making a spontaneous breath)
- Delivers a specific pressure
- Ventilator assists, but ________ regulates the respiratory rate and tidal volume
- patient
- patient
Volume Support (VS):
- _______ volume and ______ are set
- _________ initiates breathing
- Ventilator delivers support in proportion to patient’s inspiratory effort and target volume
- tidal volume and PEEP
- patient
Continuous Positive Airway Pressure (CPAP):
- Continuous pressure is maintained in airways to prevent collapse
- _________ regulates all other respiratory functions
-patient
PART 3
PART 3
Before you touch your patient who is on a vent, what do you look at?
- Mode of ventilator
- RR
- FiO2
- PEEP
Do we need to document the ventilation settings in our PT notes?
Yes. Include mode, FiO2, PEEP
What are the (3) main sedative drugs that patients on mechanical ventilation will be on?
- Propofol (Diprivan)
- Precedex (Dexmedetomidine HCl)
- Fentanyl
What is propofol?
- Very strong anesthetic given by IV, has a rapid effect.
- Has a short half-life, can be reversible in a few minutes if patient needs to participate in PT.
What is precedex?
- Baby propofol.
- Keeps people calmer, more interactive.
What is fentanyl?
-Opiate analgesic used to treat severe pain, but also produces state of relaxation.
Mechanical Ventilation Alarms:
- What are the causes of RED alarms? (3)
- What are the causes of YELLOW alarms? (4)
RED
- high pressure
- circuit disconnected
- apnea
YELLOW
- low tidal volume
- high respiratory rate
- low minute ventilation
- low inspiratory pressure
Mechanical Ventilation: Weaning:
- What is weaning?
- Will PTs work with patients during this process?
- Process of decreasing or discontinuing mechanical ventilation
- Yes
What are the (5) major factors to consider during weaning?
- Respiratory demand and ability of neuromuscular system to cope with O2 demand.
- Oxygenation
- CV performance
- Psychological factors
- Adequate rest and nutrition
Weaning Signs of Distress:
- Tachypnea > __ breaths/min
- Decreased pH < ____-_____ with increased PaCO2
- Paradoxical breathing patterns
- O2 saturation < ___%
- HR change of > ___ bpm
- BP change > ___ mm Hg
- Agitation, panic, diaphoresis, cyanosis, angina, or arrhythmias
- 30 breaths/min
- 7.25-7.30
- 90%
- > 20bpm
- > 20mmHg
What are the pros/cons to working with a patient on full mechanical ventilation support vs SBT?
- If working with someone on full mechanical support they breath less hard (longer endurance while working).
- If someone is on SBT, they tend to be more awake and interactive, but are breathing on their own (less endurance).
What are 2 common sedation scales that are used? (not by PTs)
- Richmond Agitation Sedation Scale (RASS)
- CPOT Pain Scale
What is the goal score for patients on the RASS?
between -1 and -2
PART 4: PT IMPLICATIONS
PART 4: PT IMPLICATIONS
Contraindications:
- _______/___________, does not follow commands**
- Severe agitation/combativeness
- PEEP > ___cm H2O or FiO2 > ____
- Uncontrolled active _______
- comatose/unresponsive
- 10cm, 0.60 (60%)
- bleeding
Prolonged vent support may lead to what (3) things?
- skin breakdown (decubitus ulcers)
- joint contractures
- deconditioning
