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Assisted Ventilation
Section G
| Question | Answer |
|---|---|
| Describe how you would teach a patient to do any respiratory therapy treatment. | slow deep inspiration, hold 1-3 seconds, exhale slow and relaxed. |
| what is the main indication for incentive spirometry? | prevention of atelectasis |
| How often should Sustained Maximal Inspiration (SMI) be performed and what should be charted about the treatment? | hourly for 10 breaths; chart: date, time and IC volumes (not duration) |
| Describe the nine desirable physiological effects of IPPB. | prevent/correct atelectasis; prevent/decrease pulmonary edema; mechanical bronchodilation; distribute aerosols evenly; removal/mobolize secretions; manipulate I-E pattern; improve alveolar collateral ventilation; decrease WOB; improve/promote cough mechan |
| List the five hazards of IPPB. | Hyperventilation; impeding of venous return, resulting in decrease cardiac output and increase ICP; gastric distention; pneumothorax; excessive oxygenation and increased air trapping with COPD patients |
| Negative Pressure ventilator: what controls ventilation? | inspiratory time and amount of suction |
| Negative Pressure ventilator: why must the shell be the correct size? | to prevent leaks |
| Negative Pressure ventilator: what types of patients is this recommended for? | intermittent use, home care, neurological cases |
| Positive Pressure Ventilator: what does the amount of air delivered depend upon? | the amount of pressure applied and how long it is applied |
| Positive Pressure Ventilator: when does exhalation begin? | exhalation is passive and begins when the pressure is terminated and the exhalation valve opens |
| what are the two types of positive pressure ventilators? | volume cycled and pressure cycled |
| In which type of positive pressure ventilator will pressures increase or decrease with changes in compliance and/or airway resistance (Raw)? | volume cycled |
| Which type of positive pressure ventilator is pneumatically powered and will apply positive pressure to the airways until a pre-set pressure limit is reached? | pressure cycled |
| How is ventilation adjusted on a pressure cycled ventilator? | by increasing or decreasing the pressure limit |
| what remains constant ans what changes on a pressure cycled ventilator as the lung compliance and/or airway resistance changes? | peak pressure remains constant, volumes change as lung compliance and/or Raw changes |
| what types of patients is a pressure cycled ventilator best used for? | short term treatments or long term continuous ventilation with normal lungs |
| what is the coanda effect? | when a stream of air passes by a wall with a turbulent gas flow causing an attachment of the stream to the wall |
| what type of ventilator used fluidics? | pressure-limited ventilators |
| What types of ventilators can be used in the home? | negative and positive ventilators |
| when should a backup ventilator be used in the home? | for any patient that requires to be ventilated a majority of the time |
| when should you calculate the duration of flow when using a transport ventilator? | when oxygen is being used to power the ventilator |
| transport ventilator: what happens if the tank pressure is running low? | respiratory rate or tidal volume may decrease |
| Describe how BiPAP delivers positive pressure | provides two levels of CPAP (IPAP and EPAP) |
| BIPAP: where should the IPAP and EPAP setting be set? | I:E ratio 1:2 |
| Microprocessor ventilator: what type of ventilator is this used with? | volume cycled, flow limited, or pressure control |
| list three examples of microprocessor ventilators | Bennett 7200, Hamilton Veolar, Bourns Bear 1000 |
| High Frequency ventilation: what are the primary controls used to adjust ventilation and control gas exchange? | rate control, drive pressure regulator (volume), injector line, IV infusion pump for humidity, % inspiratory time (I:E ratio) |
| High Frequency ventilation: how is ventilation adjusted? | ventilation is adjusted using rate, drive pressure and % inspiratory time |
| What are some of the noted benefits of high frequency jet ventilation? | adequate ventilation at lower peak and mean airway pressures and the ability to ventilate patients with a bronchopleural fistula |
| what are the indications for continuous mechanical ventilation? | apnea, acute ventilatory failure, impending respiratory failure, oxygenation |
| normal tidal volume | 5-8 |
| normal and unacceptable vital capacity | 65-75 (10 x Vt), <10 |
| normal and unacceptable respiratory rate | 8-12, >20 or <8 |
| normal and unacceptable minute ventilation | 5-6, >10 |
| normal and unacceptable MIP | -80, <-20 |
| normal and unacceptable MEP | 160, <40 |
| normal and unacceptable A-a DO2 (21% O2) | 5-10, >15 |
| normal and unacceptable A-a DO2 (100% O2) | 25-65, >300 |
| normal and unacceptable Qs/Qt (%)(Shunting) | <5%, 20-30% |
| normal and unacceptable Cst (static compliance) | 60-100, <25 |
| what mode(s) is acceptable for initial set-up of a continuous ventilator? | control, assist/control, IMV/SIMV |
| continuous ventilator set-up: what two controls should be set first to achieve adequate ventilation? | tidal volume and respiratory rate |
| continuous ventilator set-up: what should tidal volume be set at? | 10 mL/kg of ideal body weight(Vt range= 8-12) |
| continuous ventilator set-up: what should the rate be set at? | 8-12 bpm |
| continuous ventilator set-up: what are the guidlines for the FiO2 and PEEP? | if no prior info, 40-60% O2 and no PEEP.if patient was on O2 prior to vent, same FiO2 and/or PEEP |
| what type of ventilator would you use with a patients who need a ventilator but dont have and real lung problems? | pressure cycled or volume cycled |
| what type of ventilator would you use with a patient who has pneumonia? | volume cycled |
| what are the vital signs and patient assessment you would need to monitor with a patient on a ventilator? | heart rate, respirations, blood pressure, temperature, EKG monitor, sensorium, auscultation, response to the vent., MIP & NIF, MEP, BCB, ABG |
| what are the measurements taken with patient OFF the ventilator? | tidal volume, respiratory rate, vital capacity, MIP |
| what are the measurement taken while the patient is ON the ventilator? | exhaled tidal volume, respiratory rate, minute ventilation, inspiratory flow, alveolar ventilation, deadspace ventilation, airway pressures |
| what is the formula for alveolar ventilation? | VA = (Vt - VD)f |
| how is alveolar ventilation best increased? | by increasing tidal volume |
| how would you calculate the dynamic compliance? | (exhaled volume - tubing expansion volume)/(peak inspiratory pressure - PEEP) |
| what causes an increase in airway resistance? | accumulated secretions, bronchospasm |
| what decreases static compliance? | stiff lungs (atelectasis, shunt), decreasing FRC |
| how would you calculate the static compliance? | (exhaled volume - tubing expansion volume)/(plateau pressure - PEEP) |
| describe mean airway pressure | the average pressure transmitted to the airway from the beginning of one breath to the beginning of the next |
| List the factors that afffect mean airway pressure | peak inspiratory pressure (PIP), rate, inspiratory time, PEEP, peak flow, tidal volume |
| what are the modes of ventilation? | assist, control, assist/control, SIMV, PCV, IPPV, APRV, BiPAP |
| Describe Assist Mode | patient can initiate ventilation, used with IPPB, not recommended for continuous ventilation |
| describe control mode | self-cycled at preset rate; not patient initiated; sedation recommended; indicated for head trauma, status asthma, flail chest |
| describe assist/control mode | allows patient to set rate, vent will maintain a minimum rate, used in most cases |
| Describe SIMV | patient can breath spontaneously, minimum minute ventilation, used with COPD patients to normalize ABGs, used with tachypnea to avoid hyperventilation, used for weaning, used instead assist/control to reduce barotrauma, used with PEEP to reduce barotrauma |
| describe BiPAP | non-invasive ventilator, provides 2 levels of CPAP, breaths are flow-triggered and require patient effort initiate inspiration |
| describe PCV | pressure controlled breaths, used with PIPs are very high (>50 cmH2O |
| What are the steps to normalize a high PaCO2? | decrease or remove deadspace, increase tidal volume, increase respiratory rate |
| what are the steps to normalize low PaCO2? | increase deadspace, decrease respiratory rate, decrease tidal volume |
| what are the steps when you wish to increase a low PaO2? | increase FiO2 by 5-10% (up to 60%), increase PRRP levels by 5 cmH2O until acceptable oxygenation or unacceptable side-effects occur |
| what are the steps when you wish to decrease a high PaO2? | decrease FiO2 to less than 0.60, decrease PEEP |
| what adjustments in the I:E ratio is needed for COPD patients? | COPD patients need more time to exhale (1:4, 1:5 etc.) |
| what is expiratory retard (expiratory resistance) used with? | used with COPD patients to prevent airway collapse. similar pursed-lip breathing |
| what is the purpose of inspiratory plateau (inflation hold)? | purpose is to increase diffusion of gases (improve distribution) and to decrease microatelectasis formfation |
| how would you position a patient for mechanical ventilation? | initially supine position then lower or semi-Fowler's may be used later. |
| what does pressure support help the patient overcome? | this helps the patient overcome the resistance of breathing through the ventilator circuit |
| What is the physiological effect of PEEP/CPAP therapy on the lungs? | improves patient's FRC, compliance, oxygenation (caused by shunting) |
| What clinical condition(s)would indicate indicate the need for PEEP/CPAP therapy? | oxygenation problems caused by shunting, decreased cardiac output, decreased myocardial oxygenation |
| How would you know if PEEP/CPAP is helping the patient? | PO2 increases, static compliance increases, cardiac output and hemodynamic pressures are stable |
| How would you know if PEEP/CPAP is too high? | PO2 decreases, static compliance decreases, cardiac output decreases and hemodynamic pressures increase |
| what is meant by optimal PEEP? | the least amount necessary to provide good oxygenation without any side effects |
| List the components of a typical ventilator circuit. | inspiratory limb, expiratory limb, Wye adapter, nebulizer, humidifier, exhaled volume monitor |
| what type of ventilator uses an H-valve assembly device? | ventilators that do not have built in IMV systems |
| what should be done in an external IMV system if the reservoir bag over inflates? | check for high flow, check for proper direction of one way valve and draining tube |
| List the common ventilator alarms. | pressure limit, oxygen alarm, PEEP/CPAP, failure to cycle, loss of power, oxygen failure, minimum exhaled volume, low pressure, temperature |
| where should the alarms be set at? | pressure limit (10-15 above peak airway pressure), O2 alarm (5% above and below FiO2), minimum exhaled volume(100 mL below exhaled tidal volume), low pressure (10 cmH2O below peak airway pressure) |
| How does morphine sulfate affect the lungs? | causes a decreased respiratory rate and tidal volume |
| How does Valium/versed act of the CNS? | for anxiety and relieves fears |
| What does Pavulon cause? | total muscle relaxation |
| What does Curare cause? | paralyzation |
| What is Anectine primarily given for? | intubation |
| What ABG values indicates that the patient is ready for weaning? | pH:7.35-7.45, PCO2: 35-45, PO2: 80-100 |
| what bedside pulmonary function values indicate that the patient is ready for weaning? | Vt:>5 mL, VC:>10 (2 x Vt), f: 8-20, Ve:<10, MIP/NIF:>20, MEP:>40, RBSI:<100 |
| when decreasing the O2 therapy, what level is the FiO2 setting reduced to? | to a level below 60% |
| how much are the PEEP levels reduced by? | 2-5 cmH2O at a time |
| what are the lowest setting on a ventilator prior to extubation? | SIMV/IMV: 4 bpm, FiO2: 0.40, PEEP: 5 cmH2O |
| What are the methods used for weaning? | traditional (trial and error); SIMV/IMV- decreasing rate and allowing patient to breathe spontaneously; PSV- IPAP to support inspiration |
| during weaning, if the heart rate increases 20 beats or more from baseline, what should be done? | stop weaning and resume ventilation |
| if the patient's sensorium changes during weaning, what would that indicate? | need to resume ventilation |
| What are other areas of assessment to be evaluated during weaning? | ABG after 20-30 min, breath sounds, urine output, recommend IPPB or SMI to prevent atelectasis, and continuous abservation for symptoms of problems |
Created by:
grumpeme
on 2008-08-08