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MV Exam 1
Mechanical Ventilation Exam 1
| Question | Answer |
|---|---|
| Indications for mechanical ventilation | IRF, ARF, prophylactic support, severe hypoxemia |
| Contraindications for mechanical ventilation | Absolute: untreated pneumothorax, Relative: Pt informed consent, Medical futility, Reduce or eliminate pain & suffering |
| Goals of mechanical ventilation | Provide pulmonary system w/ support, Maintain adequate ventilation, Decrease WOB, Restore acid/base balance, Improve oxygenation, Improve bronchial hygiene |
| COPD nutritional needs | Require 10x normal caloric intake |
| MawP equation | [RR x I time/60 x PIP-PEEP] +PEEP |
| Static compliance equation | VT/PLAT-PEEP |
| Dynamic compliance equation | VT/PIP-PEEP |
| Hepatic Perfusion | Hepatic perfusion: liver function accounts for 15% of total C.O., more PEEP= less liver function, higher PEEP lower Hepatic perfusion |
| Positive Pressure Ventilation (PPV) | Pressure generated by forcing air into the lungs, Decreased preload, SV, & C.O., Decreased renal function leading to fluid retention & decreased urine output, Decreased venous return, Increased ICP |
| Ways to decrease MawP | reduce VT, PIP, PEEP, I time, & E time |
| PPV Complications | Intubation complications, Barotrauma/volutrauma, Ventilator induced injury, Oxygen toxicity, VAP, Auto PEEP, Cardiovascular effects |
| Hepatic Complications | Increased prothrombin time: blood doesn’t clot as quickly, NL= 12-15 sec; Increased bilirubin levels: Causes jaundice; Decreased albumin: Albumin: protein that helps maintain blood volume & pressure |
| Urinary output | Kidneys need at least 400 mL/day to adequately remove waste, NL urine output 50-90 mL/Hr (60 mL) or 1200-1500 mL/day |
| Renal perfusion | Hypoperfusion -> decreased glomerular filtration rate (GFR) -> decreased renal tube secretion of drug -> reabsorption of drug |
| Hemodynamics & PEEP | Without PEEP: Decreases SV due to decreased venous return, Less blood pumped into pulm vessels, lowers PAP & increases CVP W/ PEEP: Compresses pulm blood vessels significantly, Increases PAP & CVP due to backup of blood, pressure on lungs at all times |
| VD/VT associated problems | high deadspace= perfusion problem |
| Severe Hypoxemia | ARDS, pulmonary edema, CO poisoning, PaO2 <60 mmHg on >50% FiO2, PaO2 <40 mmHg on any FiO2, PaO2 is critical if <200 mmHg on 100% FiO2 |
| Hypoxemic respiratory failure | Respiratory failure caused by severe hypoxemia, Pt will have continued high RR (also tachycardia, dyspnea, accessory muscle use, etc), Eventually they poop out & hypoventilate or become apnic, PaCO2 climbs & pH drops, Sends them into respiratory failure |
| Raw factors | Viscosity of the gas (least affect & directly affected), Velocity of gas (directly related), Length of airway (directly related), Diameter of airway (indirectly related) |
| Decreased cL | Atelectasis, pneumonia, pulmonary edema, ARDS, pneumothorax, pulmonary fibrosis, obesity, chest wall deformities (kyphosis) |
| Increased cL | Improvement in previous, emphysema, position change, flail chest (no stability to rib cage) |
| Types of hypoxia | Anemic- availability, Hypoxic- oxygenation, Histotoxic- utilization, Circulatory- pump |
| Increased E time | Air trapping= increase E time |
| Signs of hypoxia | Dyspnea, Tachypnea, Tachycardia, Cyanosis |
Created by:
geko546
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