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MV Exam 1

Mechanical Ventilation Exam 1

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