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RSPT Mechanical vent
mechanical ventilation slides
Question | Answer |
---|---|
What is is the definition of mechanical ventilation | An intervention classification defined as the use of an artificial device to assist the patient to breathe. |
What are the indications of MV | -apnea- acute respiratory failure- impending respiratory failure sever hypoxemia |
What is considered acute respiratory failure | hypercapnia and hypoxemia |
What are the general goals of MV | Provide adequate ALVEOLAR ventilation, provide adequate oxygenation, avoid ALVEOLAR over distention, maintain ALVEOLAR recruitment, avoid auto peep, use the lowest possible FIO2 |
What are the requirements for spontaneous ventilation | Size of the tidal volume and rate or initiation |
In phase 1 of MV what is the summary of what's going on | Establish the need, connecting the patient to the vent for the first time after the first blood gas is the end of phase 1 |
In phase 2 of MV what is the summary of what's going on | Stabilize arterial blood gases as much as possible. |
In phase 3 of MV what is the summary of what's going on | Weaning of the machine |
What are the guidelines to EST. The need for phase 1 and acceptable values | Vt= 5-8ml/kg, RR <35, Vc >15ml kg or 2x Vt, Nip or Mop < 20cmh2o -30 or -40 is better, Ve >10L |
What are the initial settings on the vent | Pplt pressure <30 cmh20, full support mode for the first 24 hours, Vt 5-8 ml/kg, f: 8-12/ min, FIO2 < or equal to 60 |
What are the things that the vent needs to know | What is the oxygen requirements, what is the mandatory RR, mode, Vt, how fast and what fashion such as the I:E ratio |
What are the 2 modes of ventilation | Volume ventilation, pressure ventilation, pressure is most often used in neonatal due to the anatomy of the baby body not needing a cuff |
What are the different types of breaths | Controlled- vent respond. For both rate and volume Assisted- patient is respond for rate and initiating and vent is reps for volume, Spontaneous- patient is reps. For both rate and volume. |
What are the different types of modes | Control, assist, assist/control, SIMV, CPAP |
CPAP | Works on all spontaneous breaths, can't leave patient unless know they can intiate and provide all volume. |
Strategies to improve vent. According to the NBRC | Decrease dead space, increase tidal volume, increase RR, increase the spontaneous tidal volume, increase the pressure support, beware of the CO2 retainer |
Strategies to improve oxygenation | assure that the adequate vent., increase FIO2, add/increase PEEP |
What are some causes of height alarm sounding | Cough, secretions, biting the tube, pneumothorax, patient distress |
What are some causes of low alarm sounding | leak, cuff leak, disconnect, extubtion, patient fatigue |
Different waveforms | Square, sine, decelerating |
Square waveform pattern: | Produces a constant flow throughout insp. Used mostly in non compliant lungs |
Sine waveform pattern: | Flow begins slowly and increases to a peak then decrease at the end of inspiration, gives good distribution of ventilation |
Decelerating flow pattern: | Flow is fast during the beginning of insp peak, then gradually decreases useful for people who need high flow rates |
What is dynamic compliance: | identifies changes in the airway, change in volume usually Vt as the dynamic compliance decreases the airway is getting more narrow. |
What is plateau pressure | The pressure that is at during a inspiratory hold, once the Vt is delivered you hold the insp. And the pressure at the hold is the pplat |
What is static compliance | Identifies the condition of the lungs, normal is 60-100 ml/cmh2o |
What is resistance | This is increased as the air way grows more narrow, normal is 0.6-2.4 cmh20/l/sec |
What is the formula for Tidal volume | You take the IBW and times it by 5 and by 8 to get the range of tidal volume you need. 105+5(ht"-60)/2.2 for female and 106 for male. |
What is the formula for dynamic compliance Cd | Change in volume/PIP-PEEP Peak insp. Pressure- positive end exp. pressure |
What is the formula for static compliance Cs | Change in volume/Pplat-PEEP Plateau pressure- positive end exp. pressure |
What is the formula for RAW | PIP-Pplat/FLOW(60) |