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Mech/Vent Unit 4

SPC Mechanical Ventilation Unit 4 Exam 2

QuestionAnswer
Mechanical Ventilation was sporadically used in the early what? 20th Century
Mechanical Ventilation was Initially used when? Postoperatively
What year was mechanical ventilation used in Polio units? 1958
What are the 5 main uses of Mechanical Ventilation? 1. Support of Ventilation 2. Support of Oxygenation 3. Development of PEEP 4. Protection of the Airway 5. Delivery of Medication
What are the different type of Ventilators? 1. Negative or Positive Pressure 2. Invasive of Non-Invasive 3. Pneumatic or Electrically/Microprocessor Powered 4. Volume or Pressure Mode
What is Negative Pressure Ventilation? Used in patients with chest wall deformaities or neuromuscular disorders or absence of central drive to breath (central sleep apnea)
What is the frequency range for Negative Pressure Ventilation? 12-24 breaths/min
What is the pressure range for Negative Pressure Ventilation? -15 to -45 cmH2O
Where do you find Negative Pressure Ventilation most often used? Found in home care
What are the disadvantages to an Iron Lung? Large & Cumbersome but also makes bronchial drainage, IV therapy, and physical contact very difficult
Iron Lung can cause what? Pooling of blood in abdominal vasculator leading to low venous return and low cardiac output.
If volume is loss in an Iron Lung you should do what? Check for cracks in the chamber
Is an ET tube required in an Iron Lung? No
Where does an Iron Lung seal at ? At the neck leaving only the head exposed.
What are the 3 Negative Pressure Ventilator support devices used in the home? 1. Chest Cuirass 2. Poncho 3. Pneumosuit
What is a Non-Invasive Ventilator? A Ventilator that is used without an artificial airway (i.e. ET tube or trach is an artificial airway)
What part on S.A.V.O. is the only lone indication for use of a Non-Invasive Ventilator? V for Ventilation
Can a patient still talk when using a Non-Invasive Ventilator? Yes
What must be clear before using Non-Invasive Ventilator? No airway complications (i.e. pneumonia, vocal chord issue)
What does NPPV or NIPPV stand for? Non-Invasive Positive Pressure Ventilation
What are 6 important points about NPPV or NIPPV? 1. Patient must have intact respiratory drive 2. Patient must be able to maintain their own airway 3. Can’t be to acidotic 4. Can’t be too freaky 5. Can’t be nauseous 6. Reduces WOB
What are 2 alternatives to Invasive Mechanical Ventilation in the home? CPAP & NIPPV
What type of patients is CPAP used on? Used on those patients with adequate muscle strength but who become hypercapneic and hypoxemic during sleep
What type of patients is NIPPV used on? Used on those whose respiratory muscle strength is inadequate to support adequate ventilation
What are advantages of CPAP and NIPPV? 1. Less cumbersome than negative pressure vents and allows more patient mobility 2. Simple to apply 3. Removes need for trach 4. Cost effective of NPV and other mechanical vents
What is a pneumatic ventilator? Works entirely on high air pressure and relies on that pressure to ventilate and is usually a transport vent. IF THERE IS AN ELECTRICAL PLUG ITS NOT PNEUMATIC
What is an electronic/microprocessor vent? Uses modern electronic and computer circuitry to govern the ventilation process. Vast majority of ventilators today use these type ventilators
What is the most commonly used vents in the ICU? Microprocessor Controlled Vents
Combined Powered Vents are what? Consist of Electric and Pneumatic. (Pneumatic) where two 50 PSI gas sources (Oxygen and Air) provide pressure to deliver inspiratory gas flow. (Electric) where control of the flow is regulated by a microprocessor.
What are the positive pressure vent components? 1. Control Panel/User Interface 2. Pneumatic Circuit 3. External/Patient Circuit
What does the External Circuit/Patient Circuit do? Connects the ventilator to the patients artificial airway
What pieces pertains to the External Circuit/Patient Circuit? 1. Main inspiratory line 2. Adapter that fits this tube to patient’s airway 3. Expiratory line carries expired gas away for the patient to the exhalation valve 4. Expiratory valve that conducts exhaled gas from the line to the room
Where is the control panel located and what is it used for on a ventilator? Located on the top, outside of the ventilator. Contains controls for the operator to set the desired parameters for ventilation such as respiratory rate (f), tidal volume (Vt), pressure (Pset), inspiratory time (T1), and FIO2.
What does the Pneumatic Circuit consist of? A series of tubing and directs the gas flow both within the ventilator (internal circuit) and from the ventilator to the patient (external or patient circuit) with either internal or externally mounted exhalation valves
What is spontaneous ventilation? Movement of air in and out of the lungs
Positive Pressure in ventilators is what? 1. The most common method of ventilation 2. A pressure above the ambient in created at the mouth causing air to flow into the lungs
Negative Pressure in ventilators is what? Enclose the thoracis area and creat a negative pressure around the chest wall. (i.e. iron lung and chest cuirass)
What are the 3 types of breath delivery? 1. Mandatory 2. Assisted 3. Spontaneous Breath
What is a Mandatory Breath? Ventilator does all the work of breathing
What is an Assisted Breath? Inspiration begun by patient, but the ventilator controls the inspiratory phase and ends inspiration
What is a Spontaneous Breath? Patient controls all phases of the breath
What are the 4 phase of a breath during Mechanical Ventilation? 1. End of expiration and beginning of inspiration. 2. Delivery of inspiration 3. End of inspiration and beginning of expiration 4. Expiratory phase
What does TCT stand for? Total Cycle Time
What is the definition of TCT? The total respiratory cycle, which consists of both inspiration (TI) and expiration (TE) and the events that occur during that time
What is the calculation for TCT? TI + TE =TCT
What are the 3 phase variable of a breath? 1. Triggering 2. Limiting 3. Cycling
What is triggering as a phase variable? When a patient attempts spontaneous breath causing breath to begin by the machine.
What 3 things does the machine sense during the Triggering phase variable. 1. Pressure (negative pressure usually set at -1 to -2 cmH2O) 2. Flow (drop in flow--baseline may be set at 6 L/m, sensitivity set at 2-3 L/P) 3. Time Triggering (used most often in neonates)
What is Limiting as a phase variable? Places a maximum value on a inspiration (pressure, volume, flow, and/or time limits the delivery of a breath
What is Cycling as a phase variable? Causes breath to end (uses pressure, volume, flow or time)
What are the control variables on Inspiration? The primary variables that the ventilator manipulates to cause inspiration are Volume, pressure, flow and sometimes time.
What are the control variables on Expiration? Exhalation is passive
What is Volume controlled ventilation? A volume breath is one in which Tidal volume is constant and limited. Flow is also controlled
What also needs to be known about Volume controlled ventilation? Gas flows until a desired tidal volume is reached. Inspiratory pressures and I: E ratios will be variable. Respiratory rate is set but can increase as patient breaths on own.
What is the MOST common parameter encountered in adult mechanical ventilation. Volume
What is Pressure Controlled Ventilation? Pressure will be constant and limited. Volume and flow vary
What also needs to be known about Pressure controlled ventilation? Gas flows until a desired inspiratory pressure is reached. Tidal volumes and minute ventilation are variable. (Dependant on compliance and resistance of the lungs.) Respiratory rate is set but can increase as patient breaths on own
What parameter is often used in settings of acute lung injury (i.e. ARDS)? Pressure
What is flow controlled ventilation? Flow and volume waveforms remain constant Pressures will vary depending on compliance and resistance
What also needs to be known about Flow controlled ventilation? Most current generation vents can function this way but are more complex and sophisticated than the older infant style vents that utilized flow meters for controlling flow.
What is time controlled ventilation? Inspiratory time is constant- gas flows until a set inspiratory time is reached. Pressure, volume and flow may be variable.
What also needs to be known about Time controlled ventilation? Usually encountered in high frequency ventilatory/oscillatory techniques (mostly pediatric/neonatal).
What are Pressure Curves? Usually rectangular (constant), rising exponential or ascending ramps
What are Volume Curves? Usually ascending ramp or sinusoidal volume output ramp
What are Flow Curves? Commonly rectangular (constant), ramp (ascending or descending)
What is considered when transporting a mechanically ventilated patient? 1. Usually necessary for diagnostic/therapeutic procedures? 2. Patient should be stable 3. Monitoring should be maintained during transport 4. Risk:Benefit ratio should be evaluated 5. Done by physicians order only
What are the precautions/complications of transporting a mechanically ventilated patient? 1. Hyperventilation 2. Accidental Extubation 3. Accidental removal of IV access 4. Loss of O2 supply/PEEP, resulting in Hypoxemia 5. Position change resulting in hypotension, hypercarbia, & hypoxemia
What are the 5 goals for home ventilation? 1. To sustain and extend life 2. To enhance the quality of life 3. To reduce morbidity 4. To improve or sustain physical and physiological function 5. To provide cost effective care
What is the criteria for a home ventilator selection? Reliability, Safety, Versatility, User-friendly, and Easy Patient Cycling
Created by: Langhout1418