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Mech/Vent Unit 7

SPC Mechanical Ventilation Unit 7 Exam 4

The most important factor to be considered when evaluating a patient for weaning? A significant improvement or reversal of the main problem or disease process that required the patient to be placed on continuous mechanical ventilation.
What are the 13 clinical factors for liberation of mechanical ventilation? Acid-base Balance--Anemia--Cardiac Arrhythmias--Caloric depetion/malnutrition--Fluid Balance--Hemodynamic Stability--Infection--Psychological Condition--Renal Function--State of Consciousness--Pain--Nutritional Status--Sleep Deprivation
What are some physical signs of increased WOB? 1. Use of accessory muscles 2. Asynchronous breathing 3. Diaphoresis 4. Anxiety 5. Tachypnea 6. Substernal & Intercostal retractions 7. Patient asynchronous w. vent
What are the 4 methods of weaning? 1. T-Piece Trials/Trach collar Trials 2. Tube compensation 3. SIMV 4. Spontaneous Breathing trials with CPAP/PS
What are T-piece trials/Trach collar Trials? 1. Stop ventilator and place patient on T-piece or trach collar at an FIO2 5-10% higher than ventilator setting 2. Monitor patient’s appearance, cardiac status and ventilatory status for X period of time.
When using T-piece trials for weaning how often should the procedure be repeated? Q1-2 hours increasing time off the vent as tolerated
When using T-piece trials for weaning how often should ABG's be checked? PRN (20min off vent)
What are the 5 disadvantages of T-piece weaning? 1. Labor intensive 2. Requires high level of staff attention 3. No back up ventilation 4. No respiratory alarms 5. Increased WOB
What is Tube Compensation? 1. Overcomes the imposed work of breathing through an artificial airway. 2. Assists the patient’s spontaneous breaths with positive pressure proportional to the inspired flow and the internal diameter of the artificial airway.
Tube compensation has been shown to closely mimic what? Post Extubation
Tube Compensation is used as what? Weaning tool prior to extubation
What happens with SIMV/PS when used for weaning? 1. Helps overcome system imposed WOB 2. Patient controls f, depth, and time of each spontaneous breath 3. Improves ventilator muscle endurance 4. PSV levels can be set to optimize a reasonable tidal volume for given patient
What must be done when weaning with SIMV? 1. Assess patient 2. Decrease rate by 2 bpm. Healthy patients may be able to tolerate rate changes of more. Difficult patients may only tolerate changes of 1. Continue to decrease SIMV rate as tolerated reassessing vital signs and ABG’s per protocol.
When weaning using SIMV/PS how often should ABG's be checked? 20-30 min Post vent change
When assessing the patient on SIMV for weaning what should be checked? SPO2, cardiac status, capnography, vital signs
What are advantages with SIMV? 1. Provided backup ventilation 2. Provides a method of giving large periodic breath
What are disadvantages of SIMV? 1. Increased WOB due to sudden decrease in mandatory rate
What happens with Spontaneous Breathing Trials when used for weaning? 1. Patient placed on spontaneous breathing mode or CPAP with 0-5 PEEP 2. Pressure support is added at a min 5-7 cm H2O to overcome the WOB (resistance of tubing and ET-tube). The smaller the tube, the more PS they need to overcome this resistance.
What is monitored using SBT for weaning? 1. Hemodynamics 2. RR 3. VT 4. VE 5. SPO2
If SBT's are tolerated what can happen? Can extubate patient
T/F ABG's are done to evaluate patient when using SBT's? True
What are the signs indicating problems during SBT's? 1. RR >30 2. VT <300mL 3. BP changes high or low 4. HR Increase >20% or >140bpm 5. Sudden onset of PVC's 6. Diaphoresis 7. Any signs of anxiety or that patient is not ready 8. ABG's
When weaning by PSV (CPAP or spontaneous mode), levels are set between what? 5-20 cmH2O
When weaning by PSV (CPAP or spontaneous mode), you can also set a level of spontaneous VT of what and rates of what? 1. VT 300-600mL 2. F 15-24
When weaning by PSV (CPAP or spontaneous mode), PSV levels a decreased usually by what? By 5 as tolerated
When weaning by PSV (CPAP or spontaneous mode), you should always what? Continue to monitor patient!!!
When weaning by PSV (CPAP or spontaneous mode) if successful what can happen? Patient can be placed on t-tube or extubated per policy
What are the benefits of Therapist Driven Protocols? 1. Found to be Safe 2. Shortens time required for vent support 3. Reduces hospital cost 4. Heightens staff awareness and promotes its success
When is weaning by NIPPV used? Used predominantly for patients with no need for artificial airway but who are having difficulty weaning from conventional ventilation
Weaning by NIPPV may also be used for what? To avoid reintubation when respiratory failure occurs after extubation
What are the 4 benefits of weaning by NIPPV? 1. Increasing evidence 2. Improves survival 3. Lowers mortality 4. Shortens ICU stay
What evidence is out there regarding weaning? 1. A very small percentage of people needs to be weaned 2. SBT's & sedation vacations are the standard of care 3. SBT is the best method for a vast majority of patients
Weaning is best facilitated by who? The experts
What should you evaluate before discontinuing mechanical ventilation? 1. Need for protecting of the airway 2. Patients ability to mobilize secretions 3. Ability of the patient to cough effectively 4. Gag reflex 5. Ability to ventilate/oxygenate w/o an airway 6. Hemodynamic stability HR, BP, ECG
What are some common causes for failure to wean? 1. Attempt to wean too soon 2. Increase secretions can increase WOB 3. Psychological dependence on vent 4. Generalized weakness and fatigue
What equipment is needed for extubation procedure. 1. Resuscitation bag 2. O2 source 3. O2 mask or nasal cannula 4. Suction equipment 5. Supplies for reintubation if needed
What are the fist 6 steps for extubation procedure? 1. Monitor patient. 2. Place patient in semi - or high fowler’s position. 3. Explain procedure to patient. 4. Pre - oxygenate patient. 5. Suction mouth and pharynx. 6. Suction airway.
What are the last 5 steps for extubation procedure? 7. Loosen tape and deflate cuff. 8. Have patient cough while removing the tube. 9. Administer same FIO2 prior to extubation. 10. Encourage patient to deep breathe and cough. 11. Monitor patient.
Most common complication of extubation is what? 1. Sore Throat 2. Hoarsness
Most significant problem with extubation is what? Laryngeal Edema one of two 1. Glottic Edema- involves vocal cords and can be treated with cool mist, racemic epinephrine, heliox 2. Subglottic Edema- may cause complete obstruction requiring immediate reintubation or emergency trach
What is long term ventilation? Refers to those patients who are no longer acutely ill but who are presumed to have a permanent need for ventilatory support.
Patients who are medically able to leave the ICU but who have not been successfully weaned have several options? 1. Regional weaning centers 2. Long term acute care facilities 3. Extended care facilities 4. Chronic vent units in acute-care hospitals 5. Home
Created by: Langhout1418