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DrReedChp4
mech vent chp 4 test 3/1/18
| Question | Answer |
|---|---|
| Barotrauma | Hyperinflation of alveoli past the rupture point. |
| Points past the "rupture" point in barotrauma | PEEP > 10; Mean >30; or PIP > 50; any pt hits PIP 50, change to PCV |
| Results of barotrauma | Pneumothorax, tension pneumothorax, pneumomediastinum, tracheal shift |
| Causes barotrauma | Volume control & a lot (too much) PEEP: should switch to pressure if this happens |
| Causes ICP? | PEEP 8 to 12. |
| Complications barotrauma to renal function | It alters renal function and water metabolism. |
| "clinical" guide for refractory hypoxemia | When pts PaO2 is 60 mm Hg or lower at an FiO2 of 50% or greater. |
| Primary indication for PEEP | Refractory hypoxemia caused by intrapulmonary shunting. |
| Causes of intrapulmonary shunting | ↓ of FRC, atelectasis,or ↓ V/Q mismatch |
| Auto-PEEP | Air trapping caused by severe airflow obstruction or insufficient expiratory time |
| Significant reason to use BiPAP | To avoid intubation by using inspiratory and expiratory pressure difference. |
| BiPAP | Bilevel Positive Airway Pressure: Applies independent positive airway pressures (PAP) to both inspiration and expiration. |
| Initial settings BiPAP | IPAP 8 EPAP 4; Pressure is titrated based on pt need. |
| What is the difference between IPAP and EPAP for? | The pressure support needed by the pt. |
| What are the correct increase increments for IPAP and EPAP? | Always increase in increments of 2's as pt can tolerate. |
| What conditions should pt report immediately while using BiPAP? | Headache, Chest pain, WOB or SOB |
| What is T-low? What is normal? | The release time = 0.8 to 1 second is normal. |
| What happens with T-low at .05? | Pt has less time to exhale Vt, most of Vt will stay inside. |
| What is status asthmaticus? | You've given asthma treatment & doesn't help the pt. Usually requires "knock out" 24 hrs & vent support |
| Full ventilatory support (FVS) | Provides all breathing support to pt |
| 2 primary advantages of FVS? | 1) Pts WOB ↓ & exceeds pts inspiratory flow demand. 2) Allows pt to control frequency. |
| Complications of FVS? | Compensated Alveolar Hyperventilation, Respiratory alkalosis, pH ↑ and PaCO2 ↓ |
| What is the only time we add additional tubing? | When pt is brain-dead; to normalize pressure until get pts organs if organ donor. |
| Indications for partial vent support (PVS) | Pt on AC for 24 hrs, then switched to SIMV. Give trial run, gradually, to see how pt does |
| Parameters for weaning? | DO NOT WEAN until underlying condition is fixed. |
| Advantages to PVS? | 1) Pt uses their respiratory muscles, so they won't atrophy. 2) Reduces V/Q mismatch, 3) ↓ MAP or mPAW |
| Why does partial vent support decrease MAP or mPAW? | When pt is on AC. every breath is positive. When pt is on SIMV and spontaneously breaths, the breath is negative; this ↓ MAP |
| Why is Peak pressure not as important as MAP? | Because the MAP is in the actual airway; If you ↑ MAP, then you ↓ RVR & ↓ CO |
| Complications of weaning SIMV mode | Desire to wean too fast, must ↓ SIMV slowly and monitor closely |
| Why is it not a good idea to use MMV if pt has a high RR? | Because on MMV mode, it will increase RR to reach the Ve you set. You can only use this if pt is breathing w/o spontaneous rate. Only use if pt has low Ve and low RR. |
| What is a good exception to MMV mode? | On the Hamilton Veolar Vent, it operates as VS, augments spontaneous Vt, it increases PS, which in turn increases Ve |
| What is good about PC? | I-time is your cycle |
| Can you use VS by itself? | Yes, vent automatically adjusts the PS to reach the Vt you set. |
| Vented | Expiratory valve opens to allow pt to cough |
| Time Triggered Mandatory | allows spontaneous breathing |
| T-high | how long to hold P-high |
| T-Low | how long to hold P-low |
| If you find alarms set too high | Document what you found vent set at, then document what you change it to. Protect yourself and pt |
| Normal release time | 0.8 to 1 second; allows short time so can get breath in |
| BiPhasic PAP | like APRV; except pt spends more time @ low level (expiration) |
| ↑ MAP | improved shunting |
| AutoPEEP | refractory hypoxemia |
| CVP | affects press coming to right side of heart |
| PAP | affects pulmonary artery & lungs |
| Airway Pressure Amplitude | Delta P/pressure, frequency = Hz. 3Hz=180, 5Hz=300; MAP adjusted according to set, iTime%, Bias flow=Exhalation pressure, FiO2 |
| Max out Delta P Pressure | then change frequency ↓ |
| Bias flow | 1st thing set, powers vent & allows pushing exhalation valve out= exhalation |
| MAP | effected by iTime, PIP, PEEP, and RR |
| negative pressure ventilation | alveolar pressure > atmospheric pressure |
| Mechanical breath ventilation | positive pressure ventilation at airway opening |
| Mechanical Breath Variables | Control, Trigger, and Cycle |
| Breath sequence | Continuous mandatory, intermittent, continuous spontaneous |
| Type of control or target scheme | Set point, Servo, Adaptive, and Optimal |
| Spontaneous Ventilation | pt doing the work |
| PEEP | positive end expiratory pressure: ↑ end-expiratory or baseline pressure to value greater than atmosphere; anything above zero |
| CPAP | Continuous positive airway pressure; PEEP without a rate; all spontaneous breathing, no mechanical vent; to use pt MUST have adequate spontaneous breathing |
| CMV | Controlled mandatory ventilation; Preset Vt, Time triggered; spontaneous vent from pt not possible. |
| AC | Assist control; pt triggered, negative pressure deflection (below baseline), control = time trigger. It may be pt triggered or time triggered. Pt gets set Vt & Pressure. You can see what pt efforts are -- Danger: Hyperventilation!! |
| IMV | intermittent mandatory ventilation; Not synchronized!; vent dlvrs mandatory breath & pt can breath in between |
| SIMV | Synchronized intermittent mandatory ventilation; Synchronized! If pt attempts to take a breath, machine takes over instead of breath stacking. NBRC says 1/2 second before vent. Permits pt to breath spontaneously. "truly spontaneous" |
| MMV | Mandatory minute vent: Provides Ve you set, mandatory frequency increases automatically; preventing hypoventilation & respiratory acidosis |
| PSV | Pressure support vent: It lowers the work of the pt and augments spontaneous Vt b/c of ett & vent circuit |
| ASV | Adaptive support vent: changes #of mandatory breaths & PS according to pt; it's a dual control mode, providing MMV |
| PAV | proportional assist vent: Dragger 4; it adjusts PS level according to V, Elastance, RAW, & flow demand: good for pt with COPD and can combine w/ PAX and CPAP |
| VAPS | Volume-assured pressure support: Stable Vt by using PS with VAV (volume assisted cycles), prolongs the I-time: Watch carefully! |
| PRVC | Pressure regulated volume control: PIP kept lowest by changing peak flow & iTime according to RAW & C. |
| APC | adaptive pressure control |
| VV+ | Volume ventilation plus: Puritan Bennett 840, Dual mode = Volume Control + Volume Support |
| PCV | Pressure controlled vent: Time triggered, Plateau Press created & maintained for cycle iTime **used for ARDS (must sedate) b/c only mandatory breaths dlvrd , then wean back to VC when can |
| APRV | airway pressure release vent; Expiration occurs when high pressure is changed to low pressure. We set Phigh & P-low |
| Biphasic PAP | Biphasic positive airway pressure; just means BiPAP |
| IRV | Inverse ratio vent: iTime ↑ than eTime; for ARDS need this; 2:1 or 4:1; mean ↑; creates more PEEP. Reduces intrapulmonary shunting & ↑ oxygenation. |
| ATC | automatic tube compensation: ↑ or ↓ flow according to tub size |
| NAVA | Neurally adjusted volume assist: electrodes on diaphragm controls/stimulates diaphragm, checks RR; to wean pt w/spinal cord injury or head injury |
| HFOV | High-frequency oscillatory vent: Hypoventilation managed by ↓ RR |
| Closed Loop system | the input (pressure) is constant and the output (flow) is variable; Sustains pressure plateau; MMV, ASV, PRVC, PAV, VAPS, VA; |
| Role of vent during spontaneous mode (not a mode set on vent) | 1) inspiratory flow to pt in timely manner; 2) flow adequate to fill pt inspiratory demand; 3) adjunctive modes (PEEP) to help pt spontaneous effort |
| Apnea Ventilation | Safety feature within spontaneous mode; dlvrs Vt, RR, FiO2, and vent functions essential to pt |
| Difference of PS and PC | iTime |
| Simple operating mode | whatever you set on vent becomes the constant. ie: Set Vt, dlvd at constant flow |
| Indications PEEP | refractory hypoxemia due to intrapulmonary shunting; ↓ FRC, ↓ Compliance |
| Physiologic PEEP | Reduces threshold for alveolar opening; FRC ↑, enhances gas diffusion & O2 |
| Complication PEEP | ↓ venous return, ↓ CO, barotrauma, ↑ ICP, ↓ renal function & water metabolism |
| Indication BiPAP | Prevent intubation, Chronic vent failure, restrictive chest wall disease, neuromuscular disease, nocturnal hypoventilation (apnea) |
| Indications CMV | Tetanus seizures, complete rest, crushed chest injury, paradoxical chest wall movement |
| Complication CMV | Prolonged sedation = vomiting, apnea & hypoxia, rapid atrophy b/c disuse of resp muscles |
| Indications AC | Full vent support, minimize atelectasis |
| Advantages AC | ↓ WOB, pt can ↑ Ve |
| Complications AC | Hyperventilation |
| Indications IMV | Mandatory vent, RR w/precise timing, Spontaneous breathing allowed in between |
| Complication IMV | Breath stacking, air-trapping |
| Indications of ARDS | PaO2 < 60 and FiO2 50% or greater |
| P/F Ratio | |
| Indication Refractory hypoxemia | FiO2 of 50% or greater |
| Target Pressure for BiPAP | 5-7 ml/kg |
| VCV | Volume Control: Dlvrs Vt, & PIP is variable, according to pt. We set Vt & if C ↑, Pressure ↓ |
| PCV | Pressure Control: If ↑ RAW & ↓ C, will ↓ dlvd volume. We set pressure & Vt is variable. Set iTime=plateau pressure. ↓RAW=↑Ve, iTime is constant. Don't mess with rate, it changes iTime; changes TCT, messes with volume |
| VS | Volume Support: apneic pt. won't get breath needs backup PRVC or VV+ |
| What is PEEP without a RR? | CPAP |
| P-high | Is inspiration = oxygenation |
| P-low | Is expiration = ventilation |
| Normal P-high | 6 ml/kg |
| Inverse Ratio means | Creating another plateau trying to oxygenate; longer iTime |
| Why do we get auto PEEP? | Air Trapping: not long enough to exhale |
| What is an oscillator? | Decreases pressure, then frequency. SV; high rate range & 3-15 Hz |
| Advantages SIMV | ↓ MAP, need PS to help with Vt |
| What is auto mode? | On the Servo i vent |
| Indications PCV | ARDS, stiff lungs, respiratory disease |
Created by:
Beccaboop
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