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MV - Exam #1

Mechanical Ventilation Exam 1

What are the four indications for mechanical ventilation? Acute ventilatory failure, impending ventilatory failure, severe hypoxemia, prophylactic support
What are the absolute contraindications for mechanical ventilation? Untreated pneumothorax
What are the relative contraindications for mechanical ventilation? Patient's informed consent (DNR, DNI, family wishes/POA), medical futility, reduce or eliminate pain and suffering (terminal cases)
What are the goals of mechanical ventilation? Provide pulmonary system with support, maintain adequate ventilation, decrease WOB, restore acid/base balance, improve oxygenation, improve bronchial hygiene, avoid harmful side effects
What is the most common reason to vent a patient? Post-op patients
What kind of nutritional support is needed for COPD patients? COPD patients require higher caloric intake due to using all of their calories support breathing; COPD patients need 10x more calories than normal individuals
What is sustained hyperventilation? Used to reduce cerebral blood flow and therefore decrease ICPs, patient is hyperventilated to create RAK
What is TPN? Total Parenteral Nutrition, nutrition given through IV
What are possible hepatic complications from mechanical ventilation? Inversely (indirectly) related to amount of PEEP being applied, more PEEP = less liver function, pressure causes decreased perfusion to hepatic artery, decreased perfusion = decreased liver function
What are the signs of hepatic complications? Increased prothrombin time (blood doesn't clot as quicky; normal 12 - 15 seconds), increased bilirubin levels (jaundice), decreased albumin
What mechanical ventilation settings effect hemodynamic values the most? Level of airway pressures (PIP and MawP), tidal volume, PEEP
What mechanical ventilation settings effect hemodynamic values the least? Inspiratory flow rate, respiratory rate
How does mechanical ventilation affect CVP? Increased PVR = back up of blood from RV into RA; decreased C.O. = less venous return
How does mechanical ventilation affect PCWP? Not affected as much by PPV, unless using high PEEP, high PEEP will cause an increase in PCWP; body reabsorbs majority of back up fluids - edema in body
How does mechanical ventilation affect aortic pressure and C.O.? Increased pressure = decreased SV = decreased C.O. = decreased BP
How is PAP effected by mechanical ventilation without PEEP? Decreased SV due to decreased venous return, less blood pumping into pulmonary vessels, which lowers PAP and decreases CVP
How is PAP effected by mechanical ventilation with PEEP? Compresses pulmonary blood vessels significantly, increases PAP and CVP due to back up blood, constant pressure on lungs at all times, not just inspiration
How are venous return and stroke volume affected by PPV? Decrease preload, SV, and C.O., decrease renal function leading to fluid retention and decreased urine outpute, decreased venous return, increased ICP
How can you decreased MawP? By decreasing any of the factors that directly effect MawP; I-time, RR, PIP, PEEP, RAW
What are possible complications of PPV? Intubation complications, barotrauma/volutrauma, ventilator induced injury, oxygen toxicity, VAP, auto PEEP, cardiovascular effects
How is hepatic perfusion effected by PEEP? More PEEP = less liver function, pressure causes decreased perfusion to hepatic artery, decreased perfusion = decreased liver function
What is normal urine output? 1200-1500 cc/day (50-90 cc/hr)
What is the 1st sign of decreased cardiac output? Decreased urine output
How much blood is needed to ensure that the kidneys can adequately remove waste? 90 mL/min
How does PEEP affect out of hemodynamic values? Increased intrathoracic pressure, decreased venous return, decreased SV and CO, increased PAP, increased CVP
How do you calculate deadspace? VD/VT = PaCO2 - PeCO2 / PaCO2 (>20% gets a vent)
What is the normal value for normal oxygenation? 80 - 100 mmHg
What is the normal value for mild hypoxemia? 60 - 79 mmHg
What is the normal value for moderate hypoxemia? 40 - 59 mmHg
What is the normal value for severe hypoxemia? <39 mmHg
What is oxygen failure (severe hypoxemia)? aka "hypoxemia respiratory failure", PaO2 < 60 mmHg on >50% FiO2 or PaO2 <40 mmHg on any FiO2 - refractory hypoxemia
What causes hypoxemic respiratory failure? Diffusion impairment, intrapulmonary shunting, low V/Q ratio
What are the four factors that affect RAW? Viscosity of gas, velocity of gas, length of airway, diameter of airway
What are causes of increased cL? Improvement in problem, emphysema, position change, flail chest (no stability of rib cage)
What are causes of decreased cL? Atelectasis, pneumonia, pulmonary edema, ARDS, pneumothorax, pulmonary fibrosis, obesity, chest wall deformities (kyphosis)
What are the four types of hypoxia? Anemic, hypoxic, histotoxic, circulatory
What is the equation for shunt? QS/QT = CcO2 - CaO2 / CcO2 - CvO2
How do you calculate dynamic compliance? VT / PIP - PEEP
How do you calculate static compliance? VT / Plat - PEEP
What happens if a patient has increased cL and an increased E time? Air trapping
Created by: ashconrad417