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MV - Exam #3

Mechanical Ventilation Exam 3

QuestionAnswer
What is a trigger? Signals ventilator to begin inspiration; how breath is started
What is a cycle? Parameters on the vent that terminate inspiration; how the vent ends the breath
What are the different triggers that can be set on the vent? Time, Pressure, Flow
What is time triggered ventilation? Inspiration initiated when a preset time interval has been reach; controlled RR, only machine breaths
What is pressure triggered ventilation? Inspiration initiated when ventilator senses patient's spontaneous inspiratory efforts; controlled by pressure sensitivity
What is the normal sensitivity setting? -1 to -5 cmH2O (-2 is ideal)
How does increasing the sensitivity number effect the sensitivity of the vent? Higher the number (-5), less sensitive the setting; harder to initiate a breath, more the patient has to pull back
How does lowering the sensitivity number effect the sensitivity of the vent? Lower the number (-1), more sensitive the setting; easier to initiate a breath, less patient has to pull back
What should be done if the patient is having difficulty triggering a breath on the vent? Decrease sensitivity # (this makes the vent MORE sensitive)
What is flow triggered ventilation? Low amount of continuous air flows through circuit, as patient tries to initiate a breath, amount of flow at patient wye changes triggering inspiration, controlled by flow (sensitivity) - more flow = easier to inspire, ONLY patient breaths
What are the different ways a ventilator can be cycled? Volume, Time, Pressure, Flow, HPL, HVL
What is volume cycled ventilation? Inspiration ends when preset VT is reached; volume is constant, PIP is variable
What is the advantage of volume cycled ventilation? Guaranteed VT
What is the disadvantage of volume cycled ventilation? PIP may increase too high (causing barotrauma) - PIP must be monitored closely
What is time cycled ventilation? Inspiration ends when preset inspiratory time has been met; volume is variable
What is the advantage of time cycled ventilation? Best method to control I:E ratio
What is the disadvantage of time cycled ventilation? VT dependent on lung cL and RAW (atelectasis), very important to monitor exhaled VT
When does the breath end in PCV? When time has been met, not pressure
What is pressure cycled ventilation? Inspiration ends when preset PIP is reached; volume is variable (varies directly with lung cL and indirectly with RAW); flow and pressure are constant
What is the advantage of pressure cycled ventilation? PIP (and MAP) is controlled (reduces barotrauma)
What is the optimal PIP in pressure cycled ventilation? < 50 cmH2O
What is the optimal MAP in pressure cycled ventilation? < 30 cmH2O
What is the disadvantage of pressure cycled ventilation? Decreased cL and increased RAW = lower VT (can build up CO2; atelectasis) - need to monitor exhaled VT (MOST important to monitor!)
What is high pressure limit (HPL or HVL) cycled ventilation? Safety measure (alarm setting), ends inspiration when high pressure limit value is reached, even if full VT is not delivered. Used with volume ventilation to protect against barotrauma
Which waveform mimic spontaneous breathing? Sine (Sinusoidal) - flow starts slow, goes to peak flow, then slowly back down
What is normal MawP? <10 cmH2O (<30 cmH2O)
What is critical MawP? >30 cmH2O
What is TCT? Total Cycle Time - total time it takes for both inhalation and exhalation to occur
How is TCT calculated? 60/RR
How is inspiratory time calculated? TCT/I+E
How is expiratory time calculated? TCT - I time
What is I time %? Percentage of total breath that is allowed for inspiration
How is I time % calculated? I / I+E
What is inspiratory flow? Speed of the gas flowing in during inspiration
How is inspiratory flow rate calculated? Set MV / I time%
What is barotrauma? Trauma caused by high pressure
What is volutrauma? Trauma caused by high volumes of gas
What are the benefits of CPAP? Increased FRC, decreased pressure need for alveolar inflation, decreased WOB, less FiO2 to achieve adequate PaO2, most therapeutic for hypoxemia secondary to intrapulmonary shunting, increased cL, stabilizes alveoli
What is PEEP? Positive End Expiratory Pressure, preset pressure present in airways at end expiration, can be used in ANY mode of ventilation
How does PEEP improve gas exchange? Preventing alveolar collapse, recruiting more lung units (alveoli), increasing FRC, redistributing fluid in alveoli, improving lung compliance
What are the indications for PEEP? Hypoxemia, mechanical ventilation, severe restrictive lung disease, flail chest (ALWAYS)
What are the contraindications for PEEP? Increased ICPs, untreated pneumothorax, brocho-pleural fistula
What is VC-CMV? Volume Control-Controlled Mandatory Ventilation - set RR, set VT, PIP is variable, time triggered, volume and HPL cycled, machine breaths ONLY, patient cannot breath over vent
What is PC-CMV? Pressure Control-Controlled Mandatory Ventilation-Set RR, set PIP, set I time, VT is variable, time triggered, time and HVL cycled, machine breaths only, patient cannot breathe over vent
What is VC-AC? Volume Control-Assist Control-set RR, set VT, PIP is variable, time, pressure, and flow triggered, volume and flow cycled, machine and assisted breaths, patient can breathe between machine breaths, VT is constant
What is PC-AC? Pressure Control-Assist Control-set RR, set PIP, set I time, VT is variable, time, pressure, and flow triggered, time and HVL cycled, machine and assisted breaths, patient can breathe between machine breaths, PIP is constant
What is VC-SIMV? Volume Control-Synchronized Intermittent Mandatory Ventilation- Set RR, set VT, PIP is variable, time, pressure, and flow triggered, volume, HPL, and flow cycled, machine and spontaneous breaths, patient can breathe between machine breaths, VT varies
What is PC-SIMV? Pressure Control-Synchronized Intermittent Mandatory Ventilation-set RR, set PIP, set I time, time, pressure, and flow triggered, time, HVL, and flow cycled, machine and spontaneous breaths, patient can breathe between machine breaths, PIP varies
What is APRV? Airway Pressure Release Ventilation-aka Bilevel or Biphasic Ventilation: has set RR, but VT is not set, patient can initiate breaths between machine breaths during either high or low pressure
What are the two pressures of APRV? High PEEP and low PEEP, high pressure maintained majority of time, low pressure maintained for very short intervals - allows for exhalation and gas exchange, recruit alveoli to improve oxygenation and FRC
What are the disadvantages of APRV? Variable VT, RCP must closely monitor MV and ABGs for CO2 changes
How can you confirm correct placement of ET tube? CXR, breath sounds, chest rise, CO2 detector (EZ cap or in line)
What are the indications for trach placement? Long term ventilation (>14 days), upper airway/facial trauma, sleep apnea
What is pressure support ventilation? No set RR or VT, pressure and flow triggers, flow cycled, spontaneous breaths only, can be used as a stand alone mode or added to other spontaneous breath modes, set pressure delivered and held through inspiration
Define I:E ratio Portion of inspiratory time compared to portion of expiratory time
What are the different drive mechanisms? Piston (Rotary and Linear), Reducing Valve, Bellows, Microprocessor-controlled pneumatics
What is Fluidics? How does it work? Gas flow and pressure controlled without moving parts; uses flow splitters to direct flow of gas
What is sensitivity? Amount of negative pressure that must be generated to begin inspiration; determines how easy or difficult it is for patient to initiate inspiration, only for when patient initiates breath in between machine breaths (or all breaths of CPAP)
What are machine breaths? Breaths triggered and ended by machine (any set breath)
What are assisted breaths? Breaths triggered by the patient and ended by the machine
What are spontaneous breaths? Breaths triggered and ended by the patient
What cuff pressure occludes lymphatic flow? >5 mmHg
What cuff pressure occludes venous flow? >18 mmHg
What cuff pressure occludes arterial flow? >30 mmHg
What is an OPA? Oropharyngeal airway-holds tongue away from posterior wall of the pharynx, only used on unconscious patient, measure from tip of ear to corner of mouth for correct size
What are the two types of OPAs? Guedell (tubular with hole in the middle) and Berman (channels on the side - I beam)
What is an NPA? Nasopharyngeal airway (aka nasal trumpet), holds tongues away from posterior wall of the pharynx, best tolerated by conscious patients, measure from tip of ear to tip of nose
What is an ETT? Endotracheal tube, tube inserted into trachea via nose or mouth, can be cuffed or uncuffed (kids)
What are the indications for ETT? Facilitate suctioning, protect lower airway, bypass upper airway obstruction, facilitate mechanical ventilation, administration of drugs
What are the possible complications or hazards of ETT? Infection, tracheoesophageal fistula, loss of communication, cuff rupture, cuff herniation
What are the different types of laryngoscopes? Miller (straight - lifts directly), Macintosh (curved - lift indirectly
What is normal PaO2? 80 - 100 mmHg
What is the range for mild hypoxemia? 60 - 79 mmHg
What is the range for moderate hypoxemia? 40 - 59 mmHg
What is the range for severe hypoxemia? <40 mmHg
What are the indications for pressure support ventilation? Decreased spontaneous VT (<5 mL/kg of IBW), increased RR (>25-30), increased WOB (accessory muscle use, fatigue, increased vitals, diaphoresis, decreased SpO2)
Created by: ashconrad417