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Pediatric MV Exam 1
| Question | Answer |
|---|---|
| What settings can be adjusted on the vent in PCV? | PIP, RR, FiO2, PEEP |
| What are the indications for CPAP? | Conditions that decrease FRC, airway collapse, weaning from mechanical ventilation, abnormal physical exam |
| What conditions can decrease FRC? | Pneumonia, atelectasis, pulmonary edema, post-thoracotomy, MAS, RDS, TTN |
| What findings indicate an abnormal physical exam? | Increased RR by 30-40%, retractions, grunting, nasal flaring, cyanosis with good ventilation |
| What is a good indicator for adequate VT? | MawP is the best indicator of balance between adequate ventilation and excessive vent pressures |
| What settings can be adjusted on the vent in VCV? | VT, RR, FiO2, PEEP |
| What are the hazards of suctioning? | Bradycardia, hypoxemia, mucosal damage, increased ICPs, atelectasis, accidental extubation, infection, vagal stimulation |
| On BiPAP, what does adjusting IPAP affect? | Improves ventilation (CO2), larger tidal volume and minute ventilation |
| On BiPAP, what does adjusting EPAP affect? | Improves oxygenation by increasing FRC, relieves upper airway obstruction with splinting action |
| What is the initial IPAP setting? | 10 cmH2O |
| What is the initial EPAP setting? | 5 cmH2O |
| What is the initial CPAP setting? | 2 - 6 cmH2O |
| What is the max level for CPAP? | 10 cmH2O |
| In what increments should CPAP be increased? | Increments of 2 cmH2O |
| How do we know CPAP has failed? | CPAP has failed if PaO2 < 50 mmHg on FiO2 of 80 - 100% at CPAP of 10 cmH2O |
| When is a patient ready to be weaned from nasal CPAP? | Wean when patient shows signs of clinical improvement |
| What are the steps for weaning a patient off nasal CPAP? | Decrease FiO2 by 5% until at 40-50%, decrease CPAP by 2 cmH2O until down to 2-3 cmH2O, remove from CPAP and place in oxyhood with same FiO2 (or up to 10% more), wean FiO2 once in hood as tolerate to room air |
| How is I time calculated? | TCT/(I+E) |
| How is static compliance calculated? | VT / Plat-PEEP |
| At what weight should babies be placed on VCV? | >10 kg |
| For infants or neonates, what mode of ventilation should be used? | PC - SIMV |
| Why is PCV ideal for neonates? | Need to protect their little lungs, preemies don't have enough surfactant |
| How is minute ventilation altered in PCV? | PIP and RR (VT is variable according to cL and RAW) |
| What is the initial mode for neonates? | PC-SIMV |
| What is the initial PIP for neonates? | Adjust to achieve adequate VT of 4-6 mL/kg |
| What is the initial PEEP setting for neonates? | 2-4 cmH2O (or set at same CPAP level prior to ventilation) |
| What is the initial FiO2 setting for neonates? | 40-60% (or set at same level prior to ventilation) |
| What is the initial RR setting for neonates? | 20-30 BPM |
| What is the initial I time setting for neonates? | Good I:E ratio (at least 1:2) |
| What is the initial flow setting for neonates? | To meet PIP before I time is met |
| What are the signs of right mainstem intubation? | Absence of breath sounds of the left side, unilateral chest rise, increased PIP |
| What must a baby have before being weaning from the vent? | Good spontaneous movement and respiratory effort (NIF > -20), underlying disease process resolving, minimal ventilatory support |
| How much more O2 may be needed after baby is extubated? | 15% or more O2 (OK as long as under 60%) |
| When weaning a pediatric patient from mechanical ventilation, what must the child first have? | Underlying disease process resolving, alert and wake (little sedation ok), FiO2 <50% and PEEP < 8 cmH2O, minimal RR and PS (like adults), NIF > -20 and VC >10mL/kg |
| What are the types of vent triggers? | Time, Flow, Pressure |
| What are the types of vent cycling? | HPL or HVL, time, flow, volume, pressure |
| How does cL affect VT? | Decreased cL = decreased VT |
| What things can affect MawP? | PIP, PEEP, I time, and RR |
| What is the best CPAP device for newborns? | Nasal CPAP via prongs or pillows |
| What factors affect RAW? | Viscosity of gas, velocity of gas, length of tube, diameter of tube |
| What are the goals of mechanical ventilation? | Maintain normal acid/base balance, prevent complications, support of respiratory needs |
| What are possible complication of mechanical ventilation? | Barotrauma, infection, anxiety, pain |
| What is the purpose of giving surfactant? | Improve lung cL |
Created by:
ashconrad417
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