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Pediatric MV Exam 1

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