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RCP 180 Exam 3

Early mobilization of patients on vent can decrease what: the consequences of ICU-acquired weakness (reduce incidence of delirium)
Single best indicator of alveolar ventilation PaCO2
When C02 rises by ten, pH will decrease by approximately 0.08 units
Know what happens to pH when C02 and Hc03 changes When CO2 increases pH decreases; when HCO3 increases pH increases
When Vt changes are made when increased CO2 drops pH increases; when decreased CO2 increases pH drops
When RR changes are made when increased CO2 drops pH increases; when decreased CO2 increases pH drops
When FiO2 and PEEP changes are made can be used to improve oxygenation
Pplats should be kept <28-30
More mechanical dead space increases PaC02: may cause an increase in PaCO2 if there is no change in Vt or RR
Minute volumes of ____ are required to maintain a normal PaCO2 80-100mL/kg/min
What are the three scalars commonly seen on the ventilator display Flow-time, pressure-time, and volume-time
Routine monitoring of oxygenation the ICU often involves the use of continuous pulse oximetry and intermittent arterial blood gas analysis
Patient with a head truama will likely have a device monitoring ICP
In PC, we want to monitor tidal volumes because they are variable and can change depending on Cl and aw
A mode of mechanical ventilation which provides a form of IMV which incorporates a targetign scheme Automode
What all does an inspiratory pause tell us Plateau pressure; determinations of lung mechanics, compliance, and resistance can be made
Vt range for non-ARDS patients 400-700mL (about 7ml/kg IBW)
Ideal temp for heated wire circuit 34-41°C to achieve 33-44 mg H2O/L humidity
I:E ratio should be _______ or lower for most patients 1:2 or lower
When set appropriately, ventilator mode and settings should reduce WOB while avoiding ventilatory muscle atrophy
Modes that reduce inspiratory effort without eliminating respiratory muscle use Assist/control volume ventilation, assist/control pressurecontrol ventilation, SIMV with pressure support, and standalone pressure-support ventilation can reduce inspiratory work without eliminating respiratory muscle activity
Sustained increase in ventilatory workload may cause what ventilatory muscle fatigue and structural injury which cause ventilatory failure
Common problems seen soon after intubation Accidental extubation, Airway malfunction, Obstruction, Secretions, Kinks, Cuff leaks, Pilot balloon failure, Aspiration of secretions due to cuff failure or improper inflation
Peak flow should be set to do what, in VC-CMV? In general, PIP should be ≤ 40 cm H2O while maintaining Pplateau ≤ 28 to 30 cm H2O
The work of breathing to trigger a machine breath is termed Trigger work
Pressure trigger sensitivity is usually set at the trigger generally is set between –0.5 and –1.5 cm H2O, although some circuits may require trigger sensitivity be set at –2.0 cm H2O to avoid autotriggering.
How is patient ventilator asynchrony usually detected Physical assessment and observation of ventilator graphics
Mode asynchrony occurs when the mode selected does not match the patient’s spontaneous ventilatory efforts
Flow asynchrony occurs when the inspiratory gas flow from the ventilator does not match the patient’s inspiratory flow demand
Cycle asynchrony occurs when there is poor coordination between the patient’s respiratory drive and the ventilator
Auto triggering occurs when the ventilator initiates inspiration without a corresponding patient effort due to inappropriate ventilator trigger sensitivity settings
Double triggering ventilator may cycle to the expiratory phase while the patient continues to make an inspiratory effort or patient may try to breath in longer or deeper than the ventilator is set to provide
Reverse triggering may occur during controlled ventilation in which a time-triggered ventilator breath stimulated the diaphragm, resulting in diaphragmatic contraction which then triggers the next breath
What is ‘least PEEP’ Minimum PEEP is the least PEEP needed to achieve adequate arterial oxygenation at a safe oxygen concentration
Harmful effect of PEEP includes what? Pulmonary barotrauma or VALI (alveolar overdistention), may reduce venous return and compromise cardiac output and BP
Tissue oxygenation is determined by what Inspired oxygen concentration, alveolar ventilation, ventilation-perfusion relationships, diffusion across the alveolar-capillary membrane, arterial oxygen content, cardiac output, and peripheral perfusion
Oxygenation goals for adults on a vent are what A clinical goal of PaO2 = 60 to 80 mmHg and SaO2 = 90% to 95% at FIO2 ≤ 0.50 to 0.60 is appropriate for most patients. SpO2 ≥88% with FiO2 ≤66%
Patients with ARDS need high PEEP High PEEP strategies employed in patients with ARDS may improve mortality in patients with moderate to severe ARDS but worsen it in patients with mild ARDS. High PEEP strategies probably work best in ARDS patients with a large volume of recruitable lung.
Calculation for static auto-PEEP Subtract extrinsic PEEP from the observed end-expiratory pressure observed during the expiratory pause
Various recruitment maneuvers can be done. PEEP of 20 for 20 seconds, 30 for 30, 40 for 40. Which is used for ARDS patients? 30 for 30 or 40 for 40
How dynamic auto PEEP is detected Can be measured in spontaneously breathing patients by observing the flow-time curve
A method used to identify optimal PEEP for patients with ARDS following a lung recruitment maneuver includes A decremental PEEP trial
What is autoPEEP PEEP caused by incomplete gas expiration prior to the initiation of the next breath provided by the ventilator (Intrinsic PEEP)
Types of patient-ventilator asynchrony Trigger asynchrony, flow asynchrony, mode asynchrony, and cycle asynchrony
When should the respiratory care clinician drain the ventilator circuit tubing When there is visible condensation
What happens to the waveform, PIP, and Pplat when compliance decreases? PIP and Pplat rise
How to identify a patient triggered breath looking at the waveform A pressure deflection below baseline just before a rise in pressure indicates a patient’s inspiratory effort resulting in a delivered breath
Most common trigger variable Time and patient effort
The primary function of a mechanical ventilator is to do what? To augment or replace normal ventilation
Four major indications for mechanical ventilation Apnea, acute ventilatory failure, impending ventilatory failure, and severe oxygenation problems
When expiratory flow takes longer to return to baseline, what does this indicate on a flow waveform? Air trapping/ Auto-PEEP
What therapy may be useful to prevent post extubation respiratory failure? NIV
What do you do if the pressure deflection is greater than normal Raise PEEP
A mode of ventilation which may be time or patient triggered and is pressure limited and time cycled PCV (pressure controll ventilation)
An increase in airway resistance causes the pressure-volume loop to do what? Widen and slope lowers
Increased RR Decreased PaCO2
Decreased RR Increased PaCO2
Increased Pi Increased Vte, decreased CO2
Decreased Pi Decreased Vte, increased CO2
Increased Ti Increased Vte, decreased CO2
Decreased Ti Decreased Vte, Increased CO2
FiO2 and PEEP Alter PaO2
Review conditions that will lead to air trapping, or AutoPEEP Emphysema, COPD,
Pressure control pressure-targeted mode of ventilation that allows for mandatory, time triggered breaths or patient assisted breaths
Volume control volume-targeted mode of ventilation that allows for mandatory, time triggered breaths or patient-assisted breaths
CMV continuous mandatory ventilation
IMV intermittent mandatory ventilation
CSV continuous spontaneous ventilation
Review what decremental recruitment is Used to identify optimal PEEP for patients with ARDS following a lung recruitment maneuver
Advantages of PC-CMV Inspiratory pressure is constant Pplat can be maintained at safe levels Resultant PIP may be lower than can be achieved with VC-CMV Risk of alveolar over distention is reduced Desired Vt may be achieved by adjusting PIP or Ti
Advantages of VC-CMV Vt remains constant Minute vent delivered based on f and Vt Full support Minimizes or eliminates WOB Time-triggered vent eliminates the WOB but requires apnea Allows for vent muscle rest and recovery Suited for most pts
Prone positioning is used to improve what Improve oxygenation in ARDS patients
SOFA: sequential organ failure assessment- scores predict ICU mortality based on the level of dysfunction of 6 organ systems: respiratory, cardiovascular, neurologic, renal, coagulation, and hepatic.
START the most common prehospitalization triage system in the US; used by first responders on site, and the individuals are transported to acute care facilities based on the prioritized triage results
JUMPStart the pediatric version of START
Common ways to reduce airtrapping in NIV and invasive ventilation Increase PEEP
RSBI is used to assess what Rapid shallow breathing index; somewhat predictive of patient’s ability to maintain spontaneous breathing and weaning readiness; measure of adequate ventilation
When is fluid resuscitation indicated When intravascular volume is inadequate; blood loss, hemorrhagic shock, septic shock, traumatic shock
Hypovolemia may cause what Low BP and low urine output (intravenous volume replacement therapy may be indicated in cases of hypovolemia, hypotension, and shock.)
Causes of hypotension Bleeding or fluid loss, reductions in cardiac output, inappropriate peripheral vasodilation as may occur in sepsis or anaphylaxis
When are vasopressors indicated When mean arterial pressure is less than 60 mmHg resulting in inadequate organ perfusion (inotropic drugs increase myocardial and cardiac output)
EKGs provide what information Heart rate, rhythm, and recognition of dangerous arrhythmias and recognize episodes of myocardial ischemia
What type of catheters are used to assess central venous (right atrial) pressure, right ventricular pressures, pulmonary artery pressures, pulmonary capillary wedge pressures (PCWP) and cardiac output? Central venous catheter and pulmonary artery pressure
Which of the following techniques provides a noninvasive estimate of arterial oxygenation and carbon dioxide Transcutaneous monitoring by using sensors placed on skin
BUN, serum creatinine, and GFR allow for assessment of which of the following Kidney function
Glasgow scale assesses what Level of consciousness in the ICU; 3-15 less than 8 intubate
Complications of intubation Difficult intubation, prolonged intubation, hypoxemia, hypercarbia, acidosis, trauma to the airway, glottis, vocal cord, or laryngeal trauma, aspiration, inadvertent mainstem bronchial intubation, inadvertent esophageal intubation, airway obstriuction
Patients in the ICU who are malnourished often need what kind of support Nutritional support (enteral or parenteral nutrition)
Indications for chest tube insertion and for thoracentesis Pleural effusion, pneumothorax
Created by: K.Moskowitz
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