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2brt chapter 44 Egan

initiating and adjusting vent suport

QuestionAnswer
MOST COMMON DIAGNOSES REQUIRING MECH VENT SUPPORT 1. ACURE RESP. FAILURE 2. COPD EXACERBATION 3. COMA 4.NEUROMUSCULAR DISEASE
MOST COMMON CAUSES OF ACUTE RESP. FAILURE REQURING MECH VENT 1. POST OP 2.SEPSIS 3.HEART FAILURE 4.PNEUMONIA 5.TRAUMA 6.ARDS 7.ASPIRATION
PRIMARY INDICATIONS FOR MECH VENT (BIG FOUR) 1.APNEA 2.ACUTE VENT. FAILURE 3.IMPENDING VENT FAILURE 4.SEVERE OXYGENATION PROBLEMS
GOALS OF MECH. VENT. SUPPORT 1.MAINTAIN ADEQUATE ALVEOLAR VENTILATION 2.O2 DELIVERY 3.RESTORE ACID-BASE BALANCE 4.REDUCE WOB WITH MINUMUM SIDE EFFECTS OR COMPLICATIONS
SECONDARY TO HYPOXEMIA AND AN INCREASED WOB MECH VENT MAY ALSO REDUCE WHAT? INCREASED MYOCARDIAL WORK
OTHER PHYSIOLOGIC OBJECTIVES OF MECH. VENT. MAY INCLUDE INCREASING OR MAINTAINING LUNG VOL WITH WHAT? PEEP FOR PROMOTION IMPROVEMENT OR MAINTENANCE OF LUNG RECRUITMENT
LUNG PROTECTIVE VENTILATORY STRATEGY IS? A SMALL TIDAL VOL AND APPROPRIATE LEVELS OF PEEP
WHAT PT'S ARE LUNG PROTECTIVE VENT STRATEGY USED FOR? ARDS\ALI BUT SHOULD BE USED FOR ALL REQUIRING VENT SUPORT WITH ACUTE FAILURE
LUNG INJURY DURING MECH VENTILATION IS CAUSED BY? ELEVATED TRANSALVEOLAR PRESSURE DURING POSITIVE PRESSURE BREATHING
TRANSALVEOLAR PRESSURE IS THE DIFFERENCE BETWEEN ALVEOLAR PRESSURE AND PLEURAL PRESSURE DURING POSITIVE PRESURE VENTILATION
NORMAL LUNGS NOT OVER DESTENDED IF TRANSALVEOLAR PRESSURE OS LESS THAT WHAT? LESS THAN ABOUT 30CM H2O
PLATEAU PRESSURE REFLECTS ALVEOLAR PRESSURE
LIMITING PLATEAU PRESSURE BELOW WHAT REDUCES RISK OF VENT INDUCED LUNG INJURY? <30 CM H2O
PATIENTS WITH DECREASED LUNG COMPLIANCE MAY REQUIRE PLATEAU >30CM H2O WHY? WHAT KINDOF PT'S RE THESE? 1.BECAUSE OF DECREASE IN CHEST WALL COMPLIANCE. 2.OBESE, MASSIVE FLUID RESUSCITATION, ABDOMINAL DITENTION, AND ELIVATED BLADDER PRESURE.
LUNG INJURY IS CAUSED BY? WHAT CAN STABILIZE TO HELP PREVENT INJURY? 1.REPETITIVE OPENING AND CLOSING OF UNSTABLE LUNG UNITS. 2.PEEP STABILIZES IN OPEN POSITION REDUCING LIKELY HOOD OF INJURY
PHYSIOLOGIC GOALS OF VENT SUPPORT 1.SUPPORT/MANIPULATE GAS EXCHANGE 2.INCREASE LUNG VOL. 3.REDUCE OR MANIPULATE THE WOB 4.TO MINIMIZE CARDIOVASCULAR IMPAIRMENT
CLINICAL OBJECTIVES OF VENT SUPPORT 1.REVERSE HYPOXEMIA, AUTE RESP. ACIDOSIS, VENT MUSCLE DYSFUNCTION, AND ATELECTASIS 2.REDUCE ICP.3.RELIEVE RESP. DISTRESS 4.ALLOW SEDATION/NEURO BLOCK 5.DECREASE SYSTEMIC OR MYOCARDIAL O2 CONSUMPTION 6.MAINTAIN/IMPROVE CARDIAC OUTPUT 7.STABILIZE THE CHEST
HOW DO U CALCULATE MINUTE VENTILATION VE=f X Vt
PACO2 TELLS WEATHER YOU ARE DOING WHAT? VENTILATING
PAO2 WEATHER YOU ARE DOING WHAT? OXYGENATING
WHAT IS PRESURE CONTROL USED FOR? used to keep presure low for ARDS AND ALI.
WHAT ARE THE INITIAL SETTINGS THAT SHOULD BE SET FOR AN ARDS Vt SET AT LESS THAT 8ML/KG IBW I:E OF 1:2 AND PEEP OF 10CM H2O.
WITH SMALL Vt, WHAT SHOULD BE MONITORED TO PREVENT WHAT? MAINTAINING AN ADEQUATE VE AND PREVENT ACUTE SEVERE RESP. ACIDOSIS.
WHAT IS VOLUME CONTROL USED FOR? HYPERCABIA (PACO2) AND TO CONTROL MINUTE VENTILATION
WHAT WILL AFFECT A PT'S I:E TIME? HIGHER FLOW WILL (UP TO 100l/MIN) WILL INCREASE THE E TIME.
I FLOW SHOULD BE ADJUSTED TO ENSURE THAT? THE FLOW PROVIDED MEETS OR EXCEEDS THE PT'S SPONTANIOUS I FLOW
ACUTE HYPOXIC RESP FAILURE FINDINGS (MILD TO MODERATE) TACHYPNEA DYSPNEA PALENESS
ACUTE HYPOXIC RESP FAILURE FINDINGS (SEVERE0 SLOWED, IRREGULAR BREATHING, RESPIRATORY ARREST DYSPNEA CYANOSIS
PRESURE TRIGGER RANGE -0.5 TO -1.5 CM H2O
SENSITIVITY SHOULD BE ADJUSTED TO -2 CM H2O
FLOW TRIGGER RANGE 1 TO 3ML
WHAT WE SET ON THE VENT MODE, VT, RATE, PEEP, FIO2
WHAT IS FLOW RANGE 60 TO 80
PEEP DOES WHAT INCREASE PAO2, INCREASE FRC, AND IMPROVES OXYGENATION
PT'S THAT WOULD BENIFIT FROM PEEP ACURE RESTRICTIVE DISEASE, ALI, PNEUMONIA, PULMONARY EDEMA, AND ARDS
PT'S THAT WOULDN'T BENIFIT MUCH FROM PEEP COPD PTS PR ACUTE ASTHMA. AUTO PEEP IS USED TO OF SET AUTO PEEP.
IF PAO2 IS LOW WHAT WILL HELP TO IMPROVE IT? INCREASE PEEP BY 2 TO IMPROVE PAO2
HAZARDS OF MECH VENTILATION DECREASED VENOUS RETURN, INCREASE WOB AND CARDIO OUTPUT DYSFUNCTION, VENT INDUCED LUNG INJURY NOSOCOMIAL INFECTION
VT TO START KIDS ON? 8-16YRS 8-10 0-8YRS 6-8
NVVP NOT USED FOR? PT'S PRONE TO ASPIRATION, PT NEEDING HIGHER AIRWAY PRESURE
PARTIAL VENT MODE USED FOR? PT'S WITH DRIVE TO BREATH, BEING WEANED, OR TO MINIMIZE ADVERSE EFFECTS OF POSITIVE PRESSURE
NERO PT WITH ICP WE WANT TO? HYPERVENTILATE 25-30
TITRATE FIO2 DOWN BY? IF SPO2 IS GREATER THAT 97%,TITRATE DOWN EVERY 5 TO TEN MIN. IF .95% BUT LESS THAN 97% TITRATE BY .05 UP OR DOWN
Created by: laura2brt