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2brt chapter 44 Egan
initiating and adjusting vent suport
| Question | Answer |
|---|---|
| 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 |
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laura2brt
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