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Mechanical Vent tes3

Initiation of Mechanical Ventilation

QuestionAnswer
Initiating mechanical vent: What mode do you choose? doesnt matter as long as you can set RR
Name 2 Full Support Modes in which you can set RR Controlled Mandatory Ventilation(CMV), Assist control (A/C)
Name 2 Partial Support modes in which you can set RR Intermitetnt Mandatory Ventilation(IMV), Synchronized intermittent mandatory ventilation(SIMV)
Name 1 little to no support mode CPAP
What 2 options on the vent allow you to manage CO2? RR and Vt
What is the initial setting of RR for a new mechanical vent patient? 8-12 breaths per minute
What is the initial setting for VT for a new mechanical vent patient? 8-12 ml/kg IBW
Spontaneous Vt is driven by ___ ____ and not considered on initiation of mechanical vent pressure support
What 2 options on the vent allow you to manage O2 (SaO2)? FiO2 and PEEP
What is the initial FiO2 setting for mechanical vent? 40% or 100%
Which patients FiO2 should be set at 40% on initiation? non-cardiopulmonary issues
Which patients should be started at 100% on initiation? patients with cardiopulmonary issues
What is the FiO2 exception rule? pt with a known FiO2 on different device (i.e. CPAP or BiPap) should be kept on that FiO2 when put on mechanical vent
What is the initial PEEP setting on mechanical vent? 5-10 cmH2o
All patients being set up on mechanical ventilation must have what done? ABG within 30 minutes of being placed on vent
What should the VT alarm be set at? +/- 100ml exhaled Vt or +/- 10% exhaled Vt
What should the RR alarm be set at? 10-15 bpm above observed
What should the minute ventilation alarm be set at? >10LPM or +/- 1L exhaled VE
What should PIP alarmn be set at? +/- 10-15cwp, but never greater than 50cmH2o
What should Plat alarm be set at? + 10, but never greater than 35cmH2o
If PIP and/or Plat are extrememly low, what could be the cause? leak
High PIP indicates what? Increased Raw
High Plat indicates what? increased Cs
Indications for Mechanical Ventilation includE: Apnea, Acute ventilatory failure, Impending respiratory failure, severe hypoxemia, surgery, prophylactic support for pulm complications
What constitutes acute ventilatory failure? pt contain sustain spontaneous ventilation to provide adequate oxygenation and ventilation, pH<7.25, PaCO2 >50; COPD(decomp resp acidosis with PaCO2 above pt norm)
NIF or MIP < __ cmH2o, intubate 20cmH2o
Criteria for impending Respiratory failure: Vt< 5cc/kg IBW, VC< 10cc/kg IBW, RR>35 or <10, VE> 10LPM, NIF<-20cwp,RSBI>105
What is an absolute contraindication for mechanical vent untreated tension pneumo
What is %Ti Percentage inspiratory time (ex- 1:2=3, 1/3=33%)
What mode of ventilation is used in patients with ARDS? pressure controlled ventilation
Indications for PCV are: PIP>50, Plat>35, PEEP>15,FiO2 100%, Assist control rate 16/min
What are the initial settings for PCV? FiO2 100%, pressure set at or above Pplat, Vt 6-10ml/kg IBW, I:E 1:2
Why would you initially set tidal volumes lower than 8-12ml/kg IBW? low compliance(ARDS 6-8ml/kg), Increased compliance, air trapping; or need for reduced lung volumes (pneumonectomy)
What can cause Exhaled Vt to be higher that delivered Vt? circuit compressible volume loss
Greater circuit compliance = greater volume lost per unit pressure
Volume lost is not delivered to patient but is what recorded in exhaled volume measurement (some measure vol at AO, some automatically compensate for compressible vol loss)
Volume lost = compression factor x PIP
Corrected Vt = Set Vt- Vt lost
Compressible volume loss is usually only significant in which patients? neonatal and pediatric d/t low volumes used
What type of ventilation only supports spontaneous breathing and is not needed during initial setting of vent? Pressure support ventilation
PSV pressure is set to deliver how much volume? 5-7ml/kg IBW of spontaneous Vt
Estimated VE formula male 4 x BSA; female 3.5 x BSA
BSA formula [(4 x kg) + 7]/(kg + 90)
desired RR= estimated VE/ desired Vt
What 2 things must you monitor when using PEEP? BP and ABG
Why would you increase PEEP? refractory hypoxemia, FiO2 > 60%
What is the most common method of I:E change? changing the flowrate
Increasing flow rate= decrease Ti, increase Te, increase I:E
Decreasing flow rate= increase Ti, decrease Te, decrease I:E
Normal flow rate = 40-60LPM
Ti x Flowrate= Vt
Why is Longer I time 1:1, IRV is used correct refractory hypoxemia, create auto-PEEP, decrease in compliance
Changes in RR affect the length of what? exhalation
What type of flow pattern would you see with IPPB? square
This type of flow pattern enhances gas distribution for patients with airway obstruction but may cause asynchrony? Accelerating
This type of flow pattern creates high PIP and satisfies patient flow demand? Decelerating
This is the most natural type pf flow pattern similar to spontaneous breathing? Sine
Apnea alarm setting is 15-20 second delay
FiO2 alarm set at +/- 5% set FiO2
Complications of mechanical vent include Barotrauma/Volutrauma, decrease in CO, BP; pulmonary infection, Tracheal damage, decreasedUO, resp muscle fatigue, poor nutrition
PIP>50, MAP>30, Pplat>35, PEEP>10 can all cause barotrauma/volutrauma
Created by: Dabi2