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Introduction to Mech

Introduction to Mechanical Ventilation RCP 112

What are the three indications for mechanical ventilation? Ventilatory Failure oxygenation Failure Prophylactic Ventilatory Support
What is the sandard criteria for instituting mechanical ventilation? Apnea or absence of breathing Acute Respiratory Failure Impending Respiratory failure Refractory hypoxemia w/ increased WOB or ineffective pattern
What is the criteria for acute ventilatory failure? An increase of PaC02 >50 mm Hg with an accompanying respiratory acidosis (pH <7.25)
What is the criteria for impending ventilatory failure? Patient can maintain or marginally maintain normal ABG, but at the expense of significant WOB. PaC02 will trend upward.
What are assessments that can indicate impending ventilatory failure? Tidal volume Respiratory Pattern Minute Ventilation Maximul inspiratory Pressure Vital Signs
What can be a secondary complication ventilatory failure? Hypoxemia
What is oxygenation failure defined as? Severe hypoxemia that does not respond to moderate to high (>60%) supplimental oxygen.
Oxygenation failure is not a direct indication for mechanical ventilation "BUT" mechanical ventilation is needed to support WOB associated with oxygenation Failure
Mechanical ventilation is indicated typically if the Pa02 is <70mm Hg on 60% fi02 or <40 mm Hg on any fi02. P(A-a) of > 450 mm Hg on 100% fio2
Prophylactic ventilatory support is provided in clinical situations where there is risk of pulmonary complications ventilatory failure oxygenation failure is high
Prophylactic ventilatory support reduces risk of pulmonary complications risk of hypoxia on major organs WOB and oxygen consumption Cardiopulmonary stress
Hyperventilation therapy (blowing of c02) decreases ICP
What are the three conditions leading to mechanical ventilation? Depressed respiratory drive Excessive Ventilatory Workload Failure of Ventilatory Pump
Depressed Respiratory Drive (CNS) can include drug overdose, acute spinal cord injury, head trauma, neurologic dysfunction, sleep disorders, metabolic alkalosis
Excessive Ventilatory Workload (CNS) can include acute airflow obstruction, deadspace ventilation, acute lung injury, congenital heart disease, cardiovasuclar decompensation, shock, increased metabolic rate, drugs, decreased complaince
Failure of ventilatory Pump (NM/WOB) can include chest trauma, premature birth, electrolyte imbalance, geriatric patients
What is the absolute contraindication for mechanical ventilation? Untreated pneumothorax
What are three relative contraindications for mechanical ventilation? Patients informed Request Medical Futility Reduction or termination of patient pain and suffering.
What are hazards of mechanical ventilation related to positive pressure ventilation? Barotrauma, hemodynamic instability, increased ICP, oxygen toxicity
What are hazards of mechanical ventilation related to patient condition? infection, multiple organ failure
What are hazards of mechanical ventilation related to equipment Ventilator or alarm malfunction, circuit disconnection, accidental extubation, endotracheal tube blockage, tissue damage, atelectasis
What are hazards of mechanical ventilation related to medical professionals? Nosocomial Infection, Inappropriate settings
What are 2 things that affect the work of ventilatory muscles? Compliance Resistance
Compliance is defined as the elastic forces of the lung
Compliance is indirectly proportional with ventilatory work
compliance is directly porportional to amount of volume inhaled
Resistance is defined as the force that must be overcome to move gas in and out of the lung
resistance is directly proportional with ventilatory work
Resistance is indirectly proportional to amount of voulume inhaled
Poiseuilles Law goes along with resistance and states that there is a 16 fold increase in airway resistance when the radius of the airway is decreased by half.
What is the definition of a ventilator? A machine/device that can fully or partially substitute for the ventilatory work.
What are the 2 types of ventilators? Negative Pressure Ventilators Positive Pressure Ventilators
The iron lung encloses patient in tank except for the head and neck and works by evacuating air to produce a negative pressure around the chest, which is transmitted to the lung.
The greater the negative pressure the greater the? volume moved into the lung
What is andvantage of the iron lung? noninvasive
What are some disadvantages to the iron lung? Poor Patient Access decreased cardiac output (tank shock) Requires added oxygen therapy
The Chest Cuirass is also known as the turtle shell
Why was the chest cuirass created? To improve patient access and minimize tank shock
The chest cuirass covers the chest only and must have? an airtight seal between shell and chest wall
The chest cuirass works similar to the iron lung in that it generates a negative pressure that is transmitted to the lung
What is the advantage of the chest cuirass? It's noninvasive
What are disadvantages to the chest cuirass? An airtight seal between patient and shell is difficult. Requires added oxygen therapy
What are four physical characteristics of a mechanical ventilator? Power source/ input power type of ventilator power transmission and conversion system. Control systems and circuits
The power source or input power can be pneumatic, electrical or both "built in" batteries/air compressors
The type of ventilator can be either Negative or positive pressure
In regards to the power transmission and conversion system the drive mechanism is the mechanism by which the ventilator transmits or converts the input power to useful ventilatory work.
The Control panel is also known as the user interface
The control pannel allows for the ability to manipulate pressure, volume, and flow; controls the drive mechanism
The pneumatic circuit is double lined and recognizes settings and sends signals
Control variable corresponds with the ventilator class
Pressure controller pressure does not change as a result of compliance and resistance changes
Volume controller volume does not change as a result of compliance and resistance changes
A volume controller ventilator class measures volume directly
A time controller ventilator class is whereby pressure, volume, and flow change as compliance and resistance changes.
In a time controller ventilator class time is constant
In a flow controller ventilator class volume does not change as a result of compliance and resistance changes
in a flow controller class volume is measured indirectly by measuring flow
What is the average bias flow? 6 lpm (flow that's always in the circuit)
Phase 1 change from expiration to inspiration
Phase 2 inspiration
Phase 3 change from inspiration to expiration
Phase 4 Expiration
The trigger variable corresponds with Phase 1 and triggers (starts) breath delivery
The limit variable coressponds with phase 2 and Is the variable not exceeded above the preset value during inspiration.
It is important to note that inspiration does not end when the variable reaches the preset value
The Cycle variable corresponds with phase three and is the variable that cycles (stops) the breath delivery)
Expiration is Passive and corresponds with phase 4
Ventilator Alarms can be visual audible both
Input Power alarms warns loss of electrical or pneumatic power
Control Circuit Alarms Warns that settings are not acceptable or that ventilator has failed some part of self-diagnostic test
Output (patient alarms) Warns of problems with pressure, volume, flow, time, fi02, or circuit temperature problems
Respiratory cycle time can also be called Total Cycle Time
Respiratory cycle time is calculated as 60/Frequency
Created by: kparkerlehman