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PB840
Puritan Bennet 840 Unit III
| Question | Answer |
|---|---|
| What are the circuit basics for the PB 840? | Double circuit (heated or non heated wire) Filters: Insp/Expiratory (smaller w/mount clip for NICU; regular for adults |
| How do you clean the PB 840? | Change Circuits and filters, wipe down with approved cleaner |
| Functionality | Turn, Touch Access |
| The air compressor is separate and may provide | up to 200 L/minute flow w/minute ventilation of 50 L/minute |
| GUI stand for | Graphical User Interface |
| The GUI contains the | screen and is "AKA" the brain; input data |
| The BDU stands for | Breath Delivery Unit |
| The BDU is the | box and is also known as the lungs or heart; performs the task |
| The BDU has a | flow transducer, fully charged battery and internal air compressor |
| The monitor | sends information to the lower portion of the vent and receives information to monitor graphics. |
| The rectangular box contains the | batter and has a 45 minute life if fully charged |
| Portions of the screen | top includes patient data and graphics bottom includes ordered parameter and alarms |
| Self Testing includes the | POST EST SST |
| The POST is the | Power on Self test and occurs automatically. |
| The EST is the | Extended self test and is done every 6 months by biomed |
| The SST is the | short self test and takes 3 to 6 minutes. It is a function test and must pass to use. You must have an open circuit when the machine is turned one |
| The SST works by | hitting SEST on the screen and then there is five seconds to hit the EST |
| The MA1 has the following modes | Control-VC AC-Volume Controlled IMV |
| The 84o has the following modes | AC-VC or PC SIMV- VC w or without P/S; SIMV PC w or without P/S Spont-with or without PS |
| Assist control is | volume or pressure targets |
| In assist control breaths have one of the following | preset volume preset pressure volume targeted |
| Pressure is a | square wave form |
| Flow is | decelerating |
| In AC/VC TLC is as follows | T-RCT/P or F triggered L- Flow C-It |
| The settings in AC/VC are | rate volume peak insp flow fio2 Trigger PEEP Alarms |
| The advantages of AC/VC are | guaranteed set VT gauaranteed VE |
| The disadvantages of AC VC are | pressure varies which can lead to potential barotrauma |
| In AC/PC the TLC is | T-RCT/ P or F L-Pressure C-It |
| The settings for AC/PC are | Rate PIP IT O2 Trigger PEEP Alarms |
| The advantages of AC/PC are | control pressures |
| The disadvantages of AC/PC is that | TV and VE can vary and there is a variable Peak flow |
| SIMV is the same as IMV except it | avoids breath stacking |
| If a pts spontaneous breath is initiated at the same time as a mandatory breath is required it will | deliver an assisted mechanical breath (like and ac breath) |
| What are the indications, advantages and complications of SIMV | same as with IMV, except machine breaths are synchronized with pts spontaneous breaths |
| CPAP is used on | spontaneous breaths when there is no pressure support |
| Spontaneous made includes | NO set rate and may be used with CPAP and/or Pressure Support |
| What else must be set in spontaneous mode? | Apnea parameters |
| What are the indications for spontaneous mode? | Facilitate weaning |
| What are the complications of spontaneous mode? | muscle fatigue Increased WOZBZ |
| Mean airway pressure is | the average pressure in the airway during one complete respiratory cycle |
| Mean airway pressure is affected by | pressure and time and the relationship is directly proportional. |
| The greater the mean airway pressure the greater the risk of | barotrauma. |
| MAP does have some oxygenation benefits especially | when used with the inverse ratio ventilation |
| MAP should be less than | CVP |
| Normal MAP is | 5-10 cmH20 |
| Map for obstructive patients is | 10-20 cmH20 |
| MAP for ARDS patients is | 15-30 cmH20 |
| MAP on the 840 Ventilator is calculated based on 1 | RCT |
| Intrinsic PEEP is unintentional PEEP and may also be termed as | Auto-PEEP Inadvertant PEEP Occult PEEP |
| Unintentional PEEP during mechanical ventilation is present when | end-expiratory pressure does not return to baseline pressure |
| Unintention PEEP is commonly associated with | significant airway obstruction insufficent flow rates rapid respiratory rates |
| What are the complications of inadvertant PEEP? | barotrauma and decreased CO Increased WOB |
| How do you correct Auto-PEEP? | increased expiratory time (with flow or rate change) Reverse the airway obstruction |
| PEEP can reduce effects of | Auto PEEP |
| List of ways to fix Auto-PEEP | increase Peak Flow Decrease Respiratory Rate PEEP Bronchodilators |
| What is the formula to calculate MAP? | (It*PIP)+(ET*PEEP)/RCT |
| When using a ventilator in which peak flow is preset a change in flow wave form from square to any other pattern will change | I time |
| Any flow wave form other than square must be calculated as such | It=RCT/Total Parts of the I:E ratio The I:E will come from the vent |
| Raw cannot be calculated when the flow is not | constant |
| Pressure support (PSV) provides | a preset pressure plateau to the patients airway for the duration of a spontaneous breath. |
| PSV can be used with | SIMV or as a stand alone mode |
| PSV will | augment a patients spontaneolus VT |
| PSV will be terminated when the | patients flow drops to to a predetermined level |
| What are the indications for PSV? | It facilitates Weaning Helps overcome airway resistance |
| You use an expiratory hold maneuver to find the | AUTO PEEP |
| Pressure support must be automatically set at what without pressure support to overcome Raw? | 1.5 cmH20 over the PEEP level |
| In PSV what is the trigger, Limit, Cycle? | Trigger-Pressure/Flow Limit-Pressure Cycle-E-Sensitivity |
| PSV is cycled when | a patients inspiratory flow drops to a predetermined level. |
| E-sensitivity is | the sensitivity required to cycle spontaneous pressure supported breath into exhalation. |
| Expiratory Sensitivity (Esens) is defined as | the percentage of the projected peak flow at which the ventilator terminates flow, and thus cycles from inspiration to expiration during spontaneous breathing. |
| Some ventilators have already predetermined | E-sensitivity |
| ESensitivity can be adjusted up if | there is a leak in the cuff |
| the smaller the e-sensitivity the | longer the I time |
| Th larger the e-sensitivity | the shorter the I time |
| What is the predetermined E-sensitivity on several vents? | Servo 900C 25% Servo I- 40% Galileo-25% |
| The default E-sensitivity on the PB 840 is | 50% |
| Inspiratory rise time % is also known as | Pramp |
| Inspiratory rise time or Pramp determines | how quickly the pressure will rise to its peak |
| Pramp is only active in | a pressure mode of ventilation |
| The more increased Pramp the sharper the | pressure |
| Inspiratory rise time can | blunt flow so that the pressure doesn't rise immediately. |
| Pramp changes pressure curve by manipulating | flow |
| Rise Time is | 1-100 in range |
| If rise time is set too low or too high | tidal volume may be reduced or increased |
| What are the alarm parameters for fio2? | +- 7% |
| What are the alarm parameters for VE? | 2-4 liters above observed VE |
| What are the low exhaled VE alarm parameters? | 1-2 liters below observed VE |
| What are the parameters for high respiratory rate? | 10-15 breaths/minute over observed rate 30 breaths/minute is good |
| Dsens alarm parameters | disconnect sensitivity 20-95% |
| PEEP(TOT)/PEEPI is equivalent to | Expiratory Hold Maneuver |
| PO.1 can be found in respiratory mechanics and measures | pressure generated during the first 100 milliseconds of inspiration against an occluded airway |
| The apnea alarm is usually how long for an adult? | 20 seconds |
| When setting apnea parameters it is import to | consider the fluctuations in patient's spontaneous rate |
| Some ventilators require the apnea parameters to be programed but | others have the apnea parameters predetermined. |
| The other puritan bennette 840 features include | pressure ventilation volume support neomod bilevel PAV+ Respiratory mechanics tube compensation |
| PAV+ stands for | proportional assist ventilation |
| Proportional assist ventilation is when the | patient generates flow and volume and the machine will push pressure based on their needs to assist. |
| For proportional assist ventilation a percentage is chosen and is | what percentage the machine will add to help ventilation (5-100%) |
| What are the advantages of volume ventilation? | Tidal volume is guaranteed |
| What are the disadvantages to volume ventilation? | pressure is not limited which may result in unnecessary barotrauma. Flow rate is fixed (limited, therefore patient cannot control flow demand |
| What are the advantages of pressure ventilation? | Pressure is limited so barrotrauma risk is decreased. Flow rate is variable and changes in response to pt effort/lung characteristics. More even distribution of gas flow to lung, resulting in lower pressure requirements to achieve VT. |
| what are the disadvantages to pressure ventilation? | VT varies with changes in resistance and compliance. May be uncomfortable if the inspiratory time is not set appropriately. |
| Volume support is | pressure support ventilation with target volume. |
| What is the TLC for volume support? | T- Patient (flow or pressure) L-Pressure Limited C-Patient (Flow-ETS) |
| For VS pressure is adjusted to meet the target volume but will not exceed | high pressure limit minus 5 cmh20 |
| If apnea the following with associated parameters must be chosen | VC or PC |
| Bilevel ventilation provides | 2 levels of PEEP or C PAP |
| Rate and Time for what must be set? | PEEPH and PEEPL |
| How is time shown for bilevel? | TH and TL |
| Pressure support is set for | Spontaneous breaths |
| What are the advantages to BiLevel Ventilation? | Increased Patient Comfort Reduced Requirement for sedation Prevention of alveolar collapse and overdistention |
| The PEEP High can be set between | 5 and 90 cmh20 |
| The PEEP low can be set between | 0-45 cmh20 |
| PEEP high can be set at | 2-3 cmh20 above Mean airway pressure |
| PEEP high can also be set at | 12 above Ppl |
| Bilevel ventilation | can cause airtrapping |
Created by:
kparkerlehman
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