WillWallace Mech Vent Chap 39
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| show | electricity, pneumonic (gas) or combined (most common)
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| show | converts input power to useful power, 1 direct-compressed gas via reducing valve or 2 indirect-elec motor or compressor
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| show | regulates flow of gas to pt (on/off), can shape output waveform
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| 2 most common waveforms are | show 🗑
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| Waveforms | show 🗑
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| Sinosodal waveform | show 🗑
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| Constant waveform | show 🗑
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| Decelerating waveform | show 🗑
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| show | changeable variables of pressure, volume and flow, that are measured relative to their baseline or end expiratory values
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| show | in any mode of ventilation, the E time should be at least three time constants long to avoid gas trapping
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| show | Time constant, (Raw x CS)e, where e represents volume exhaled as a percent, 1 is 63%, 2 is 86%, 3 is 95% and 5 is 100% exhaled. TC <3 leads to air trapping.
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| Control circuit/system | show 🗑
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| show | uses coanda effect, no moving parts, no metal, used for MRI
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| show | electronic
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| show | end expiration
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| show | more laminar flow, less RAW
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| Where is RAW lowest | show 🗑
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| show | primary variable vent manipulates to cause inspiration. press (pt initiated), flow (pt initiated) and time (mach initiated)
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| show | if the ventilator controls press, the press wave form will remain constant, but the volume and flow will vary with changes in resp system mechanics (>Raw=<vol and <flow)
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| Volume control variable | show 🗑
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| Volume and flow are inverse functions of what | show 🗑
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| Can flow or time effect press | show 🗑
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| show | 4 phases, initiation of inspiration, the inspiration itself, end of inspiration and expiration
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| Phase variables | show 🗑
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| show | causes breath to begin, time (mach), press (pt) or flow (pt)
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| Trigger variable | show 🗑
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| Patient triggering | show 🗑
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| Time triggering | show 🗑
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| show | the pressure drop need to trigger a breath, norm is .5-1.5 cmH20 below baseline. To > and pt works to hard to get breath, to low and mach is to sensitive.
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| Response time | show 🗑
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| show | large pressure drop (low sensitivity setting), delay in flow delivery
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| Flow-triggering system | show 🗑
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| show | decreases pt WOB
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| What is the disadvantage of flow triggering over pressure triggering | show 🗑
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| Limit variable phase | show 🗑
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| show | variable that is measured and used to end the inspiration, can be press, volume, flow or time ENDS THE BREATH!
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| Pressure cycling | show 🗑
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| show | delivers flow until preset volume is met, and then expiration begins. (volume cycled volume limited)
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| show | (push support) delivers flow (at a preset pressure) until level is met, most often used in pressure control mode EPAP, IPAP BIPAP.
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| show | expiratory flow starts because a preset time interval has elapsed
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| Baseline variable phase | show 🗑
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| show | breathing at a baseline above 0, norm 5-15
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| show | <venous return, >ICP, <CO, <BP
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| show | CONTROL pt ventilation and oxygenation because they can’t, or SUPPORT pt as they wean from vent
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| Control modes (variables) | show 🗑
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| PC | show 🗑
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| PC advantages | show 🗑
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| Disadvantage of PC | show 🗑
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| show | volume control, volume limited time cycled, set VT & set flow (IT) pt gets full mach breath, so V is FxT, can be pt or mach trigger DOES NOT CONTROL PIP
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| VC uses | show 🗑
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| show | regulate CO2 and regulate VE
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| Disadvantage of VC | show 🗑
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| show | PRVC or VC+, control both press and volume, allows for both press limit and target VT, mach adjusts press until target VT is met, wave is square, with mandatory breath mach controls volume, sacrifices volume for press
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| show | VC+PRVC-CVM, press limited time cycled volume target
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| show | press limited flow cycled, PS, spont only (no fixed breath), VAPS and VS (volume assured, press limited, flow cycled, volume targeted)
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| PS | show 🗑
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| VS or VAPS | show 🗑
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| *Control mode with the highest MAP | show 🗑
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| show | VC-SIMV
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| show | increases MAP 1:1, has the biggest impact of MAP
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| Support modes | show 🗑
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| What is the variable in Volume Control | show 🗑
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| show | volume and time
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| show | decreasing flow >IT, increasing flow <IT
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| Flow control minimum | show 🗑
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| show | starts the breath, time (mach), press (pt) or flow (pt)
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| show | actual breath mach delivers, press (mach), volume (mach), limits breath to a set volume or press set by machine
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| Cycle variable phase | show 🗑
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| Baseline variable phase | show 🗑
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| Types of breaths | show 🗑
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| show | continuous mandatory ventilation, <WOB, best way to control CO2, best on apneic and exhausted pt, locks pt out-use w/caution
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| show | VC, PC and PRVC, vent guarantees pt will receive the set minimum number of breaths and pt is able to trigger more
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| show | machine determined, based on phase variables trigger, limit, cycle and baseline
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| show | pt initiated, but depending on limit variables, mach may or may not control volume and press
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| Advantage of AC | show 🗑
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| Disadvantage of AC | show 🗑
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| CMV | show 🗑
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| SIMV | show 🗑
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| SIMV uses | show 🗑
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| show | allows work with the pt, somewhat friendlier
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| show | any other breaths during the cycle are not supported
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| show | SIMV with pressure support, extra breaths in the cycle are supplemented with pressure support
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| PRVC | show 🗑
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| PRVC uses | show 🗑
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| show | gives guaranteed VT but minimizes barotraumas
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| show | new, none
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| How can RT get the affects of control mode without using it? | show 🗑
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| show | volume control, volume cycled volume limited
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| show | press control, press limited time cycled
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| Relationship between PS and RAW | show 🗑
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| show | PC-SIMV+PEEP+PS
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| Press limited time cycled | show 🗑
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| show | PC-SIMV+PEEP
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| show | VC-SIMV
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| Spont breathing at a level above baseline | show 🗑
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| PS+PEEP | show 🗑
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| What effect does an >VT have on IT | show 🗑
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| show | <IT
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| show | none, can only be effected by > or < in flow
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| When using IT% what is the best setting | show 🗑
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| Can RAW be to low | show 🗑
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| show | Minute ventilation, calc is VT x RRset, flow of expired gas in one minute, norm is 5-8L/min
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| show | Airway Resistance norm is 5-12cmH2O/L/Sec for intubated pt, (PIP-Pplat)/(flow in min/60 sec). Increase in RAW reflects an issue with airways, bronchospasm, secretions, edema etc.
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| show | static lung compliance, aka Cstat or CLstat, norm for vent pt is .035-.055L/cmH20, calc is Vt(L)/(Pplat-PEEP), represents the combination of lung elasticity and chest wall recoil while on vent. Up with stiff lungs
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| show | VEtot-(VTset x RRset)
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| SpontRR | show 🗑
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| SpontVT | show 🗑
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| show | Peak pressure, norm is <50cmH2O, the press required to overcome both compliance and resistance
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| show | total cycle time, 60 sec/RRset, amount of time for a single breath cycle both I and E. If I:E is 1:2 then TCT is 3
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| I-time | show 🗑
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| How much flow do you need for a 1 second I-time and a VT of 750cc? | show 🗑
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| High press on vent | show 🗑
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| show | leak in system
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| show | CPAP
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| show | PEEP
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| show | Hypoxemic respiratory failure, PaO2 <60 on R/A, caused by VQ mismatch, shunt, diffusion impairment, perfusion/diffusion impairment, altitude, pneumonia, atelectasis
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| Resp failure type II is caused by | show 🗑
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| Control types | show 🗑
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| Which setting is pure control | show 🗑
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| show | 1-3L below baseline flow of 6-8L
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| *PRE-SET PRESS FOR INSPIRATION | show 🗑
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| *SEPARATE REGULATION OF INHALATION AND EXHALATION | show 🗑
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| COPD lungs | show 🗑
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| ARDS lungs | show 🗑
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Created by:
williamwallace
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