SPC Mechanical Ventilation Unit 5 Exam 3
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| What do you do if plateau pressures are >30? | show 🗑
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| show | Time for full exhalation and may cause "auto-trapping/auto-PEEP"
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| show | Oxygen Toxicity and Intrapulmonary Shunting
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| What is PEEP? | show 🗑
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| show | The positive baseline pressure continuously applied to th airway of a SPONTANIOUSLY breathing patient.
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| PEEP and CPAP are used to increase what? | show 🗑
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| What 4 things does PEEP do specifically? | show 🗑
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| show | 1. PaO2 <60mmHg
2. P(A-a)O2 >300 on 100% FiO2
3. Refractory Hypoxemia
4. Shunt of >30%
5. Recurrent atelectasis with low FRC
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| What are Relative contraindications of PEEP? | show 🗑
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| What are Absolute contraindications of PEEP? | show 🗑
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| show | PEEP that is set on the machine
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| Intrinsic PEEP is also known as what? | show 🗑
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| show | The amount of pressure in the lungs at the end of expiration when expiration is incomplete.
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| show | 1. Ventilation-associated
2. Disease-associated
3. High Inflation Volume
4. Rapid Respiratory Rate
5. Relative decrease in exhalation time relative to inspiration time
6. Airway Obstruction
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| show | As PEEP increases so does thoracic pressure. This will decrease venous return and lower CO & BP
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| show | As PEEP increase so does CaO2 and Oxygen Transport improves.
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| What happens with CMV-AC mode? | show 🗑
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| show | The sickest patients to guarantee a minimum VE
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| What are 4 issues with CMV-AC mode? | show 🗑
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| show | Tidal Volume is constant, PIP is variable, Flow, Rate & I-Time is set
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| What happens with PC-CMV mode? | show 🗑
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| What 4 things should be known about Pressure Control Ventilation (PCV)? | show 🗑
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| show | Used to treat Acute Respiratory Distress Syndrome (ARDS)
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| show | 1. TI is set longer than TE.
2. May improve oxygenation by increasing mean airway pressure.
3. Prevents full exhalation causing air-trapping/intrinsic/ auto-PEEP.
4. Uncomfortable and require sedation and sometime paralysis.
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| show | f and VT or pressure is set.
Vent delivers breaths in synchrony with patient’s inspiratory effort. Assist window.
During spontaneous breaths, patient sets rate and volume (usually with pressure support ventilation (PSV) to reduce WOB).
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| show | PSV Pressure Support Ventilation
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| show | Spontaneously breathing patients
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| show | May improve oxygenation, used prior to extubation and liberation from ventilator, always have back-up ventilation settings in case of fatigue or failure
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| show | Augments patients spontaneous inspiratory effort.
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| show | True
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| show | WOB and Inspiratory effort
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| show | Weans until patient is doing all of the work of breathing.
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| show | Pressure Regulated Volume Control (PRVC), Autoflow, Volume Control (VC), Adaptive Pressure Ventilation (APV)
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| What happens in APRV mode? | show 🗑
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| What 3 things should be known about APRV mode? | show 🗑
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| Settings in APRV mode include? | show 🗑
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| APRV is also known as what? | show 🗑
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| show | Refractory hypoxemia and non-compliant lungs. (i.e. ARDS)
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| show | HFV delivers a small amount of gas at a rapid rate (as much as 60-100 breaths per minute.)
Tidal volumes < anatomical dead space.
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| show | Sedation and Pharmacological Paralysis
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| show | Used when conventional mechanical ventilation would compromise hemodynamic stability, or for patients who are at high risk for pneumothorax
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| show | 1. Microsurgery of URT (upper respiratory tract).
2. ARDS - to reduce the risk of barotrauma.
3. Fistulas (B-P, T-E) - when large leaks are present.
4. To reduce cardiovascular side effects.
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| What are the 3 patient disadvantages of HFV mode? | show 🗑
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| show | 1. Poor humidification
2. Necrotizing Tracheobronchitis
3. Tracheal tissue trauma
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| What happens in HFOV mode? | show 🗑
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| HFOV mode uses what approach? | show 🗑
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| What is known of HFOV? | show 🗑
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| What is the key in HFV & HFOV? | show 🗑
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| Because of higher rates, tidal volumes are usually smaller than deadspace. Therefore, elimination of CO2 comes from a what in rate. | show 🗑
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| show | 1. Has Oxygenation issues
2. OSA Obstructive Sleep Apnea
3. Ventilate Fine
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| BiPAP mode is acceptable to be used when the patient? | show 🗑
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| IPAP is set to what to increase what? | show 🗑
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| EPAP is set to what to improve what? | show 🗑
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| What are the 4 BiPAP settings? | show 🗑
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| In BiPAP rate is set for what? | show 🗑
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| show | To improve Oxygenation
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| How is BiPAP different than CPAP? | show 🗑
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| show | Pressure Support
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| T/F Mouth piece ventilation is relatively new? | show 🗑
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| What is mouth piece vent used to treat? | show 🗑
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| show | Does not require airway, patient can talk
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| Increased flow rates lead to what? | show 🗑
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| Describe Square Wave | show 🗑
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| show | COPD & Asthma
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| Describe Sine or Sinusoidal Wave | show 🗑
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| show | Allows for an adequate I:E ratio with a normal flow rate. This optimization of I:E ratio is beneficial for those patients in which air trapping is a concern
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| What to know of Sine Wave | show 🗑
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| show | Utilizes a rapid acceleration of flow followed by a gentle tapering.
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| show | True
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| What to know of Descending Wave | show 🗑
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| What is the Sensitivity setting? | show 🗑
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| show | No amount of patient effort will initiate a machine breath, and the machine is in the controlled ventilatory mode.
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| show | The vent can auto-cycle or chatter
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| show | Occurs when a patients inspiratory effort causes a drop in pressure within the circuit and when this drop in pressure is sensed by the pressure sensing mechanism of the ventilator, the ventilator triggers on and delivers a breath.
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| What is important to remember about patient sensitivity triggering? | show 🗑
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| What is Flow Sensitivity is usually set how? | show 🗑
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| show | About 10 cm/H2O below PIP
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| Where is High Pressure alarm set? | show 🗑
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| show | About 2-3 cm/H2O below set level
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| Where is the high rate alarm set? | show 🗑
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| Where is the Apnea alarm set at? | show 🗑
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| show | 1. Ensure Vent is working
2. Check humidifier or add HME
3. Set initial startup parameters (as ordered or per protocol)
4. Adjust Alarms
5. Emergency Airway Tray
6. Suctioning Equipment
7. ECG monitor
8. Resuscitation bag & mask
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