Modes of Mechanical Ventilation
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| What type of pressure ventilation involves normal respirations, Chest cuirass, and iron lung? | Negative pressure
🗑
|
||||
| 5 examples of positive pressure ventilators are | CMV, A/C, IMV, SIMV, CPAP
🗑
|
||||
| Positive pressure ventilators can be ____ vs ____ controlled | pressure, volume
🗑
|
||||
| There is ____ and ____ modes available for PPV | adaptive, dual
🗑
|
||||
| 2 types of non conventional ventilation | HFOV (cpap with a wiggle), APRV (cpap with spontaneous breaths)
🗑
|
||||
| During spontaneous breathing when does pressure equalize? | at end inspiration and end exhalation
🗑
|
||||
| How does PPV create transairway pressure? | by increasing airway opening pressure above alveolar pressure
🗑
|
||||
| PPV generate gas flow, therefore ____ ____, by producing a positive pressure gradient | tidal volume
🗑
|
||||
| 2 things to consider when using PPV | alveolar/capillary filling occurs during active phase of inspiration which is usually neg pressure and under PPV, vascular flow can be impeded
🗑
|
||||
| Modes of PPV from the most support to the least support | CMV, A/C, IMV, SIMV, CPAP
🗑
|
||||
| Advantages of volume controlled | Ensures minimal VE
🗑
|
||||
| Disadvantages of volume controlled | pressure variable:barotrauma/volutrauma possible, volume limited by high pressure alarm
🗑
|
||||
| Advantages of pressure limited | less risk of barotrauma d/t set inspiratory pressure
🗑
|
||||
| Disadvantages of pressure controlled | doesnt ensure VE; Vt variable
🗑
|
||||
| What 2 things are variable on pressure controlled vent | volume(dependent on set pressure) and Flow
🗑
|
||||
| 4 types of triggers | Time, patient, pressure, flow
🗑
|
||||
| What is the control used to adjust ventilator sensory of patient inspiratory effort called | sensitivity
🗑
|
||||
| What are the 2 types of sensitivity controls? | pressure (ex:IPPB), and Flow
🗑
|
||||
| How does a perssure trigger work? | ventilator senses a drop in pressure below the baseline, senses pt negative inspiratory effort
🗑
|
||||
| Pressure transducers are placed at these 3 locations | proximal airway- at teh wye connector, internally where gas flow leaves the unit, and where exhaled gas leaves the unit
🗑
|
||||
| Which trigger type is more sensitive, pressure or flow? | flow
🗑
|
||||
| How does a flow trigger work? | when a pt initiates a breath base flow returning to the vent is reduced thus triggering inspiration
🗑
|
||||
| Describe Controlled Mandatory Ventilation | Time triggered, machine breath, volume or pressure cycled
🗑
|
||||
| What does CMV control to equal VE? | (Vt or Pressure) + RR=VE
🗑
|
||||
| What are the indications for CMV? | Need to control VE completely; need to control chest expansion completely like with flail chest
🗑
|
||||
| Complications of CMV? | pt is totally vent dependent, alarams are essential, unable to assess weaning and seizures interrupt delivery of breath
🗑
|
||||
| Time/breath/cycle for A/C vent | Patient or Time triggered, machine driven, volume cycled
🗑
|
||||
| Indications for A/C mode | full ventilatory support, need to support high VE with low O2 consumption, sedation after intubation
🗑
|
||||
| Advantages of A/C mode | Decrease WOB(pt trigger only), pt controls RR therefore VE (resp compensation, normalize CO2)
🗑
|
||||
| Complications of A/C mode | hyperventilation(resp alkalosis), pain/anxiety/CNS disease, Biots or Cheyne stokes respirations
🗑
|
||||
| Describe IMV mode | first widely used mode that allowed partial ventilatory support, facilitates weaning, increase muscle strength. Not widely used today
🗑
|
||||
| Complications of IMV | breath stacking(spont effort immediately followed by mechanical breath) which leads to increased PIP, barotrauma, cardiac compromise
🗑
|
||||
| What is baotrauma/volutrauma? | lung injury that occurs from hyperinflation of alveoli past rupture point (PIP>50, Pplat>35)
🗑
|
||||
| SIMV triggers/type of breaths/cycling mechanism | trigger:mandatory(time or pt triggered/assisted), Type:mechanical, assisted, or spontaneous; Cycle:mechanical/assisted(preset Vt or pressure), Spontaneous:pt determines Volume
🗑
|
||||
| What is the synchronization window? | time interval just prior to time triggering in which the ventilator is responsive to the patient's spontaneous breath
🗑
|
||||
| Indications for SIMV | parital vent support, pt can actively participate in VE
🗑
|
||||
| If the set rate is high(8-12) in SIMV mode | can provide total support (SIMV with no spontaneous rate is the same as A/C)
🗑
|
||||
| Setting the rate low (<8) in SIMV: | facilitates weaning, strengthens respiratory muscles, decreases mean airway pressure making spont breaths have a lower peak pressure than mandatory
🗑
|
||||
| Complications of SIMV: | low rate can increase WOB causing muscle fatigue/failure
🗑
|
||||
| What mode of PPV has a positive baseline pressure continuously applied to the circuit and airway during both I and E? | CPAP
🗑
|
||||
| in this mode of PPV the ventilator delivers a time triggerd breath and allows patient to breath at own Vt bw mechanical breaths. | IMV
🗑
|
||||
| In this mode of PPV the ventilator delivers a set Vt or pressure at a time triggered rate but the patient can trigger a mechanical breath above preset rate | A/C
🗑
|
||||
| In this mode of ventilation patient can not trigger mechanical or spontaneous breath so there is no negative deflection on graphics. The pt must be sedated or paralyzed.Not commonly used | CMV
🗑
|
||||
| In order for this mode of PPV to be used the pt must be spontaneously breathing, have adequate lung function to maintain normal PaCO2, and are not at risk for hypoventilation | CPAP
🗑
|
||||
| 3 things pressure support does? | augments spontaneous Vt, Decreases spontaneous RR, and reduces patient WOB, Raw
🗑
|
||||
| How does pressure support decrease spontaneous RR? | increased volume decreases need for high RR to achieve required VE, decreases deadspace ventilation
🗑
|
||||
| Desired RR is less than __ | 25
🗑
|
||||
| What is Vt dependent upon with Pressure support mode? | set inspiratory pressure, lung compliance, and airway resistance
🗑
|
||||
| What makes flow variable in PS? | dependent upon flow needed to maintain pressure plateau
🗑
|
||||
| PS:trigger, breath, cycle | patient triggered, spontaneous, pressure limited, flow cycled
🗑
|
||||
| CPAP with PS is | BiPap
🗑
|
||||
| CPAP with no PS is | CPAP
🗑
|
||||
| Management of PS | begin with 5-10cwp, increase in increments of 3-5cwp
🗑
|
||||
| Titrate PS according to what 3 things? | Spont Vt 5-7ml/kg IBW, RR less than 25, Decrease in WOB
🗑
|
||||
| This is not a “stand alone” mode | PEEP
🗑
|
||||
| Effects if PEEP | recruit alveoli, increase FRC(oxygenation), increase alveolar surface area(gas diffusion), increase compliance, prevent VILI
🗑
|
||||
| Complications of PEEP | cardiac compromise, increase intrathoracic pressure, decrease venous return, decrease CO and BP
🗑
|
||||
| Indications for PEEP | refratory hypoxemia and 5cwp is considered physiologic to replace glottic closure
🗑
|
||||
| PEEP mgmt | 5cwp=physiologic, increase in increments of 3-5cwp while watching BP, decrease to previous level or zero for low BP, treat low BP with vol expansion or vasopressors then increase PEEP again while observing BP
🗑
|
||||
| What is compliance | volume change per unit pressure
🗑
|
||||
| Inverse ratio ventilation is ___ controlled | pressure
🗑
|
||||
| Long I, Short E causes what? | air trapping, auto PEEP and prevents alveolar collapse
🗑
|
||||
| Auto-PEEP= | increased oxygenation, peep effects, increased FRC, PaO2, and surface area
🗑
|
||||
| How does IRV prevent alveolar collapse? | critical opening pressure reduced, pressure needed for ventilation is less, improves ventilation
🗑
|
||||
| Complications of IRV | barotrauma, requires paralysis sedation, cardiovascular compromise similar to PEEP effect
🗑
|
||||
| Mandatory minute ventilation activates when | a pts spont breathing is less than minimum set VE, ventilator increases ventilation
🗑
|
||||
| The method of increased ventilation with MMV varies upon what? | ventilator model(some icrease RR, some Vt, and some PSV)
🗑
|
||||
| What should VE be set to achieve? | satisfactory PaCO2
🗑
|
||||
| Advantages of MMV | promotes spont breathing, minimal support but protects against hypoventilation and resp acidosis, permits weaning but compensates for apnea
🗑
|
||||
| Disadvantages/complications of MmV | doesnt protect against RSB(deadspace breathing), High RR with low Vt = patient breathing above VE(MMV remains inactive but PaCO2 increases, resp acidosis)
🗑
|
||||
| Describe Pressure control(PCP | Vt variabl, Inspiration begins at preset pressure, Plat is created and maintained for preset I-time, Flow is variable dependent on flow required to maintain pressure plat
🗑
|
||||
| Pressure control generates a ____ flow to increase the airway pressure to a preset pressure limit | high
🗑
|
||||
| When is inspiration terminated in Pressure Control | when the preset I-Time is reached
🗑
|
||||
| Indications fro PC | low lung compliance-high PIP during volume ventilation (PIP > 50, Plat>35); ARDS-ARDS net protocol
🗑
|
||||
| Advantages of PC | PIP is reduced while maintaining adequate oxygenation and ventilation, reduced risk of barotraumas
🗑
|
||||
| Management of PC | Pip is set to achieve a goal Vt, unless pt is allowed to become hypercapnic in the interest of limiting PIP; VT and VE must be carefully monitored
🗑
|
||||
| What is APRV? | airway pressure release ventilation
🗑
|
||||
| What happens during inspiration of APRV | applie positive airway pressure to augment spont breathing (High CPAP level, reduces WOB, Increases MAP to increase O2, allow spont inspiration at any point during the breath-elevated pressure delivery)
🗑
|
||||
| What happens during exhalation with APRV | positive pressure is periodically released to allow exhalation (brief 1-2 seconds), decreases FRC and allows for exhalation and release of CO2
🗑
|
||||
| APRV is inappropriate for what kind of patients? | those at risk for an inadequate spontaneous RR
🗑
|
||||
| APRV can resemble IRV when | expiratory pressure release time is less than spontaneous effort
🗑
|
||||
| Why is APRV beneficial alternative to IRV | does not require paralytics
🗑
|
||||
| APRV: trigger/limit/cycle | time triggered but pt is allowed to breathe spontaneously at any time; mandatory and spont pressure limited; time cycled d/t preset I-time
🗑
|
||||
| Describe HFOV | reduces risk of lung destruction by keeping alveoli open at constant pressure, oscillates very rapidly (high RR, Hertz, small volumes), early intervention is key!
🗑
|
||||
| Managing oxygenation with HFOV | Mean airway pressure, FiO2, alveolar recruitment
🗑
|
||||
| Managing ventilation with HFOV | amplitude-delta “P”, Hertz, % I time, cuff deflation, permissive hypercapnia
🗑
|
||||
| Amplitude delta “P” | change in stroke volume, force delivered by piston by setting power, CWF-chest wiggle factor
🗑
|
||||
| Hertz | (1 hertz=60rr), set at 3-6 Hz, decrease rate to eliminate CO2
🗑
|
||||
| % I time determines delivery of | Paw
🗑
|
||||
| Patient care HFOV | Sx PRN, humidity circuit, bronchodilator, sedate or paralyze, pronation, fluid bolus prn, vasopressors, bronchoscopy
🗑
|
||||
| Assesment HFOV | Hr, SpO2, BP, CWF, Auscultate, CXR, ABG
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Dabi2
Popular Respiratory Therapy sets