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Question: What is failureAnswer: inability of heart and lungs to provide adequate tissue oxygenation or removal of Question: resp failureAnswer: PaO2 <60 on RA, of CO2 Question: Hypercarbic resp Answer: aka ventilatory failure or pump , PaCO2 >50 Question: disease states that can result in respiratory Answer: acute resp fail; post op complications, , heart failure, pneumonia, trauma, ARDS, aspiration, COPD exacerbation, coma, neuromuscular Question: clinical symptoms of respiratory Answer: restless, tachycardia, head ache, hypotension, poor expansion, confusion, cyanosis, depressed respiration Question: what are the most common causes of vent Answer: >WOB and muscle Question: what are the critical values for initiating vent in a pt with decreased ventilationAnswer: >50 w/PH <7.2 Question: what are the values for initiating vent support in a pt with hypoxemiaAnswer: PaO2 <50-60 on 40-50%, A-a (on 100%) >350, PaO2/FIO2 <200 Question: What are the critical values for vent support in a pt with inadequate lung expansionAnswer: VT <500 mL/kg (norm 5-8), VC <10mL/kg (norm 65-75), RR >35 (norm 12-20) Question: what are the critical values for initiating vent support in a pt w/decreased strength (tired)Answer: MIP >-20cmH20 (norm -80-100), VC <10mL/kg (norm 65-75), MVV <2xVE (norm 120-180L/min) Question: what are the values for initiating vent support in a pt w/>WOBAnswer: VE >10 (norm 5-6), VD/VT >.6 (norm .25-.40) Question: what is impending failureAnswer: severe air hunger, resp rate >35, diaphorisis, use of accessory muscles, w/normal or near normal ABG (or prior to ABG if condition is ) Question: critical values or indications of impending failureAnswer: air hunger-RR>35, diaphorisis, use of accessory muscles, for neuromuscular-VC <1L or MIP <-20 to-30 Question: what is refractory Answer: >PaO2 of less than 10 increasing FIO2 by 20%, inadequate arterial oxygenation w/acceptable FIO2, PaO2 <60 (SaO2 <90) w/FIO2 >40-50%, P/F <300 ALI, P/F <200 ARDS. Question: Clinical for ALIAnswer: P/F <300 w/bilateral Question: clinical values for Answer: P/F <200 w/bilateral infiltrates and Pul Cap Wedge <18 Question: What is Answer: spontaneous breathing with an elevated baseline , small alveolar press to spont breathing pts on I and E to increase alv press, causes alveolar recruiting, benefit is lower FIO2 to maintain PaO2 Question: what are the indications for Answer: refractory hypoxemia (PaO2 <60 on FIO2 >40-50%) with ventilitory status (PaCO2 <45, PH 7.35-7.35) and to reduce the WOB in severe CHF. Question: What are the most reasons for initiating vent supportAnswer: BIG 4-APNEA, ACUTE VENT FAILURE (>CO2 W/PH <7.2), IMPENDING VENT FAILURE (RR >35 AND “CLINICAL PRESENTATION), O2 PROBLEM (SHUNT, DIFFUSION DEFECT) Question: Goals of mechanical Answer: 1-support and manipulate gas exchange (alv vent CO2 & PH), 2-increase lung volume (end inspiratory-end expiratory inflation and FRC), 3-reduce or WOB, 4-minimize cardiovascular involvement Question: What are the of mechanical ventilationAnswer: reverse-hypoxemia, acute resp acidosis and ventilatory muscle fatigue, to relieve resp distress, prevent or reverse atelectasis, allow for sedation and neuromuscular blockade, < O2 consumption, maintain or improve CO, <ICP, stabilize Question: Common initial for VT areAnswer: ACNN- ARDS (4)6-8, COPD 8-10, Normal 10-12, Neuro 12-15 (all are on IBW, ideal body weight) Question: Common setting for RR areAnswer: ACNN- ARDS 12-15, COPD 10-12, 10-12, Neuro 8-10 (all are based on IBW) Question: initial ventilator setting for normal lung areAnswer: VT 10-12 mL/kg (can go to 15 for big person), RR 10-12 (can go down to 6-10 if VT is for big person), Flow is based on Itime, Itime target 1 second, I:E 1:2 or 1:3, mode VC-SIMV, Peep 3-5, FIO2 40-50% (in doubt use 100%) Question: Common initial settings for ARDSAnswer: VT 6-8, RR 12-15 (can go to 30), Flow set to , ITime target is 1.2 seconds, mode VC-CMV, PEEP 5-8, FIO2 100% Question: initial ventilator settings for COPD and status asthmaticusAnswer: venting COPD pt always try bilevel or bipap, VT 8-10, RR 10-12, Flow set to IT, IT target .8 to maximize Etime, mode VC-SIMV, FIO2 60-100, peep 3-5 Question: Common initial ventilator for Post Op ptAnswer: same as Question: Common ventilator setting for Neuromuscular DiseasesAnswer: VT 12-15, RR 8-10, Flow/ITime 1 second, Peep 3-5, FIO2 40-50% Question: initial ventilator setting for head injuryAnswer: same as normal, but may adjust after 24 hours for increased ICP, hyperventilation to target CO2 of 25-30 to reduce ICP (<CO2 will cause vasoconstriction and <blood therefore reducing ICP Question: initial ventilator setting for Unilateral diseaseAnswer: to prevent ventilation from going only to healthy lung, use Karlan's ETT and add second machine, set one lung to ARDS and good lung to ½ settings except RR increase to 12-15 to compensate for smaller VT. Or use HFJV high freq jet vent. Question: Common initial ventilator setting for spinal cord Answer: set to normal Question: what is a fistulaAnswer: persistent air leak into the space. Caused by trauma, surgery or invasive procedure like central line or from infections Question: Management of bronchopleural on ventilated pt Answer: assess leak size by measuring inspired versus VT, BFV need chest tube, VC not working change to high frequency, also keep PEEP to minimum or 0, and small VT 4-8, may need surgical repair. Question: What is flowAnswer: 40-80 L/min, set to meet pt inspiratory demand (so spont breaths will have flow and pt will not have to work to hard) Question: Who benefits from higher Answer: pts with >RAW like COPD, shorter provides longer Etime to prevent airtrapping Question: Who benefits from flowsAnswer: ARDS, longer IT recruiting Question: Constant flow in VC Answer: or rectangular Question: WHAT IS BEST WAVEFORM FOR Answer: DECENDING Question: what are the hazards of a IT (high flow)Answer: higher peak and poor gas distribution Question: what are the of longer IT (slower flows)Answer: increased Paw that can lead to cardio effects, Etime, long ITime can cause airtrapping Question: How do we shorten the Itime on a ventilated Answer: the flow Question: What are the parameters that must be set on a mech Answer: mode, VT, RR, I:E , Flow, VE, PEEP, Trigger/Sensitivity, FIO2, Alarms Question: Setting flow if IT is 1 second (works on all except Servo)Answer: F equals VTx60, so for VT of , if IT is 1 second then .700x60 is a flow of 42L/min Question: Inverse ratioventilatio Answer: IT is longer than Question: compication of Answer: MAWP increases , >VD, <Venous return, <CO, >autoPEEP Question: when an IRV be usedAnswer: ARDS (rare) Question: Alv Answer: VA eq (VT-VD)xRR Question: advantages of NPPV (noninvasive pressure ventilation)Answer: avoid intubation and assoc complications, natural defenses, pt comfort, maint speech and swallow, less sedation, intermittent use Question: of NPPVAnswer: pt cooperation needed, limits acess to airway and , mask discomfort, air leak, transient hypoxemia from lost mask, bipap limit to 20-30, time consuming Question: who are best pts for Answer: sleep apnea, acute COPD exacerbation, premature extubation, acute resp failure, Question: conraindications of Answer: cant tolerate or poor mask fit, secretions, severe hypoxemia, severe acidosis, hypotension, aw obstruction, prone to aspirations, need airway protection Question: what is full supportAnswer: mechanical support such that all energy necessary for alv vent is provided-key is to set VT and RR to ensure a minimum effective level of alv vent (vt10-12 rr 10-12) Question: ventilatory support Answer: vent settings that require pt to provide some of the support (simv rates <10) Question: what allow for effective spontaneous breathingAnswer: SIMV, PSV, VS (volume support), APV (adaptive ) Question: 3 ways to a breath areAnswer: time, flow and Question: PC-CSVAnswer: controll-cont spontaneous ventilation Question: critical values for specific physiological to vent supportAnswer: RR>35, VT <300 ml, RSBI >105 (RR/VT), MIP >30cmH2O, VC <1L (15-20mL/kg) Question: ABG consistant to mech Answer: PaCO2 >45-50 w/corresponding decrease in Ph, w/supplimental O2, PaO2 <60 w/FIO2 >40-50% Question: vent setup decisionsAnswer: indication, noninvasive/invasive, press/volume, /full support, Mode-AC, SIMV w/ or w/o PS, PSV, PSV, PCV, dual control |
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