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Question: What type of ventilation involves normal respirations, Chest cuirass, and iron lung?Answer: Negative Question: 5 examples of pressure ventilators areAnswer: CMV, A/C, IMV, SIMV, Question: Positive pressure ventilators can be ____ vs ____ controlledAnswer: pressure, Question: There is ____ and ____ modes available for PPVAnswer: adaptive, Question: 2 of non conventional ventilationAnswer: HFOV (cpap with a ), APRV (cpap with spontaneous breaths) Question: spontaneous breathing when does pressure equalize?Answer: at end inspiration and end Question: How does PPV create pressure?Answer: by increasing airway opening pressure alveolar pressure Question: PPV generate gas flow, therefore ____ ____, by producing a positive pressure gradientAnswer: tidal Question: 2 to consider when using PPVAnswer: alveolar/capillary filling occurs active phase of inspiration which is usually neg pressure and under PPV, vascular flow can be impeded Question: Modes of PPV from the most support to the supportAnswer: CMV, A/C, IMV, SIMV, Question: Advantages of controlledAnswer: Ensures VE Question: Disadvantages of controlledAnswer: pressure variable:barotrauma/volutrauma possible, limited by high pressure alarm Question: Advantages of pressure Answer: less risk of barotrauma d/t set pressure Question: of pressure controlledAnswer: doesnt VE; Vt variable Question: What 2 things are variable on controlled ventAnswer: volume(dependent on set ) and Flow Question: 4 types of Answer: Time, patient, pressure, Question: What is the control used to adjust ventilator sensory of patient effort calledAnswer: sensitivity Question: What are the 2 types of sensitivity ?Answer: (ex:IPPB), and Flow Question: How does a perssure work?Answer: ventilator senses a drop in pressure below the baseline, senses pt inspiratory effort Question: Pressure are placed at these 3 locationsAnswer: proximal airway- at teh wye connector, internally where gas flow leaves the unit, and where gas leaves the unit Question: Which type is more sensitive, pressure or flow?Answer: Question: How does a flow work?Answer: when a pt initiates a base flow returning to the vent is reduced thus triggering inspiration Question: Describe Controlled VentilationAnswer: Time triggered, machine , volume or pressure cycled Question: What does CMV to equal VE?Answer: (Vt or ) + RR=VE Question: What are the for CMV?Answer: Need to control VE completely; need to control chest expansion completely like with chest Question: of CMV?Answer: pt is totally vent dependent, are essential, unable to assess weaning and seizures interrupt delivery of breath Question: Time/breath/cycle for A/C Answer: Patient or Time triggered, driven, volume cycled Question: Indications for A/C Answer: full ventilatory support, need to high VE with low O2 consumption, sedation after intubation Question: Advantages of A/C Answer: Decrease WOB(pt only), pt controls RR therefore VE (resp compensation, normalize CO2) Question: Complications of A/C Answer: hyperventilation(resp alkalosis), pain/anxiety/CNS , Biots or Cheyne stokes respirations Question: IMV modeAnswer: first widely used mode that allowed partial ventilatory support, facilitates weaning, increase strength. Not widely used today Question: Complications of Answer: stacking(spont effort immediately followed by mechanical breath) which leads to increased PIP, barotrauma, cardiac compromise Question: What is /volutrauma?Answer: lung injury that occurs from hyperinflation of past rupture point (PIP>50, Pplat>35) Question: SIMV /type of breaths/cycling mechanismAnswer: trigger:mandatory(time or pt triggered/assisted), Type:mechanical, assisted, or spontaneous; Cycle:mechanical/assisted(preset Vt or ), Spontaneous:pt determines Volume Question: What is the window?Answer: time interval just prior to time triggering in which the ventilator is responsive to the patient's breath Question: for SIMVAnswer: parital vent , pt can actively participate in VE Question: If the set rate is high(8-12) in SIMV Answer: can provide total support (SIMV with no rate is the same as A/C) Question: the rate low (<8) in SIMV:Answer: facilitates , strengthens respiratory muscles, decreases mean airway pressure making spont breaths have a lower peak pressure than mandatory Question: of SIMV:Answer: low rate can WOB causing muscle fatigue/failure Question: What mode of PPV has a baseline pressure continuously applied to the circuit and airway during both I and E?Answer: Question: in this mode of PPV the ventilator delivers a time triggerd breath and patient to breath at own Vt bw mechanical breaths.Answer: Question: In this mode of PPV the ventilator delivers a set Vt or at a time triggered rate but the patient can trigger a mechanical breath above preset rateAnswer: A/C Question: In this mode of 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 usedAnswer: Question: In order for this mode of PPV to be used the pt must be spontaneously breathing, have adequate lung function to maintain normal , and are not at risk for hypoventilationAnswer: Question: 3 pressure support does?Answer: augments spontaneous Vt, Decreases RR, and reduces patient WOB, Raw Question: How does support decrease spontaneous RR?Answer: increased decreases need for high RR to achieve required VE, decreases deadspace ventilation Question: RR is less than __Answer: Question: What is Vt upon with Pressure support mode?Answer: set inspiratory pressure, lung , and airway resistance Question: What flow variable in PS?Answer: upon flow needed to maintain pressure plateau Question: PS:trigger, , cycleAnswer: patient triggered, , pressure limited, flow cycled Question: CPAP with PS Answer: BiPap Question: CPAP with no PS Answer: Question: Management of Answer: begin with 5-10cwp, increase in of 3-5cwp Question: Titrate PS to what 3 things?Answer: Spont Vt 5-7ml/kg IBW, RR less than 25, Decrease in Question: This is not a alone” modeAnswer: PEEP Question: Effects if Answer: recruit alveoli, increase FRC(oxygenation), alveolar surface area(gas diffusion), increase compliance, prevent VILI Question: Complications of Answer: cardiac compromise, increase intrathoracic pressure, venous return, decrease CO and BP Question: Indications for Answer: hypoxemia and 5cwp is considered physiologic to replace glottic closure Question: PEEP Answer: 5cwp=physiologic, increase in increments of 3-5cwp while watching BP, decrease to level or zero for low BP, treat low BP with vol expansion or vasopressors then increase PEEP again while observing BP Question: What is Answer: change per unit pressure Question: ratio ventilation is ___ controlledAnswer: Question: Long I, E causes what?Answer: air trapping, auto PEEP and alveolar collapse Question: Auto-PEEP=Answer: increased oxygenation, peep effects, increased FRC, PaO2, and surface Question: How does IRV alveolar collapse?Answer: critical opening pressure reduced, pressure for ventilation is less, improves ventilation Question: Complications of Answer: barotrauma, requires paralysis sedation, cardiovascular compromise to PEEP effect Question: Mandatory ventilation activates whenAnswer: a pts spont breathing is less than minimum set VE, increases ventilation Question: The method of increased with MMV varies upon what?Answer: ventilator (some icrease RR, some Vt, and some PSV) Question: What should VE be set to ?Answer: PaCO2 Question: Advantages of Answer: promotes breathing, minimal support but protects against hypoventilation and resp acidosis, permits weaning but compensates for apnea Question: Disadvantages/complications of Answer: doesnt protect RSB(deadspace breathing), High RR with low Vt = patient breathing above VE(MMV remains inactive but PaCO2 increases, resp acidosis) Question: Pressure control(PCPAnswer: Vt variabl, Inspiration begins at preset pressure, Plat is and maintained for preset I-time, Flow is variable dependent on flow required to maintain pressure plat Question: Pressure control generates a ____ flow to increase the airway pressure to a preset pressure limitAnswer: Question: When is inspiration terminated in ControlAnswer: when the I-Time is reached Question: Indications fro Answer: low lung compliance-high PIP during volume ventilation (PIP > 50, Plat>35); ARDS-ARDS net Question: Advantages of Answer: PIP is reduced while maintaining adequate oxygenation and , reduced risk of barotraumas Question: Management of Answer: Pip is set to achieve a goal Vt, unless pt is allowed to hypercapnic in the interest of limiting PIP; VT and VE must be carefully monitored Question: What is APRV?Answer: pressure release ventilation Question: What happens during of APRVAnswer: applie positive airway 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) Question: What happens during exhalation with Answer: positive pressure is periodically released to allow exhalation (brief 1-2 seconds), FRC and allows for exhalation and release of CO2 Question: APRV is for what kind of patients?Answer: those at risk for an inadequate spontaneous Question: APRV can resemble IRV Answer: expiratory pressure time is less than spontaneous effort Question: Why is APRV beneficial alternative to Answer: does not paralytics Question: APRV: /limit/cycleAnswer: time triggered but pt is allowed to breathe spontaneously at any time; and spont pressure limited; time cycled d/t preset I-time Question: Describe Answer: reduces risk of lung destruction by keeping open at constant pressure, oscillates very rapidly (high RR, Hertz, small volumes), early intervention is key! Question: Managing oxygenation with Answer: Mean airway pressure, FiO2, alveolar Question: Managing ventilation with Answer: -delta “P”, Hertz, % I time, cuff deflation, permissive hypercapnia Question: Amplitude “P”Answer: change in stroke volume, force delivered by by setting power, CWF-chest wiggle factor Question: Answer: (1 hertz=60rr), set at 3-6 Hz, decrease rate to eliminate Question: % I time determines delivery Answer: Paw Question: Patient care Answer: Sx PRN, circuit, bronchodilator, sedate or paralyze, pronation, fluid bolus prn, vasopressors, bronchoscopy Question: HFOVAnswer: Hr, SpO2, BP, CWF, Auscultate, CXR, |
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