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SPC Mech Vent
SPC Mech Vent Units 6 & 7
| Question | Answer |
|---|---|
| What is Barotrauma? | Excessive pressure damage |
| What is Volutrauma? | Excessive volume damage |
| What is Atelectotrauma? | Damage from constant opening & closing of alveoli |
| What is Sheertrauma? | Damage from alveoli smacking/bumping into each other; over-distended alveoli bumping into healthy alveoli |
| What is Surfactant Alteration? | Surfactant washing to the bottom of the alveoli instead of surrounding it |
| What is Biotrauma? | Over vented pts prod chemicals that cause organs to fail (MODS - multi organ disorder) |
| What is VIDD? | Vent. Induced Diaphragmatic Disfunction - muscle atrophy |
| What is Vent. Assoc. Lung Injury? | Damage to area above alveoli caused by vent. |
| What is Vent. Induced Lung Injury? | Damage to alveoli caused by vent (ex: alveolar sheer) |
| PPV can lead to: | Increased WOB (Intrinsic & Extrinsic WOB) |
| What is Extrinsic WOB? | A result of ET tube too small, vent. settings, vent. tubing |
| What is Intrinsic WOB? | A result of trying to overcome the normal elastic & restrictive forces in the lung |
| Steps to reduce WOB in mech. vented pts: | Use largest adequate ET tube possible; suction, Peep/PSV; correctly adjust sensitivity; adequate flow rates; decr. airway resistance w/ bronchodilators, diuretics, etc. |
| PPV can cause? | Increase in deadspace due to over-expanded alveoli constricting blood flow |
| Decrease deadspace by: | Increasing Vt, larger et tube, trachea |
| Results of hypoventilation: | Acidosis, coma, hyperkalemia, increase in ICP, vasodilation |
| How long does renal compensation take to off-set HCO3? | 18-36 hrs |
| Results of hyperventilation: | Alkalosis, hypokalemia, tetany, decrease in cerebral perfusion, difficult weaning, vasoconstriction, lowers ICP, too long = Metabolic Acidosis due to HCO3 elevated. |
| Results of PPV on Pulmonary Blood Flow: | Decreased CO, redistribute to lung periphery instead of central area, V/Q mismatch & physiologic deadspace, decrease shunting w/ PEEP |
| Results of PPV on Cardiovascular: | Increase thoracic vessel pressures; Decrease venous return to thorax, pre-load, SV, CO, & systemic BP. |
| Results of PPV on Renal System: | Decrease CO = decrease in urine formation & output; redistribution of blood flow w/in kidneys causes less urine, creatinine, & sodium excreted |
| Results of PPV on ICP: | Increased central venous pressure = decr. venous return = incr. blood vol. in cranium = incr. ICP = decr. cerebral perfusion pressure = cerebral hypoxemia potential. |
| Clinical risks of PPV on ICP: | Pts who already have incr. ICP, closed head injuries, cerebral tumors, post neurosurgery |
| Mean Airway Pressures (MAP): | The average airway pressure throughout the vent cycle (I:E); affected by rate, I time, flow, pressure, or PEEP; MAP > 12 @ risk for barotrauma |
| Normal MAP: | 0; less hemodynamic compromise if kept @ a minimum |
| Paw can be kept lower by: | Changes in inspiratory gas flow & pattern, I:E ratio, PEEP, SIMV |
| Effect of ABG values on renal function: | PaCO2 > 65mmHg = decr. renal function; PaO2 decr. due to vasoconstriction = decr. renal function; PaO2 < 40mmHg = dramatic decr. of renal function |
| What is Auto Peep? | Inhaling too much & exhaling too little / air trapping. |
| Complications of Auto Peep: | Barotrauma, tension pneumothorax, circulatory depression, incr. WOB, decr. CO & venous return |
| Results of Vent. Assoc. Lung Injury (VALI): | Vent. Assoc. Pneumonias (VAPS); oxygen toxicity (ARDS); barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema); over-distention of the lungs |
| Results of Vent. Induced Lung Injury (VILI): | Altered lung fluid balance; incr. endothelial & epithelial permeability; severe tissue damage; collapse of the alveolar units. |
| Hazards of O2 therapy w/ Mech. Vent.: | FiO2>60% more than 48hrs = N washout; FiO2 @ 100% can cause damage in 6 hrs; decr. compliance, surfactant prod., tracheal mucus flow; capillary injury; progressive formation of absorption atelectatis; possibly ARDS |
| What is alveoli instability? | Opening & closing of alveoli (atelectotrauma) causing milking out of surfactant & alveolar instability |
| Causes of ARDS: | A-airway pressures(peak & plat); R-refractory hypoxemia; D-diffuse infiltrates; S-some good lung |
| 4 types of barotrauma assoc w/ MV: | Subcutaneous Emphysema; Pneumodediastinum; Pneumothorax; Pneumopericardium |
| Body positioning w/ Unilateral Lung Disease: | Independant lung ventilation (2 vents); pt's good lung is down. |
| Body positioning w/ ARDS: | Prone (face down) - pt can develop swelling in face/head/eyes if not routinely turned. |
| Most important factor when evaluation pt for weaning: | Was there a significant improvement or reversal of what caused the pt to be put on mechanical ventilation initially. |
| Weaning Parameters: | Acid-base balance, anemia, cardiac arrhythmias, caloric depletion/nutritional status, fluid balance, hemodynamic stability, infection, physiological condition, renal function, state of consciousness, pain, sleep deprivation |
| VC (to wean): | > 10 to 15 ml/kg |
| Ve (to wean): | < 10 to 15 L/m |
| Vt (to wean): | > 3-5 ml/lb or >300mL & <700mL |
| RR (to wean): | < 25 breaths/min |
| MIP/NIP (to wean): | -20 to -30cmH20 |
| RSBI (to wean): | < 100 |
| Dynamic Compliance (to wean): | > 25 mL/cmH20 |
| Vd/Vt (to wean): | < 60% |
| % Shunt Qs/Qt (to wean): | < 20% to 30% |
| Physical signs of increased WOB: | Use of accessory muscles; asynchronous breathing; sweating; anxiety; tachypnea; pt asynchronous w/ vent; substernal & intercostal reactions |
| 3 Common Weaning Methods: | T-Piece/Trach Collar Trials; SIMV; CPAP/PSV/Tube Compensation |
| Weaning w/ T-Piece/Trach Collar Trials: | FiO2 5-10% higher than vent setting; monitor pts appearance, cardiac & ventilatory statuses, check ABG's, common in PACUs, always have pulse ox on pt for alarm purposes, for pts w/ only O in SAVO |
| Disadvantages to T-Piece/Trach Collar Trials: | High level of staff attn; no backup ventilation; no alarms; incr. WOB |
| Weaning w/ SIMV: | Assess pt; decr. rate by 2BPM; monitor vitals; check ABG's 20-30mins post vent chg; cont. to decr. SIMV rate as tolerated by pt; *Considered very old school |
| Advantages of SIMV weaning: | Provides backup ventilation; provides a method of giving large, periodic breaths; useful in cases of ventilatory muscle weakness |
| Disadvantages of SIMV weaning: | Incr WOB due to sudden incr in madatory rate; time & labor intensive; lots of ABGs; more side effects from ventilation (muscle atrophy) |
| Weaning w/ SIMV w/PS: | Helps overcome system imposed WOB; pt controls frequency, depth, & time of spont. brths; improves vent. muscle endurance; PSV levels can be set to optimize a reasonable Vt for a pt |
| Weaning w/ PSV/CPAP: | PSV levels set between 5-10cmH20; set spont. Vt's @ 300-600mL; set rate @ 15-20bpm; decr. psv levels by increments of 5 as tolerated |
| Weaning w/ Spontaneous Breathing Trials: | Pt placed on spont. mode or CPAP w/ 0-5 PEEP; PS added @ a min. 5-7cmH20 to overcome WOB; hemodynamics & vitals monitored; ABG's; *Most common weaning method |
| Tube Compensation: | Mimics post-extubation; weaning tool used prior to extubation; overcomes WOB due to artificial airway; assists pt w/ spont. breaths; Assist Mode = tube comp. ON; Control Mode = tube comp. OFF |
| Weaning w/ BiPAP: | For pts w/ no need for invasive airway; used to avoid re-intubation |
| Evaluation for Discontinuance of Mech. Vent.: | Need for airway protection; ability to mobilize secretions; ability to effectively cough; good gag reflex; ability to ventilate/oxygenate w/o airway assistance; hemodynamic/vital stability |
| Common causes for weaning failure: | Attempted wean too soon; Incr secretions = incr WOB; physiological dependence on vent; generalized weakness & fatigue; malnutrition |
| Equipment for Extubation: | Ambu bag, O2 source & mask/cannula, suction equip, supplies for re-intubation if necessary, Race-Epi |
| Procedure for Extubation: | *Notify Nurse* Monitor pts appearance & vitals, Semi or High Fowler's position, Pre-Ox @ 100%, suction, loosen tape & deflate cuff, pt breathe in deep & cough - pull out tube @ cough, return FiO2 to pre-extubation rate, encourage pt to deep brthe & cough |
| Most COMMON Extubation Complication: | Sore throat & hoarsenss |
| Most SIGNIFICANT Extubation Complication: | Glottic Edema or Subglottic Edema |
| Glottic Edema: | Usually involves the vocal chords & can be tx w/ cool mist, race epi, and/or heliox |
| Subglottic Edema: | May cause complete obstruction requiring immediate re-intubation or emergency trach |
| Mild Stridor tx w/: | Cool Mist (CAM) |
| Moderate Stridor tx w/: | Race-Epi |
| Marked Stridor tx w/: | Re-intubate |
| Long-Term Ventilation: | Pts who are no longer acutely ill but who are presumed to have a permanent need for vent support |
Created by:
vgflgirl
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