WillWallace Mech Vent Chap 38
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| Respiratory failure | show 🗑
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| show | Hypoxemic respiratory failure, PaO2 <60 on R/A, caused by VQ mismatch, shunt, diffusion impairment, perfusion/diffusion impairment, altitude
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| *Three most common causes of Type I hypoxemic resp failure | show 🗑
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| show | (type 1) perfusion in excess of ventilation, COPD is most common cause, blood flow is good but airtrapping, swelling, mucus etc. causes decrease in ventilation, Responds to FIO2
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| S&S of V/Q mismatch | show 🗑
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| What is the most common cause of V/Q mismatch | show 🗑
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| show | (type 1) aka Refractory Hypoxemia, complete block of ventilation to alveoli, most common cause atelectasis, pulm ed and pneumonia. Does not respond to FIO2, refractory to O2
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| show | increased shunt
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| Most extreme shunt | show 🗑
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| Diffusion impairment | show 🗑
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| Most common complaint seen in diffusion impairment | show 🗑
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| Perfusion/diffusion impairment | show 🗑
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| show | (type 1) increased altitude decreases BP, this causes decreased press in alveoli and not enough press to oxygenate, decreases PaO2
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| *Type II failure | show 🗑
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| *Decreased vent drive | show 🗑
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| S&S of decreased vent drive are | show 🗑
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| show | (type II) neuromuscular, resp pump fails, caused by ALS, GB, MG, muscular dystrophy.
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| show | decreases VT and blows off CO2
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| Increased WOB | show 🗑
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| What is the most common cause of Type II vent failure | show 🗑
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| What is the most common cause of increased WOB | show 🗑
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| What is the relationship between RAW and WOB | show 🗑
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| PEEP | show 🗑
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| show | aka autoPEEP, inadvertent buildup of poss press in the alveoli due to incomplete exhale, results in progressive hyperinflation rise in end-expiratory press
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| Extrinsic PEEP | show 🗑
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| Why do severe burns cause increased WOB | show 🗑
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| *Chronic vent failure | show 🗑
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| *How does RT measure PH for acute or chronic vent failure | show 🗑
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| *How does RT recognize Type I from Type II from ABG on R/A | show 🗑
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| show | Body is hardwired to blow off CO2, so incr CO2 equals inc RR, so inc CO2 suggests hypoventilation and acidosis
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| What are the 3 causes of acidosis | show 🗑
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| show | PaCO2 >50 with uncompensated bicarb. Thoracic pump or bellows failure
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| show | aka combined Type I Type II failure, chronic respiratory failure with an acute complication. Emphysema pt with bacterial or viral infection
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| Complications of acute respiratory failure | show 🗑
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| Indications for vent support are | show 🗑
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| show | norm is 74%
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| show | 10-20 on room air, 25-65 on 100% O2, every 50 is approx 2% shunt above norm of 2-5%
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| show | 350-450
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| show | A-aDO2 >350 on 100% or P/F value <200
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| show | 5-8mL/Kg IBW
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| show | 65-75mL/Kg IBW
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| *Indications for vent w/inadequate lung expansion | show 🗑
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| show | PaCO2 >55torr and or PH <7.20 (or 7.25)
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| *MIP norm | show 🗑
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| show | MIP ≥-20, VC<10mL/kg, MVV <2L/minxVE
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| show | 120-180L/min
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| *VE norm | show 🗑
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| *VD/VT norm | show 🗑
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| *Indications for vent w/increased WOB | show 🗑
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| show | MIP (most reliable), VC, MVV (not often)
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| *MIP | show 🗑
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| show | max voluntary ventilation, bedside test with hand held spirometer, not often used because pt dependent.
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| show | press created by endotracheal tube, vent circuit or autopeep that causes increase pressure and therefore increases WOB
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| *What is the cardinal sign of increased WOB | show 🗑
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| show | used as indicator for vent support in increased WOB, norm is 25 to 40%, >60% indicates need of support
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| show | decr VT, decr VC, incr VE, decr CO2
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| show | central failure, transmission failure, contractile failure
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| show | exertion-induced, reversible decrease in central respiratory drive
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| Transmission failure/fatigue | show 🗑
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| *Contractile failure/fatigue | show 🗑
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| *Most easily reversible respiratory muscle weakness is | show 🗑
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| show | hyperventilate to decrease CO2 to 25 -30mmHg causing alkalosis to reduce ICP
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| show | COPD causes incr RAW and decreases exp flow, can easily cause autoPEEP aka hyperinflation and over distension, manage w/ decreased VT & rates and exp time
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| show | dynamic hyperinflation, causes over distention, decr CO, incr intra-thoracic press, and decr venous return
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