WillWallace Mech Vent chapt 41
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| What is respiratory failure | show 🗑
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| Hypoxemic resp failure | show 🗑
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| Hypercarbic resp failure | show 🗑
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| disease states that can result in respiratory failure | show 🗑
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| clinical symptoms of respiratory failure | show 🗑
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| show | >WOB and muscle fatigue
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| show | PaCO2 >50 w/PH <7.2
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| what are the critical values for initiating vent support in a pt with hypoxemia | show 🗑
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| show | VT <500 mL/kg (norm 5-8), VC <10mL/kg (norm 65-75), RR >35 (norm 12-20)
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| what are the critical values for initiating vent support in a pt w/decreased muscle strength (tired) | show 🗑
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| show | VE >10 (norm 5-6), VD/VT >.6 (norm .25-.40)
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| what is impending ventilatory failure | show 🗑
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| show | severe air hunger-RR>35, diaphorisis, use of accessory muscles, for neuromuscular-VC <1L or MIP <-20 to-30
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| what is refractory hypoxemia | show 🗑
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| Clinical values for ALI | show 🗑
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| clinical values for ARDS | show 🗑
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| What is CPAP | show 🗑
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| what are the indications for CPAP | show 🗑
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| What are the most common reasons for initiating vent support | show 🗑
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| Goals of mechanical ventilation | show 🗑
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| What are the objectives of mechanical ventilation | show 🗑
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| Common initial settings for VT are | show 🗑
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| Common initial setting for RR are | show 🗑
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| Common initial ventilator setting for normal lung are | show 🗑
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| Common initial ventilator settings for ARDS | show 🗑
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| Common initial ventilator settings for COPD and status asthmaticus | show 🗑
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| show | same as norm
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| show | VT 12-15, RR 8-10, Flow/ITime target 1 second, Peep 3-5, FIO2 40-50%
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| show | 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 volume therefore reducing ICP
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| show | 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 normal settings except RR increase to 12-15 to compensate for smaller VT. Or use HFJV high freq jet vent.
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| Common initial ventilator setting for spinal cord injury | show 🗑
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| show | persistent air leak into the pleural space. Caused by trauma, surgery or invasive procedure like central line or from infections
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| show | assess leak size by measuring inspired versus expired 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.
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| What is optimal flow | show 🗑
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| Who benefits from higher flows | show 🗑
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| show | ARDS, longer IT helps recruiting
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| show | square or rectangular
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| WHAT IS BEST WAVEFORM FOR ARDS | show 🗑
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| what are the hazards of a short IT (high flow) | show 🗑
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| show | increased Paw that can lead to cardio effects, shortens Etime, long ITime can cause airtrapping
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| show | increase the flow
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| show | mode, VT, RR, I:E ratio, Flow, VE, PEEP, Trigger/Sensitivity, FIO2, Alarms
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| Setting flow if IT is 1 second (works on all machines except Servo) | show 🗑
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| Inverse ratioventilatio IRV | show 🗑
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| compication of IRV | show 🗑
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| when would an IRV be used | show 🗑
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| Alv VE | show 🗑
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| show | avoid intubation and assoc complications, preserves natural defenses, pt comfort, maint speech and swallow, less sedation, intermittent use
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| show | pt cooperation needed, limits acess to airway and suctioning, mask discomfort, air leak, transient hypoxemia from lost mask, bipap limit to 20-30, time consuming
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| show | sleep apnea, acute COPD exacerbation, premature extubation, acute resp failure, CHF
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| conraindications of NPPV | show 🗑
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| show | mechanical support such that all energy necessary for effective 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)
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| show | using vent settings that require pt to provide some of the support (simv rates <10)
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| what modes allow for effective spontaneous breathing | show 🗑
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| 3 ways to trigger a breath are | show 🗑
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| show | pressure controll-cont spontaneous ventilation
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| critical values for specific physiological to initiate vent support | show 🗑
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| ABG consistant to mech vent | show 🗑
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| show | indication, noninvasive/invasive, press/volume, partial/full support, Mode-AC, SIMV w/ or w/o PS, PSV, PSV, PCV, dual control
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Created by:
williamwallace
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