mechanical ventilation basics
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| Describe dynamic compliance? | show 🗑
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| Describe static compliance? | show 🗑
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| show | They will become less compliant
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| show | Cstat will decrease w/ resistance or ↑ w/ air-trapping; Cdyn will decrease or become less C w/ an obstruction
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| Define the term “cycle” | show 🗑
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| show | Pressure and Flow (pt.), Timed (vent.), Manuel (operator)
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| Describe mean airway pressure, | show 🗑
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| What ventilator parameters (i.e. PEEP, Ti) that affects Paw. | show 🗑
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| What is the advantage of SIMV vs. IMV? | show 🗑
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| What blood gas value is the primary indicator of adequate ventilation? | show 🗑
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| show | barotraumas, ↓ venous return, Qt and renal blood flow, ↑ WOB, PVR, ICP, deadspace, mean airway pressure.
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| show | barotraumas*, ↓ venous return, Qt*, renal blood flow, urine output, and gastrointestinal function (due to ↓ blood flow), also an ↑ in ICP, PVR, deadspace and mean airway pressure.
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| What will be the result of an ↑ Raw or a ↓ in compliance on a volume cycled ventilator? | show 🗑
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| What will be the result of an ↑ Raw or a ↓ in compliance on a pressure, time cycled ventilator? | show 🗑
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| show | 70%
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| Heated Wick % humidity? | show 🗑
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| High Pressure Alarm Setting? | show 🗑
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| High rate alarm setting? | show 🗑
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| show | 10-15 below set Vt
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| show | 4
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| show | < 20 sec
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| I:E alarm setting? | show 🗑
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| show | flow* or I-Time* or Vt or even RR (changes TCT)
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| show | 30
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| show | 30
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| What FIO2 limit is considered dangerous in regards to possible O2 toxicity? | show 🗑
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| What settings on a ventilator are used to ↑ or ↓ the PaO2? | show 🗑
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| Describe how PEEP ↑ blood oxygenation. | show 🗑
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| Describe how ↑ the TI can improve blood oxygenation. | show 🗑
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| Calculate the corrected Vt for the following pt: PIP = 50, Cmech = 2.5 ml/cmH20, delivered Vt = 900 ml. | show 🗑
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| What is the appropriate action for any ventilator problem that is not immediately identified and corrected? | show 🗑
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| show | Increase Vt or RR (Adjust Vt first, but if Vt is ideal then go w/ RR)
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| What ventilator changes could be made to correct a respiratory alkalosis? | show 🗑
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| What 3 changes could be made to correct a low PaO2? | show 🗑
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| show | ↓ FIO2 and/or I-Time
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| What is the goal for the PaCO2 and pH when mechanically ventilating a COPDer w/ chronic hypercapnea? | show 🗑
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| show | 6-10 ml/kg
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| What factors are to be optimized before considering a pt. for weaning off a vent? | show 🗑
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| show | RSBI 105(predicts spontaneous breathing), SBT, MEP + 40,MIP = >-20 to -30 cmH2O, VE = < 10 L, VC = >10 – 15 ml/Kg, Spontaneous tidal volume = > 300 ml, Respiratory rate = < 25/min
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| show | Spontaneous breathing trial, off vent w/ T-Piece/CPAP (both spontaneous), SIMV (decrease to 2), PSV (basically CPAP)
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| show | Gradual ↑ on pt’s ventilatory load by decresing the rate, Machine breaths are decreased by 2 breaths at a time (incremental changes), Patient takes over with spontaneous efforts to maintain the VE needed to stabilize PaCO2
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| show | PSV can be added to help “fine tune” incremental changes and maintain adequate spontaneous Vt (>300 ml)
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| show | 20 seconds
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| What techniques are used to monitor the possible cardiac effects from positive pressure ventilation? | show 🗑
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| Describe possible advantages of pressure control ventilation over volume control ventilation. | show 🗑
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| show | think barotrauma; only let go of maintaining CO2 for the sake of the lungs.
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| Describe the 2 diff types of res. failure. What disease processes are associated w/ each? | show 🗑
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| A/C mode, 600 Vt w/ a rate of 12, w/o spont.efforts: 7.25/CO2 55/HCO3 23/PaO2 80/ at an FIO2 .35 | show 🗑
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| show | Compensated Respiratory Acidosis w/ moderate hypoxia; Increase FIO2
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| A/C mode, 600 Vt w/ a rate of 12, w/o spont.efforts: 7.51/CO2 25/HCO3 23/PaO2 90/ at an FIO2 .45 | show 🗑
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| show | Normal ABG; except the PaO2, so lower the FIO2. It's over the toxic level anyway.
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| A/C mode, 600 Vt w/ a rate of 12, w/o spont.efforts: 7.36/CO2 65/HCO3 38/PaO2 100/ at an FIO2 .45 (COPD pt being considered for weaning) | show 🗑
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