Modes of Mechanical Ventilation
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| show | Negative pressure
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| show | CMV, A/C, IMV, SIMV, CPAP
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| Positive pressure ventilators can be ____ vs ____ controlled | show 🗑
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| show | adaptive, dual
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| show | HFOV (cpap with a wiggle), APRV (cpap with spontaneous breaths)
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| During spontaneous breathing when does pressure equalize? | show 🗑
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| How does PPV create transairway pressure? | show 🗑
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| PPV generate gas flow, therefore ____ ____, by producing a positive pressure gradient | show 🗑
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| show | alveolar/capillary filling occurs during active phase of inspiration which is usually neg pressure and under PPV, vascular flow can be impeded
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| show | CMV, A/C, IMV, SIMV, CPAP
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| Advantages of volume controlled | show 🗑
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| show | pressure variable:barotrauma/volutrauma possible, volume limited by high pressure alarm
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| Advantages of pressure limited | show 🗑
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| show | doesnt ensure VE; Vt variable
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| show | volume(dependent on set pressure) and Flow
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| 4 types of triggers | show 🗑
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| show | sensitivity
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| What are the 2 types of sensitivity controls? | show 🗑
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| How does a perssure trigger work? | show 🗑
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| Pressure transducers are placed at these 3 locations | show 🗑
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| show | flow
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| How does a flow trigger work? | show 🗑
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| Describe Controlled Mandatory Ventilation | show 🗑
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| What does CMV control to equal VE? | show 🗑
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| show | Need to control VE completely; need to control chest expansion completely like with flail chest
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| show | pt is totally vent dependent, alarams are essential, unable to assess weaning and seizures interrupt delivery of breath
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| Time/breath/cycle for A/C vent | show 🗑
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| show | full ventilatory support, need to support high VE with low O2 consumption, sedation after intubation
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| Advantages of A/C mode | show 🗑
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| Complications of A/C mode | show 🗑
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| Describe IMV mode | show 🗑
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| show | breath stacking(spont effort immediately followed by mechanical breath) which leads to increased PIP, barotrauma, cardiac compromise
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| show | lung injury that occurs from hyperinflation of alveoli past rupture point (PIP>50, Pplat>35)
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| show | trigger:mandatory(time or pt triggered/assisted), Type:mechanical, assisted, or spontaneous; Cycle:mechanical/assisted(preset Vt or pressure), Spontaneous:pt determines Volume
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| What is the synchronization window? | show 🗑
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| Indications for SIMV | show 🗑
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| If the set rate is high(8-12) in SIMV mode | show 🗑
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| show | facilitates weaning, strengthens respiratory muscles, decreases mean airway pressure making spont breaths have a lower peak pressure than mandatory
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| show | low rate can increase WOB causing muscle fatigue/failure
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| What mode of PPV has a positive baseline pressure continuously applied to the circuit and airway during both I and E? | show 🗑
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| in this mode of PPV the ventilator delivers a time triggerd breath and allows patient to breath at own Vt bw mechanical breaths. | show 🗑
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| show | A/C
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| show | CMV
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| show | CPAP
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| 3 things pressure support does? | show 🗑
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| show | increased volume decreases need for high RR to achieve required VE, decreases deadspace ventilation
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| Desired RR is less than __ | show 🗑
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| show | set inspiratory pressure, lung compliance, and airway resistance
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| show | dependent upon flow needed to maintain pressure plateau
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| show | patient triggered, spontaneous, pressure limited, flow cycled
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| CPAP with PS is | show 🗑
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| show | CPAP
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| Management of PS | show 🗑
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| Titrate PS according to what 3 things? | show 🗑
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| This is not a “stand alone” mode | show 🗑
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| Effects if PEEP | show 🗑
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| show | cardiac compromise, increase intrathoracic pressure, decrease venous return, decrease CO and BP
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| show | refratory hypoxemia and 5cwp is considered physiologic to replace glottic closure
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| PEEP mgmt | show 🗑
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| What is compliance | show 🗑
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| Inverse ratio ventilation is ___ controlled | show 🗑
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| show | air trapping, auto PEEP and prevents alveolar collapse
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| show | increased oxygenation, peep effects, increased FRC, PaO2, and surface area
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| show | critical opening pressure reduced, pressure needed for ventilation is less, improves ventilation
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| show | barotrauma, requires paralysis sedation, cardiovascular compromise similar to PEEP effect
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| Mandatory minute ventilation activates when | show 🗑
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| show | ventilator model(some icrease RR, some Vt, and some PSV)
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| What should VE be set to achieve? | show 🗑
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| show | promotes spont breathing, minimal support but protects against hypoventilation and resp acidosis, permits weaning but compensates for apnea
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| show | doesnt protect against RSB(deadspace breathing), High RR with low Vt = patient breathing above VE(MMV remains inactive but PaCO2 increases, resp acidosis)
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| show | Vt variabl, Inspiration begins at preset pressure, Plat is created and maintained for preset I-time, Flow is variable dependent on flow required to maintain pressure plat
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| show | high
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| show | when the preset I-Time is reached
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| Indications fro PC | show 🗑
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| Advantages of PC | show 🗑
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| show | Pip is set to achieve a goal Vt, unless pt is allowed to become hypercapnic in the interest of limiting PIP; VT and VE must be carefully monitored
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| show | airway pressure release ventilation
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| What happens during inspiration of APRV | show 🗑
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| show | positive pressure is periodically released to allow exhalation (brief 1-2 seconds), decreases FRC and allows for exhalation and release of CO2
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| show | those at risk for an inadequate spontaneous RR
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| show | expiratory pressure release time is less than spontaneous effort
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| show | does not require paralytics
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| APRV: trigger/limit/cycle | show 🗑
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| Describe HFOV | show 🗑
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| show | Mean airway pressure, FiO2, alveolar recruitment
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| Managing ventilation with HFOV | show 🗑
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| show | change in stroke volume, force delivered by piston by setting power, CWF-chest wiggle factor
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| show | (1 hertz=60rr), set at 3-6 Hz, decrease rate to eliminate CO2
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| show | Paw
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| show | Sx PRN, humidity circuit, bronchodilator, sedate or paralyze, pronation, fluid bolus prn, vasopressors, bronchoscopy
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| show | Hr, SpO2, BP, CWF, Auscultate, CXR, ABG
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