resp 120

  1. Causes of respiratory acidosis!
    • Parenchymal lung problems
    • Airway disease
    • Pleural abnormalities
    • Chest wall abnormalities
    • Nuromusculars disorders
    • Central nervous system¬†
  2. Causes of respiratory alkalosis!
    • Hypoxia with compensatory hyperventilation
    • Parenchymal lung disease
    • Medications (salicylate, xanthines, analeptics)
    • Mechanical ventilation
    • Central nervous system disorders
    • Anxiety
    • Metabolic problems
  3. Metabolic acidosis
    These patients are often struggling to lower their PaCO2 to acheive some degree of hyperventilation to compensate for the metabolic acidosis
  4. Permissive Hypercapnia
    • pH can not be higher than 7.1
    • Oxygenation must be maintained
    • May have to sedate patient
    • Can give Bicarb to help bump pH up
  5. Appropriate suction levels for adults!
    -100 to -120 mm Hg
  6. Appropriate suction levels for children!
    -80 to -100 mm Hg
  7. Appropriate suction levels for infant!
    -60 to -100 mm Hg
  8. Indication for suctioning
    • Labored breathing
    • Increased RR
    • Bilateral breath sounds
    • Seeining secretions in tube
    • Feel chest
    • Increased Raw PIP
  9. Hazards and complications for suctioning
    • Decrease in dynamic lung compliance and functional residual capacity
    • Pulmonary atelectasis: reduction of lung volume
    • Hypoxia or hypoxemia
    • Tracheal or bronchial mucosal trauma
    • Cardiac or respiratory arrest
    • Bronchoconstriction or bronchospasm
    • Pulmonary hemorrhage or bleeding
    • Elevated intracranial pressure
    • Cardiac dsrhythmias
    • Hypertension
    • Hypotension
  10. 3 methods of improving oxygentation
    • Peep
    • FiO2
    • Increase Paw
  11. Mean airway pressure
    • Is the average pressure above baseline during a total respiratory cycle
    • As Paw increases, the PaO2 increases
  12. Factors that affect mean airway pressure during positive pressure ventilator!
    • PIP
    • PEEP
    • I:E
    • Respiratory rate
    • Flow
  13. Paw is a major determinant of oxygenation in patients with ARDs because...
    It affects mean alveolar pressure and alveolar recruitment and therefore oxygenation
  14. Goals of PEEP and CPAP!
    • Enhance tissue oxygenation
    • Maintain a PaO2 greater than 60 mm Hg and SpO2 at least 90%
    • Recruit alveoli and keep them open
    • Restore FRC
    • Keep FiO2 low as possible
  15. PEEP
    On a ventilaror, invasive, set rate
  16. CPAP
    Non invasive, spontaneously, one pressure
  17. Devices for PEEP/CPAP
    • Full face mask
    • Nasal mask
    • Nasal pillows
  18. Rules when using a mask device for PEEP/CPAP!
    • Patient must be able to protect airway
    • Patient must be able to support WOB
    • Maintain normal PaCO2
    • Have a PaO2/FiO2 ratio greater than 200 mm Hg
  19. Hazards when using a mask device for PEEP/CPAP!
    • Aspiration
    • CO2 retention
    • Increased WOB
    • Skin necrosis
    • Cerebral hemorrhage
  20. Devices for PEEP/CPAP
    • Nasal prongs
    • Premies longer
  21. Problem win using a nasal device with PEEP/CPAP!
    Lose pressure through open mouth
  22. Hazards when using a nasal device for PEEP/CPAP!
    • Gastric distension
    • Pressure necrosis
    • Swelling of nasal mucosa
    • Abrasion of the posterior pharynx
  23. Devices for PEEP/CPAP
    • Used for vent weaning
    • Cannot protect airway
  24. Physiologic or low PEEP ranges!
    • 3 to 5 cm H2O
    • Help preserve a patients normal FRC ranges
    • Few complications
  25. Therapeutic PEEP ranges!
    • PEEP is 5 cm H2O or greater
    • Used to treat refractory hypoxemia
    • Greater than 15 cm H2O are only benifical to ARDs
    • High levels have many side effects
  26. Optimal PEEP ranges!
    • Vary with patients
    • Most benefits with fewest side effects
  27. Indications for PEEP
    • Bilateral infiltrates on chest radiograph
    • Recurrent atelectasis with low FRC
    • Reduced¬†lung compliance
    • PaO2 less than 60 mm Hg on FiO2 greater than .5
    • PaO2/FiO2 ratio less than 200 for ARDs and less than 300 for ALI
    • Refractory hypoxemia: PaO2 increases less than 10 mm Hg with FiO2 increase of .2
  28. P(A-a)O2 (mm Hg)
    Big is bad
  29. Contraindications for PEEP
    • Hypovolemia
    • Large untreated pneumothorax
    • Tension pneumothorax
    • Incresed intercranial pressures (ICP)
    • Emphysema (use low level of PEEP)
    • Unliteral lung disease
  30. PEEP and suctioning
    • use a closed system
    • PEEP valve on ambu bag
  31. When to wean PEEP
    • Patient need a good PaO2 on less than 40%
    • Patient needs to be hemodymanic stable
    • Some improvement in lung condition
  32. Adverse effects of PPV
    • Increased thoracic pressure
    • Decreased Cardiac output due to decreased vessel filling due to increased vascular pressure
  33. PEEP has the greastest effect on...
    • Mean airway pressure
    • Cardiac output
  34. Increased pulmonary vascular resistance
    Too much peep can over stretch and pulmonary capillarily become smaller
  35. Decreasing the effects of PPV by changing
    • Mean airway pressure (Paw)
    • Inspiratory flow
    • I:E ratio
    • Inspiratory pause
    • PEEP
    • SIMV
  36. Fast flow during PPV
    Decreases Paw but increases PIP and uneven distrubution of ventilation
  37. Slow flow during PPV
    Increased WOB and causes auto PEEP because not enough E time
  38. I:E ratio with PPV
    Fewest PPV side effects with a short I time and a longer E time
  39. Inspiratory pause during PPV
    Helps improve oxygenation and gas distrubition but increases I time and Paw
  40. PEEP during PPV
    • Restore FRC
    • Recruit alveoli
    • Increase Paw too much sometimes
  41. SIMV with PPV
    Decrease in volume decreases pressures and Paw
  42. The benifits of decreased Paw
    (Fast flow)
    • Reduced risk of batotrauma
    • reduced risk of cardiovascular effects
  43. The hazards of decreased Paw
    (Fast flow)
    • Uneven distribution of gas
    • Decreased PaO2
    • Increased PaCO2
  44. The benefits of increased Paw
    (Slow flow)
    • Increased alveoli ventilation
    • Recruitment of alveoli
    • Better gas distrubition
  45. The hazards of increased Paw
    (Slow flow)
    • Decreased cardiac output
    • Decreased O2 transport
    • Increased risk of barotrauma
  46. Effects of PPV on ICP
    • Decreased BP and cerebral blood flow
    • Resp alkalosis to decrease swelling
    • CO2 25-35
  47. Effects of PPV on Renal system
    • Decreased renal blood flow
    • Decreased urine output
  48. Factors that decrease urine outptut
    • PaO2 less than 40
    • PaCO2 greater than 65
    • Impaires renal function
  49. Effects of PPV on GI systems
    • Decreased blood flow to GI
    • Gastric mucosa ischemia, which can increase risk of bleeding and gastric ulcers
  50. PPV can alter cerebral perfusion by...
    Causing a decrease in cardiac output and mean arterial blood pressure or by causing an increase in CVP, which can cause an increase in intracranial pressure
  51. Shunting
    • Perfusion without ventilation
    • Normal person has a 2 to 3% shunt
    • Greater than 30% patient is at risk for death
Card Set
resp 120
test 3