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Who devised the first classification system for describing the first vents
Mu Shin
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Who has been trying since 1980s to update vent and mode description
Chatburn
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Historically what do classification systems attempt to accomplish
The physical function of the vent
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What are 2 things chatburns classification attempt to accomplish
- Characteristics like power source
- Breathing pattern
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What is the major source of confusion regarding the different modes of ventilation
The different names
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What another name for the control panel
User interface
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What are 4 power sources for a ventilator
- Pneumatic
- Electric
- Combination
- Manual
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What are the 2 basic types of pneumatically powered vents
Pneumatic and fluidic
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What are 3 types of pressure vents
- Positive pressure
- Negative pressure
- Combined pressure
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Give an example of positive pressure vent
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Give an example of a negative pressure vent
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Give an example of a combined pressure vent
High frequency vents
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What type of vent is most common
Positive pressure
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Give an example of a closed loop system
A robot pouring 1 L into a .75 L container not looking it over flows
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How is closed loop different from open loop
It monitors volume delivered by the ventilator and exhaled by the patient and makes adjustments as needed
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What are other terms used to describe closed loop systems
- Feedback
- Servo controlled
- Intelligent system
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What is the difference between single and double internal pneumatic circuit
- Double has 1 gas source that powers the unit and another that goes to the patient
- Single only has 1 gas source for both unit and patient
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What is another name for the external circuit
- Vent circuit
- Patient circuit
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Why do almost all new vent circuits have an external exhalation valve
For its low resistance, large diameter and flexible plastic diaphragm
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What is the power transmission device for pneumatically powered microprocessor controlled system vents
Flow control valve
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Give an example of Compressor or Blowers
MA-1
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Give an example of Volume-displacement
Cardiopulmonary venturi
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Give an example of Linear-drive piston
PB 740
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Give an example of Rotary, or nonlinear-drive piston
- Lifecare PLV-100, 102
- PB Companion 2801
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Give an example of Spring-loaded bellows
Servo 900c
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What are the three different types of Flow-controlling valves
- Proportional solenoid valve
- Stepper Motors with Valves
- Digital Valve
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Give an example of proportional solenoid Valve
- Hamilton Galileo
- Drager Evita XL
- Marquet Servo i
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Give an example of stepper motors with valve
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Give an example of digital valve on/off configuration
Infant Star
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Give an example of a Fluidic ventilator, and where they are most often used.
Biomed MPV 10 most often used in transport vents
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Older expiratory valves had what two major problems?
Increased resistance to gas flow when expiratory flow was high or when the patient coughed into the vent
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How is PEEP accomplished by the expiratory valve?
Flow resistance or threshold resistance
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Where is Spring-loaded PEEP valves most commonly used?
On manual resuscitation bags
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What ventilators use electromagnetic expiratory valves?
- Marquet Servo I
- Hamilton Veolar Ventilators
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What are the two forces available to perform (the) work of breathing?
- The patients muscles
- Ventilator
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State the equation of motion
Pmus+Pvent=(V/C)+(Raw x Flow)
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Define: mandatory breath
The ventilator controls the timing/size of the breath
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Define: assisted breath
One or all part of the inspiration is performed by the ventilator
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Define: spontaneous breath
The patient controls the transition from inspiration to expiration
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Define: control variable
Parameter or variable controlled by the ventilator for any given breath
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What are the three main control variables:
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What are the other terms for volume-targeted ventilation?
- Volume Ventilation
- Volume Control
- Volume Limited Ventilation
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What are the other terms for pressure-targeted ventilation?
- Pressure Ventilation
- Pressure controlled Ventilation
- Pressure limited Ventilation
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What are the two parts of the total cycle time (TCT)?
Inspiration and Expiration
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What are the four parts of the mechanical breath?
- Trigger Variable
- Breath Delivery (inspiration)
- Cycle Variable
- Limit Variable
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What does the Trigger Variable do?
Begins inspiration
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If the ventilator is �trigged� by time, what type of breath is being delivered?
Mandatory
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What are the two major variables used to trigger (other than time)?
Pressure and Flow
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Describe the three locations for the pressure transducers or sensors so the machine may sense patients� inspiratory effort.
- Within the internal ventilator circuit near the point where the gas flow leaves
- Where the expired gas returns to the unit from the patient
- At the proximal airway
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What is another term for the background flow used in flow triggering?
Base or Bias flow
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What machine can use a Neural triggering mechanism, and what is the abbreviation for this system?
NAVA (servo i)
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How were the first positive-pressure volume ventilators classified?
Based on power source
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How many variables can the ventilator control at a time?
1
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If the ventilator is operating in a pressure-controlled manner, are the delivered volumes and flows consistent manner when a patient�s lung characteristics change?
No
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Give two examples of time controlled breaths/modes.
- High frequency jet ventilation
- High frequency oscilation
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What does ramping mean? Are there another terms used to describe this control?
Adjusting the slope of the pressure and flow curves at the beginning of inspiration
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What are the three variables graphed over time (i.e. scalars)?
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What is the maximum safety pressure usual setting? And what are the common names used for this control?
- 10 cm H2O
- Pressure limit, Upper pressure limit, High pressure limit
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What is the purpose of Maximum Safety Pressure?
To prevent excessive pressure form damaging lung tissue
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How do newer ICU ventilators prevent excessive airway pressures from developing when a patient coughs?
The exhalation valve may float
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What is the term for the phase that ends the inspiratory phase?
Cycle variable
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What four variables can end the inspiratory phase?
- Volume Cycling
- Pressure Cycling
- Time Cycling
- Flow Cycling
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What is the most frequent form of pressure cycling?
Occurs when a vent reaches the upper pressure limit set above the peak inspiratory pressure to ventilate the patient
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What happens to the ventilator when the inspiratory pause is activated
Delivery of inspiration the closing of both insp and exp valves for a fraction of a second
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What are some other terms used for this control setting
- Inflation hold
- Inspiratory plateau
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What does the term �tubing compliance factor� describe?
Volume that can be lost while the circuit expands during inspiration and returns to the NL during exhalation
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What is the typical TCF in adult circuits?
1-3 ml/cmH2O
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Which mode of ventilation most often uses flow cycling?
PSV
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What is the term for the pressure reading at the end of an inspiratory pause?
Plateau Pressure
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How is this pressure reading used to calculate the average alveolar pressure
C= vol/(plat-peep)
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What type of lung-thoracic compliance is calculated at this pressure?
Static compliance
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Why would you extend the Ti out beyond the time needed to deliver the tidal volume?
To increase MAP and potentially improve patients oxygenation
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Finish the sentence: �The expiratory phase is the�.�
Time between inspiratory time
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Finish the sentence: �A zero baseline pressure is�.�
Equal to atmospheric pressure
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Why do we perform the procedure called expiratory hold?
To estimate the pressure in the patients lung and vent circuit caused by air trapping
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What happens if the patient makes an inspiratory effort during the expiratory hold?
The reading cannot be obtained
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Give three interventions to reduce auto-PEEP:
- Lower Ve
- Increase Flow
- Bronchodilators
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