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name 4 modes the positive pressure ventilator includes
- 1. CMV - assist control
- 2. IMV - SIMV
- 3. Assist - PSV
- 4. CSV - Spontaneous - CPAP
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positive pressure ventilation may be ... controlled or ... controlled
volume (cycled) or pressure (cycled)
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most common type for ventilating adults
volume ventilation
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allows operator to set certain parameters
volume ventilation
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Name 3 parameters of volume ventilation
- 1. volume delivered (tidal volume, minute volume)
- 2. rate
- 3. flow
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volume ventilation guarantees delivery of a certain volume regardless of ...
lung characteristics
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Name a complication of volume ventilation
barotrauma (pressure will rise)
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Name the 3 factors that affect pressure levels in volume ventilation
- 1. patient lung characteristics
- 2. inspiratory flow pattern
- 3. volume setting
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what is the goal of any type of ventilation?
provide minute volume adequate to maintain physiologically acceptable levels of ventilation (ABG)
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the desired minute volume is based on ...
the size of the patient & then adjusted for metabolic rate
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Name the formula for minute volume in a man & woman
- man: 4 x BSA
- woman: 3.5 x BSA
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BSA is determined by a ... which takes height, weight, & a constant into effect
nomogram
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increases in metabolic rate require ...
increases in minute volume
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increases by ... per degree C above 37
9%
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add ... for every 2000 ft elevation above sea level
5%
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add ... for metabolic acidosis
20%
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desired tidal volume is based on ... & ...
gender & ideal body weight
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Name formula for IBW for man & woman
- man: 106 + 6 (ht in inches - 60) / 2.2
- woman: 105 + 5 (ht in inches - 60) / 2.2
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IBW in kg is multiplied by a volume of ... to determine the tidal volume
7 ml/kg
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what normal tidal volume will we use for initial settings?
7 ml/kg
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what tidal volume is used in ARDS patients?
4-8 ml/kg
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what tidal volume is used in COPD patients?
6-8 ml/kg
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tidal volumes should be adjusted based on measurement of ... & ...
plateau pressure & auto PEEP
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... is permitted to avoid lung injury
permissive hypercapnia
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remember to add the amount of ... if it is not automatically adjusted by the ventilator
tubing compliance
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initial respiratory rate should be set between ...
8-20 bpm
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... & ... are often adjusted for the patients lung characteristics
respiratory rate & volume
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flow rate should be fast enough to deliver the breath in the desired time to achieve an I:E ratio of between ...
1:1.5 to 1:4
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flow must meet patients inspiratory demands or ...
WOB increases
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fast flows shorten ... & ... which can help COPD patients or patients with high resistance
I time & lengthen expiration
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slower flows improve ... & ... with lower pressure that help with ARDS patient
gas distribution & improve oxygenation
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Name the 4 flow patterns
- 1. constant flow
- 2. ascending ramp
- 3. sine wave
- 4. descending ramp
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provides flow of gas at set value through out the breath
constant flow (square wave)
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flow rises instantly to set rate & maintained there until breath ends
constant flow
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constant flow results in a ...
higher peak pressure
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flow starts low & accelerate reaching peak at end inspiration
ascending ramp
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flow & pressure are highest in the middle & lower at both the start & end of the breath
sine wave
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more like a spontaneous breath
sine wave
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opposite of the way people breathe naturally
ascending ramp
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in sine wave, peak pressures are ... than other modes, especially when resistance is high
higher
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most commonly used flow pattern
descending ramp
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produces lowest amount of patient effort & WOB. Flow is highest initially & declines as breath goes in
descending ramp
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descending pattern improves ... within the lung & reduces ... & increases oxygenation
gas distribution & reduces dead space
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... don't always result in high alveolar pressures
high PIP
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average pressure in the lung throughout the entire breath
mean pressure
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is mean pressure is high this means ...
high pressure is applied to lung tissue for a longer time & increases chance of pressure injury
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in low compliance patients with hypoxemia, descending pattern will keep peak pressures ... & ...
lower & improve gas distribution
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in patients with high Raw, the descending pattern will deliver the volume with a ... & ...
lower pressure & better distribution
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provides a set pressure & delivered volume varies based on patient lung characteristics
pressure ventilation
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pressure ventilation can either be ... or ...
pressure control & pressure support
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