E-Mech Vent

  1. what power sources are used to provide ventilation to a pt
    • electrical
    • power
    • pneumatic (gas)
    • or a combo of both
  2. trigger breath begins in
  3. limit variable is the maximum value a variable can attain during
  4. cycle variable termination of the
    inspiratory phase
  5. when utilizing extrathoracic ventilation, ____ pressure is applied to the chest wall of the patient
    negative pressure (suction)
  6. what types of pt might benefit from the use of negative pressure ventilators
    • home care
    • pt with neuromuscular pathologies
  7. ex of neg pressure vents
    • iron lung (body tank)
    • chest cuirass
  8. if pt is breathing faster than the rate set on the vent, what would you adjust on the chest cuirass
    increase the set rate to match the pt
  9. how does positive pressure ventilator work
    vent creates a pos press that will push air into the pt's lungs and inc intrapulm press
  10. when using a volume-cycled vent, what variable ends inspiration
    pressure is applied to the airways until a preset volume is delivered
  11. pt receiving pressure-cycled vent has an elevated paco2. what vent adjustments should the therapist recommended for this pt?
    increasing or decreasing the pressure limit
  12. pressure cycled vent- although peak pressure will remain constant, the volume will change as
    lung compliance/airway resistance change
  13. what type of pt's could be managed with pressure cycle vent (ippb)
    • post op
    • neuro
  14. time cycled vents are commonly used for what type of pt's
  15. how is vt adjusted on a time cycled vent (by increasing or decreasing)
    • peak inspiratory pressure
    • ins time
    • flow
  16. Peak ins pressure on a time cycled vent is usually limited by an
    adjustable pop off valve
  17. what should you do if the rr or vt decreases on a pneumatic transport ventilator
    check the cylinder pressure
  18. 2 types of pressure cycled vent
    • bird mark 7
    • bennet pr-2
  19. how many therapists should be present to change a vent circuit
    2, manually vent w/ a resuscitation bag will be necessary while the new circuit is attached and tested by another person
  20. vent circuits should NOT be changed on a regular basis unless
    • circuit is grossly contaminated
    • malfunctioning
  21. setting for a high pressure limit
    10 cmh20 ABOVE peak airway pressure
  22. setting for a minimum exhaled volume
    100 ml BELOW exh vt
  23. setting for a low pressure limit
    10 cmh20 BELOW peak airway pressure
  24. a LEAK in the vent circuit would most likely result in activation of what alarms
    low pressure alarm
  25. an obstruction in the endo tube would be indicated by the activation of which alarm
    high pressure alarm
  26. during time cycled vent, inspiration ends when a preset _____ has been reached
    ins time
  27. initial setting for infant vent

  28. initial setting for infant vent

    20-30 cmH20
  29. initial setting for infant vent

    20-30 BREATHS/MIN
  30. initial setting for infant vent

    .5-.6 SECONDS
  31. initial setting for infant vent

    5-6 L/MIN
  32. initial setting for infant vent

  33. initial setting for infant vent

    2-4 cmH20
  34. 4 indications for continuous mech vent
    • apnea
    • acute vent failure
    • impending vent failure
    • oxy
  35. bedside pulmonary function

    5-8 ml/kg
  36. bedside pulmonary function

    65-75 ml/kg

    (10 x VT)
  37. bedside pulmonary function

    8-20 /min
  38. bedside pulmonary function

    5-6 l/min
  39. bedside pulmonary function

    -80 cmH20
  40. bedside pulmonary function

    160 cmH20
  41. physiological assessment/calculations

    A-a DO2 @ 21%= PAO2 - PaO2

    5-10 mmhg
  42. physiological assessment/calculations

    A-a DO2 @100%
    25-65 mm hg
  43. physiological assessment/calculations

    qs/qt %

    less or equal 5%
  44. physiological assessment/calculations

    vd/vt %

  45. physiological assessment/calculations

    Cst ml/cmh20

    static compliance
    60-100 ml/cmh20
  46. which mode is acceptable for initial set up
    any mode is acceptable for the initial set up
  47. initial set up

    8-12 ml/kg of ideal body weight
  48. initial set up

    8-12 breaths/min
  49. initial set up

  50. formula for ideal body weight for MALES
    106 lb + 6 lb/in over 5 feet
  51. formula for ideal body weight for FEMALES
    105 lb + 5 lb/in over 5 feet
  52. what is the ideal body weight for a female patient who is 5 feet 3 inches tall
    105 + 15 = 120 lbs / 2 (to convert to KG)

  53. what is the ideal body weight for a male pt who is 6 feet 1 inch tall
    106 + 66 = 172 lbs / 2 (to convert to KG)

  54. list some of the vital signs and assessment parameters to monitor while a pt is on a mechanical vent
    • hr
    • rr
    • bp
    • temp
    • ecg
    • sensorium -level of consciousness
    • bs
  55. what measurements should be assessed when the pt is spont breathing
    • vt
    • rr
    • ve
    • vc
    • mip
    • mep
  56. what measurements should be assessed when the pt is receiving vent support
    • exh vt
    • rr
    • ve
    • ins flow - i:e ratio
    • alveolar min ventilation
    • deadspace vent VD
    • airway pressure
  57. what is the formula used to calculate alveolar ventilation
    • (vt-vd) x f
    • use the estimate of 1 ml per lb of ideal body weight for VD
  58. alveolar vent is best inc by
    increasing vt
  59. what is the formula used to calculate static compliance
    exh vol/ (ppl-peep)

  60. decreasing static compl would be evident when the PIP ___ and the plateau pressure _____
    • PIP increases
    • PPL increases
  61. increasing airway resistance (raw) would be evident when the PIP _____ and the plateau pressure _____
    • PIP increases
    • PPL remains the same
  62. how do you treat an increased in airways resistance
    • suction
    • bronchodilator
  63. how do you treat a decreased lung compliance
    • inc peep
    • treat underlying cause
  64. avg pressure transmitted to the airway from the beginning of one breath to the beginning of the next
    mean airway pressure (PAW)
  65. list the factors that directly affect mean airway pressure
    • PIP
    • rr
    • IT
    • peep - most influence on PAW
    • peak flow
    • vt
    • inflation hold
  66. PAW of >12 mm hg is a >risk of
  67. assist/control mode, the vent controls
    vt for every breath
  68. in what pt situations would SIMV be the mode of choice
    • COPD to normalize ABG
    • tachypnea >20 bpm to avoid hyperventilation
    • weaning pt
    • used with peep to reduce barotrauma
  69. pressure control vent may help to improve ___ and reduce ___
    • help improve oxy
    • reduce barotrauma
  70. pressure control is recommend for
    • pt requiring high FIO2 and peep
    • high PIP
    • low PAo2
    • decreased compliance (ards)
  71. what do you adjust to vary exh vt
    • it
    • pip
  72. inverse ratio vent IRV is used when peak ins pressure is
    very high >50
  73. inverse ratio vent IRV is recommended for
    • pt requiring FIO2 >60% and peep >15
    • hih PIP
    • low pao2 and dec comp
  74. should pt be paralyzed and sedated while on inverse ratio breathing?
  75. where should you start with i:e ratio on inverse ratio vent IRV
    2:1 or greater
  76. what pt would benefit from inverse ratio vent
  77. a form of spont breathing at a positive press level, similar to CPAP
    APRV- airway pressure release ventilation
  78. APRV ususes a lower ____ resulting in lower ____
    • pip
    • mean airway press
  79. a form of ventilation that keeps pressure at the lowest level by providing automatic, breath to breath pressure regulation while providing a preset vol
    PRVC- pressure regulated volume control
  80. PRVC is used with pt who have difficulty in
  81. positive press vent with breathing rates in excess of 150 breaths/min and vt of approximately the anatomical dead space <5 ml/kg (more on infants)
    high freq ventilation
  82. indications for high frequency vent
    • ventilation at lower peak and mean airway pressure
    • ventilation for pt w/ bronchopleural fistula or ARDS
    • treating pulm air leak prob (pulm intersitial emphysema)
  83. allows the thoracis surgeon to work on or near a lung w/out interfering with effective gas exhange
    independent lung ventilation ILV
  84. indications for ILV
    anatomic-protect one lung from contamination or infection originating in the opp lung
  85. ILV is commonly accomplished by using what types of tubes
    • double lumen tube DLT
    • endobronchial tube
    • carlens tube
  86. when you wish to normalize a HIGH PaCO2 you should:
    • dec or remove deadspace
    • inc vt
    • inc rr
  87. when u wish to normalize a LOW paCO2 you should
    • increase deadspace
    • dec rr
    • dec vt
  88. when you wish to increase a LOW PaO2
    • inc fio2 by 5-10% (up to 60%)
    • inc peep levels by 2-5 until acceptable oxygenation is achieved or unacceptable side effects occur
  89. when you wish to decrease a high PaO2
    • dec fio2 to less than .60%
    • decrease peep
  90. normal i:e ratio
    1:2, 1:3
  91. i:e ratio for COPD pt
    1:4, 1:5
  92. increasing the flow rate will increase the time for
  93. indication for adding an ins plateau
    • increase diffusion of gases (improve distribution)
    • decrease microatelectasis formation
  94. ins plateau is not to be used with
    closed head injury pt - will inc ICP
  95. when positioning the pt for mech vent the pt should initially be placed in a
    supine position
  96. sigh volume is set at double the
    vt or less
  97. adjust sensitivity to achieve pt's
  98. when adjusting sensitivity the pressure triggering the vent- sensitivity should be set at
    1-2 cmh20 below baseline
  99. PEEP/CPAP is used to increase a pt
  100. PEEP/CPAP improves
    • increases compliance
    • oxygenation
    • myocardial oxygenation
    • inc cardiac output
  101. Optimal peep is the lowest amt necessary to provide
    good oxygenation without any side effects
  102. apply disease specific vent protocols with pt that has
    • ARDS
    • ASTHMA
  103. sustained inc in pressure in the lungs with the goal of opening as many collapsed lung units as possible is known as
    recruitment maneuvers
  104. waveforms that plow flow V pressure P or volume Vt on the vertical y-axis against time on the horizontal x-axis
    scalar graphics
  105. waveforms that plot two of the primary vent parameters against ea other
    loop graphics
  106. an abrupt change in direction of a lop graphic. normally used with the pressure vol loop to determine the best PEEP level
    infelction point
  107. also called instrinsic PEEP or occult peep. occurs when there is incomplete exhalation and air is trapped in the lungs. caused by insufficient expiratory time
    auto PEEP -occurs when u don't give the pt enough time to exh
  108. decrease anxiety and promote relations
    sedatives (versed/ativan)
  109. reduces pt's ability to perceive sensation
    anesthetics (propofol)
  110. reduce sensation of pain
    analgesics (morphine)
  111. cause paralysis of skeletal muscle
    neuromuscular blocking agents (succinylcholine/pancuronium)
  112. beside pulm function (weaning)

    > or equal 5 ml/kg
  113. beside pulm function (weaning)

    > or equal 10 ml/kg (2 x vt)
  114. beside pulm function (weaning)

    8-20 bpm
  115. beside pulm function (weaning)

    < or equal 10 l/min
  116. beside pulm function (weaning)

    > or equal -20 cm h20
  117. beside pulm function (weaning)

    > or equal 40 cm h20
  118. beside pulm function (weaning)

  119. clinical measurements

    A-a do2
    < 300 mm hg
  120. clinical measurements

  121. clinical measurements

  122. when you are weaning a pt you must verify that the underlying disease process has been
  123. 2 types of weaning methods
    • trial and error - pt is completely taken off the vent
    • imv/simv
    • psv
  124. summary of adverse conditions while on weaning trial
    • inc hr by >20
    • change in bp by 10-20 mm hg
    • inc paco2 by > 10 torr
    • rr increase by >10 or >30
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E-Mech Vent
E-Mech Vent