-
what power sources are used to provide ventilation to a pt
- electrical
- power
- pneumatic (gas)
- or a combo of both
-
trigger breath begins in
inspiration
-
limit variable is the maximum value a variable can attain during
inspiration
-
cycle variable termination of the
inspiratory phase
-
when utilizing extrathoracic ventilation, ____ pressure is applied to the chest wall of the patient
negative pressure (suction)
-
what types of pt might benefit from the use of negative pressure ventilators
- home care
- pt with neuromuscular pathologies
-
ex of neg pressure vents
- iron lung (body tank)
- chest cuirass
-
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
-
how does positive pressure ventilator work
vent creates a pos press that will push air into the pt's lungs and inc intrapulm press
-
when using a volume-cycled vent, what variable ends inspiration
pressure is applied to the airways until a preset volume is delivered
-
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
-
pressure cycled vent- although peak pressure will remain constant, the volume will change as
lung compliance/airway resistance change
-
what type of pt's could be managed with pressure cycle vent (ippb)
-
time cycled vents are commonly used for what type of pt's
infants
-
how is vt adjusted on a time cycled vent (by increasing or decreasing)
- peak inspiratory pressure
- ins time
- flow
-
Peak ins pressure on a time cycled vent is usually limited by an
adjustable pop off valve
-
what should you do if the rr or vt decreases on a pneumatic transport ventilator
check the cylinder pressure
-
2 types of pressure cycled vent
-
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
-
vent circuits should NOT be changed on a regular basis unless
- circuit is grossly contaminated
- malfunctioning
-
setting for a high pressure limit
10 cmh20 ABOVE peak airway pressure
-
setting for a minimum exhaled volume
100 ml BELOW exh vt
-
setting for a low pressure limit
10 cmh20 BELOW peak airway pressure
-
a LEAK in the vent circuit would most likely result in activation of what alarms
low pressure alarm
-
an obstruction in the endo tube would be indicated by the activation of which alarm
high pressure alarm
-
during time cycled vent, inspiration ends when a preset _____ has been reached
ins time
-
initial setting for infant vent
MODE
IMV
-
initial setting for infant vent
PEAK INS PRESSURE (PIP)
20-30 cmH20
-
initial setting for infant vent
RR
20-30 BREATHS/MIN
-
initial setting for infant vent
INS TIME
.5-.6 SECONDS
-
initial setting for infant vent
FLOW
5-6 L/MIN
-
initial setting for infant vent
FIO2
40-60% OR SET AT SAME LEVEL PRIOR TO VENTILATION
-
initial setting for infant vent
PEEP
2-4 cmH20
-
4 indications for continuous mech vent
- apnea
- acute vent failure
- impending vent failure
- oxy
-
bedside pulmonary function
VT
5-8 ml/kg
-
bedside pulmonary function
VC
65-75 ml/kg
(10 x VT)
-
bedside pulmonary function
RR
8-20 /min
-
bedside pulmonary function
VE
5-6 l/min
-
bedside pulmonary function
MIP
-80 cmH20
-
bedside pulmonary function
MEP
160 cmH20
-
physiological assessment/calculations
A-a DO2 @ 21%= PAO2 - PaO2
normals
5-10 mmhg
-
physiological assessment/calculations
A-a DO2 @100%
25-65 mm hg
-
physiological assessment/calculations
qs/qt %
shunting
less or equal 5%
-
physiological assessment/calculations
vd/vt %
deadspace
20-40%
-
physiological assessment/calculations
Cst ml/cmh20
static compliance
60-100 ml/cmh20
-
which mode is acceptable for initial set up
any mode is acceptable for the initial set up
-
initial set up
VT
8-12 ml/kg of ideal body weight
-
initial set up
RR
8-12 breaths/min
-
initial set up
FIO2
40-60%
-
formula for ideal body weight for MALES
106 lb + 6 lb/in over 5 feet
-
formula for ideal body weight for FEMALES
105 lb + 5 lb/in over 5 feet
-
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)
60kg
-
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)
86kg
-
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
-
what measurements should be assessed when the pt is spont breathing
-
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
-
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
-
alveolar vent is best inc by
increasing vt
-
what is the formula used to calculate static compliance
exh vol/ (ppl-peep)
ml/cmh20
-
decreasing static compl would be evident when the PIP ___ and the plateau pressure _____
- PIP increases
- PPL increases
-
increasing airway resistance (raw) would be evident when the PIP _____ and the plateau pressure _____
- PIP increases
- PPL remains the same
-
how do you treat an increased in airways resistance
-
how do you treat a decreased lung compliance
- inc peep
- treat underlying cause
-
avg pressure transmitted to the airway from the beginning of one breath to the beginning of the next
mean airway pressure (PAW)
-
list the factors that directly affect mean airway pressure
- PIP
- rr
- IT
- peep - most influence on PAW
- peak flow
- vt
- inflation hold
-
PAW of >12 mm hg is a >risk of
barotrauma
-
assist/control mode, the vent controls
vt for every breath
-
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
-
pressure control vent may help to improve ___ and reduce ___
- help improve oxy
- reduce barotrauma
-
pressure control is recommend for
- pt requiring high FIO2 and peep
- high PIP
- low PAo2
- decreased compliance (ards)
-
what do you adjust to vary exh vt
-
inverse ratio vent IRV is used when peak ins pressure is
very high >50
-
inverse ratio vent IRV is recommended for
- pt requiring FIO2 >60% and peep >15
- hih PIP
- low pao2 and dec comp
-
should pt be paralyzed and sedated while on inverse ratio breathing?
yes
-
where should you start with i:e ratio on inverse ratio vent IRV
2:1 or greater
-
what pt would benefit from inverse ratio vent
ARDS
-
a form of spont breathing at a positive press level, similar to CPAP
APRV- airway pressure release ventilation
-
APRV ususes a lower ____ resulting in lower ____
-
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
-
PRVC is used with pt who have difficulty in
weaning
-
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
-
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)
-
allows the thoracis surgeon to work on or near a lung w/out interfering with effective gas exhange
independent lung ventilation ILV
-
indications for ILV
anatomic-protect one lung from contamination or infection originating in the opp lung
-
ILV is commonly accomplished by using what types of tubes
- double lumen tube DLT
- endobronchial tube
- carlens tube
-
when you wish to normalize a HIGH PaCO2 you should:
- dec or remove deadspace
- inc vt
- inc rr
-
when u wish to normalize a LOW paCO2 you should
- increase deadspace
- dec rr
- dec vt
-
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
-
when you wish to decrease a high PaO2
- dec fio2 to less than .60%
- decrease peep
-
normal i:e ratio
1:2, 1:3
-
i:e ratio for COPD pt
1:4, 1:5
-
increasing the flow rate will increase the time for
exhalation
-
indication for adding an ins plateau
- increase diffusion of gases (improve distribution)
- decrease microatelectasis formation
-
ins plateau is not to be used with
closed head injury pt - will inc ICP
-
when positioning the pt for mech vent the pt should initially be placed in a
supine position
-
sigh volume is set at double the
vt or less
-
adjust sensitivity to achieve pt's
synchrony
-
when adjusting sensitivity the pressure triggering the vent- sensitivity should be set at
1-2 cmh20 below baseline
-
PEEP/CPAP is used to increase a pt
FRC
-
PEEP/CPAP improves
- increases compliance
- oxygenation
- myocardial oxygenation
- inc cardiac output
-
Optimal peep is the lowest amt necessary to provide
good oxygenation without any side effects
-
apply disease specific vent protocols with pt that has
-
sustained inc in pressure in the lungs with the goal of opening as many collapsed lung units as possible is known as
recruitment maneuvers
-
waveforms that plow flow V pressure P or volume Vt on the vertical y-axis against time on the horizontal x-axis
scalar graphics
-
waveforms that plot two of the primary vent parameters against ea other
loop graphics
-
an abrupt change in direction of a lop graphic. normally used with the pressure vol loop to determine the best PEEP level
infelction point
-
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
-
decrease anxiety and promote relations
sedatives (versed/ativan)
-
reduces pt's ability to perceive sensation
anesthetics (propofol)
-
reduce sensation of pain
analgesics (morphine)
-
cause paralysis of skeletal muscle
neuromuscular blocking agents (succinylcholine/pancuronium)
-
beside pulm function (weaning)
VT
> or equal 5 ml/kg
-
beside pulm function (weaning)
VC
> or equal 10 ml/kg (2 x vt)
-
beside pulm function (weaning)
f
8-20 bpm
-
beside pulm function (weaning)
VE
< or equal 10 l/min
-
beside pulm function (weaning)
mip/nif
> or equal -20 cm h20
-
beside pulm function (weaning)
mep
> or equal 40 cm h20
-
beside pulm function (weaning)
RSBI
<100
-
clinical measurements
A-a do2
< 300 mm hg
-
clinical measurements
qs/qt
<20%
-
clinical measurements
vd/vt
<60%
-
when you are weaning a pt you must verify that the underlying disease process has been
reversed
-
2 types of weaning methods
- trial and error - pt is completely taken off the vent
- imv/simv
- psv
-
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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