Mechanical Ventilation One Flashcards

pressure support ventilation
Terms Definitions
Causes wheezes
Airway Narrowing
Pressure control ventilation-->is duration of breath preset or controlled by pt.?
Preset
Pressure-limited
Termination of the inspiratory
alveolar hyperventilation can cause?
respiratory alkalosis
Auto-PEEP
Unintentional PEEP associated with pressure support ventilation, rapid respiratory rates, slow inspiratory flow and air-trapping.
What is normal A/a ratio?
0.8
Barbiturates
Enter your back text here.
Reason for elevated PCO2 in ventilatory failure
Hypoventilation
the classic indication for PEEP therapy is what?
ARDS
Pressure-Triggered
Initiation of a mechanical breath based on the drop in airway pressure that occurs at the beginning of a spontaneous inspiratory effort.
Hypo/Hyperventilation breakpoint for Dr. Miller for COPD patients.
above 50 Torr
Servo
A feedback system that typically consists of a sensing element, an amplifier and a servo-motor, used in the automatic control of the mechanical device of a ventilator.
To wean.....
First drop PEEP, then FiO2
Cathartic Agents
Enter your back text here.
Pressure Support Ventilation
augments the patient's inspiratory effort and decreases work of breathing
Used with SIMV to overcome the resistance of breathing
Advantage:
Helps lower peak and mean airway pressure
Disadvantage:
Mode dependent upon patient initiating their own breath
Less compliant the lungs, the less volume inspired with each breath
Characteristics of ventilatory failure
Elevated PCO2, low pH
who is at risk for alveolar hyperventilation of mechanical ventilation?
COPD
Chest Tube size for large adults
36-40 French
Prophylactic Ventilatory Support
Early intervention of potential ventilatory failure by means of mechanical ventilation.
Preload
The end diastolic stretch of the muscle fiber.
What is the benchmark for ventilatory failure?
PaCO2
Control Mode
In control mode, the ventilator delivers the preset tidal volume at a set time interval (time-triggered respiratory rate).
Name three flow types.
Laminar, turbulent, and combo
Autoclave
A method of sterilization using steam pressure, usually at 250 degrees Farenheit for a specific amount of time.
What is another name for Pulmonary Artery Catheter?
Swan-Ganz
Trocar
A trocar is a sharply pointed instrument for incision into the chest cavity.
Is Peak Pressure attributed to compliance or airway resistance?
Airway resistance
Define Renal Perfusion.
Blood flow to the kidneys.
Flow Cycled
ventilator delivers a breath until a preset flow is achieved during inspiration.
expiration begins when the flow rate reaches a pre-determined percentage of its peak value
At the start of inspiration, the flow rate is maximum, but as the lungs fill with air, pressure within them increases and flow rate decreases
What is "barotrauma?"
Injury caused by pressure differences between external environment and inside of body
When a patient is on a ventilator, what is the effect of too little food?
Weakness
What is flow triggered?
Flow-triggering strategy uses a combination of continuous flow and demand flow. Before inspiration, the delivered flow ezuals the return flow. As the patient initiates a breath
Should a chest tube be clamped or occluded for more than a minute?
No
Oxygen Delivery
Total amount of oxygen carried by blood. It is the product of O2 content and cardiac output.
Flow-Triggered
A strategy that uses a combination of continuous flow and demand flow. Before inspiration, the delivered flow equals the return flow. As the patient initiates a breath, the return flow to the ventilator is decreased and this flow differential triggers a
Alarm
An absolute value of a parameter on the ventilatory beyond which an alert is invoked to warn that the safety limit has been breached.
What is normal Cardiac Output?
4 to 8 L/minute
Solenoid Valve
A valve controlled by an electronic switching device that is used to regulate the specific functions of a ventilator.
What is an absolute contraindication for Mechanical Ventilation?
Tension Pneumothorax
Should you choose the smallest ET tube or the biggest that will fit?
Biggest
Physiologic Deadspace
Sum of the anatomic and alveolar deadspace. Under normal conditions it is about the same as anatomic deadspace.
To index anything divide it by???
Body Surface Area
How do you index stroke volume?
divide by BSA
Define Limit Variable.
The variable (pressure, flow or volume) that will not be exceeded during the breath cycle.
Define CPAP.
The end expiratory pressure applied to the airway of a spontaneously breathing patient.
Define Total Parenteral Nutrition.
Complete nutritional support provided to the patient by any method (usually intravenous) other than the intestinal route.
Low Exhaled Volume Alarm
Vent tubing not connected
Leak in ventilator/patient circuit
Leak in cuff or inadequate cuff seal
Occurrence of another alarm preventing full delivery of breath
Criteria for discontinuing mechanical ventilation for ventilatory failure: rapid shallow breathing index
Rate/tidal volume doesn't exceed 105
name 3 volume modes of ventilation?
1. controlled mandatory ventilation
2. assist control ventilation
3. syncronized intermittent mandatory ventilation
What does PEEP do to Aortic Pressure and Cardiac Output?
Decreases them.
Three-Chamber Drainage System
A chest tube drainage setup that requires a vacuum source to provide continuous suction.
Assist/Control (AC)
A mode in which the patient may increase the respiratory rate (assist) in addition to the preset mechanical respiratory rate (control). Each assist breath provides the preset mechanical tidal volume.
Pressure Control Ventilation (PCV)
Once inspiration begins, a pressure plateau is created and maintained for a preset inspiratory time.
What is normal systemic vascular resistance?
800 to 1500 dynes.sec/cm5
Refractory Hypoxemia
Low oxygen tension in the blood that responds very poorly to oxygen therapy.
How is MIP obtained?
By measuring the maximum negative pressure during a forced inspiratory manuever against a closed manometer.
Alveolar Volume
The portion of tidal volume that takes part in gas exchange.
What is the Compliance Formula?
Enter your back text here.∆V/∆P
How are large objects removed from the large airway?
Rigid Bronchoscope
In a clinical setting, what is one of the most frequent causes of increased work of breathing?
Atelectasis
Elevated intraabdominal pressure transmits excessive pressure across the diaphram to the heart and great vessels. What does this result in?
Decreased cardiac output and decreased renal perfusion.
True or False: Pressure is more of a problem in healthy lungs than in lungs with low compliance (stiff lungs)?
True
Define Stroke Volume.
Blood volume output delivered by one ventricular contraction.
High Frequency Ventilation
Delivers small amounts of gas at a rapid rate (60-100 bpm); Requires sedation and paralysis
Used for hemodynamic instability; short duration
bad sound lound and annoying
Volume cycled ventilators--.when is inspiratory phase terminated?
When preset tidal volume is delivered
when do you deflate ventilator cuff?
at the peak of inspiration
low-pressure alarm sounds when?
little or no pressure is generated during the delivery of the machine breaths
Define Oxygen Delivery.
Total amount of oxygen carried by the blood.
What pressures does PEEP increase?
Peak Inspiratory Pressures and Mean Airway Pressures.
Peak Inspiratory Pressure
The pressure used to deliver the tidal volume by overcoming non-elastic (airways) and elastic (lung parenchyma) resistance.
Normal Anion Gap when K+ is included
15 to 20 mEq/L
What urine output indicates oliguria?
Less than 20 ml per hour
Does the top or the bottom of the P-V loop bow out with increases in inspiratory resistance?
Top
Double-Lumen Endobronchial Tube (DLET)
A special airway for independent lung ventilation. It has two seperate lumens, two cuffs and two pilot balloons. Adult sizes range from 35 to 41.
Renal Perfusion
Blood flow to the kidneys. It is decreased when blood volume or cardiac output is low.
What is the formula for static compliance?
Plateau Pressure - PEEP
Esophageal Obturator Airway (EOA)
Airway with a closed (blind) distal end and it is inserted into the esophagus. The cuff must be inflated to prevent air from getting into the stomach. It is not designed to be an artificial airway for positive pressure ventilation.
What are common clinical conditions leading to mechanical ventilation?
Depressed respiratory drive, excessive ventilatory workload, failure of the ventilatory pump
What is directly related to MAP?
inspiratory time, respiratory rate, PIP and PEEP
What is PEEP used to treat?
Refractory hypoxemia caused by intrapulmonary shunting.
Passy Muir Speaking valve
a one-way valve that sits into the stoma - when the patient wants to speak the valve can be closed using pos pressure from the trachea. The air is prevented from exiting the trachea and is exhaled through the larynx
what are possible nursing diagnosis for a pt on mechanical ventilator? (6)
1. risk for injury
2. decreased CO
3. ineffective airway clearance
4. impaired physical mobility
5. anxiety
6. dysfunctional ventilatory weaning response
explain partial liquid ventilation?
what do you need to know about it?
liquivent is trickled down a ET tube while pt is intubated

-needs to be replaced every 3-5 days b/c liquivent evaporates quickly
What is a controller?
The mechanism that provides a mode of ventilation within a specific parameter such as pressure, time, volume or flow.
Why is therapeutic bronchoscopy done?
removal of secretions, mucus plugs or polyps in the airway, removal of small objects, performance of difficult intubations or drainage of an abcess.
What are the primary objectives of mechanical ventilation.
To support oxygenation and ventilation
What are 5 mechanisms that can cause ventilatory failure?
Hypoventilation, Persistent V/Q mismatch, Persistent pulmonary shunt, Persistent diffusion deficit, Persistent reduction in PiO2.
Volume-Assured Pressure Support (VAPS)
A mode of ventilation that assures a stable tidal volume by incorporating inspiratory pressure support ventilation (PSV) with conventional volume-assisted cycles (VAV).
How many blood samples does the estimated physiologic shunt equation require?
One, an arterial blood sample
Proportional Assist Ventilation (PAV)
A mode of ventilation that changes the pressure support level according to the volume, elastance, airflow resistance and flow demand.
What percentage of shunt is considered normal?
Less than 10 percent shunt
What is the formula for cardiac output?
Heart rate X Stroke Volume
What is the thoracic pump mechanism?
Alternations in pulmonary blood flow caused by changes in intrathoracic pressure during positive pressure ventilation.
T/F: in pressure support ventilation, it is important to monitor the pt.'s minute ventilation
True-->pt. is setting own tidal volume and breathing rate
gradual change in PETCO2 may accompany what?
1. increase in co2 production
2. decrease in Co2 production
What are some benefits of BiPap?
Can help prevent intubation of the end-stage COPD patient and in supporting ptients with chronic ventilatory failure.
Where should the low pressure alarm be set?
5 below the vent setting
How does airway resistance variy with the length and width of the ET tube?
resistance varies directly with the length and inversely with the width of the ET tube.
For critically ill patients, what is the clinical range for dynamic compliance?
Between 30 and 40 mL/cm H2O
What hemoglobin level constitutes anemia?
Hemoglobin less than 10 g/100 mL of blood
What are two conditions that can limit the volume delivered by positive pessure ventilation?
Peak inspiratory pressure (PIP) reached too soon. Unable to reach PIP.
What is Pulmonary Capillary Wedge Pressure?
Pressure measured in the pulmonary artery with a balloon inflated to stop pulmonary blood flow.
what are the indications for Nitric oxide? (4)
1. ARDS
2. diagnostic tool for pulm htn
3. cardiac cath
4. during/after cardiac surgery
Describe the Assist/Control (AC) Mode of ventilation.
In the AC mode, the patient may increase the respiratory rate (assist) in addition to the preset mechanical respiratory rate (control). Each assist breath provides the preset mechanical tidal volume.
How can you maintain a higher CPP?
Raise the MAP or lower the ICP
What does Pulmonary Capillary Wedge Pressure reflect?
The volume status and functions of the left heart. Left ventricular preload.
what is rapid shallow breathing index? norm?
spontaneous RR over 1 min divided by tidal volume (in liters)

norm: 60-105/L
What can cause an inability to reach PIP?
ET tube cuff leak and/or Ventilator circuit leak.
What does Chamber One in a three chamber chest tube drainage system do?
Collects the pleural fluid from the patient.
How does hypoperfusion of the kidneys affect drug concentration in the circulation?
May lead to a higher drug circulation in the circulation.
what do you do if condensate in large bore tubing?
check tubing for condensate and remove any fluids
What urine output is defined as Oliguria?
urine output less than 400 mL in 24 hours or less than 160 mL in 8 hours.
What are the 4 phases of a mechanical breath?
Change from E to I, Inspiration, Change from I to E, Exhalation
what do you do if pt has a bronchospasm with mechnical ventilation?
assess pt for cause and report to MD
What are the ranges for hypoxemia?
Normal is 80 to 100 mm Hg, Mild is 60 to 79 mm Hg, Moderate is 40 to 59 mm Hg and Severe is less than 40 mm Hg
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