|MOST COMMON DIAGNOSES REQUIRING MECH VENT SUPPORT||1. ACURA RESP. FAILURE 2. COPD EXACERBATION 3. COMA 4.NEUROMUSCULAR DISEASE|
|MOST COMMON CAUSES OF ACUTE RESP. FAILURE REQUIRING MECH VENT||1. POST OP 2.SEPSIS 3.HEART FAILURE 4.PNEUMONIA 5.TRAUMA 6.ARDS 7.ASPIRATION|
|PRIMARY INDICATIONS FOR MECH VENT (BIG FOUR)||1.APNEA 2.ACUTE VENT. FAILURE 3.IMPENDING VENT FAILURE 4.SEVERE OXYGENATION PROBLEMS|
|GOALS OF MECH. VENT. SUPPORT||1.MAINTAIN ADEQUATE ALVEOLAR VENTILATION 2.O2 DELIVERY 3.RESTORE ACID-BASE BALANCE 4.REDUCE WOB WITH MINUMUM SIDE EFFECTS OR COMPLICATIONS|
|SECONDARY TO HYPOXEMIA AND AN INCREASED WOB MECH VENT MAY ALSO REDUCE WHAT?||INCREASED MYOCARDIAL WORK|
|OTHER PHYSIOLOGIC OBJECTIVES OF MECH. VENT. MAY INCLUDE INCREASING OR MAINTAINING LUNG VOL WITH WHAT?||PEEP FOR PROMOTION IMPROVEMENT OR MAINTENANCE OF LUNG RECRUITMENT|
|LUNG PROTECTIVE VENTILATORY STRATEGY IS?||A SMALL TIDAL VOL AND APPROPRIATE LEVELS OF PEEP|
|WHAT PT’S ARE LUNG PROTECTIVE VENT STRATEGY USED FOR?||ARDSALI BUT SHOULD BE USED FOR ALL REQUIRING VENT SUPPORT WITH ACUTE FAILURE|
|LUNG INJURY DURING MECH VENTILATION IS CAUSED BY?||ELEVATED TRANSALVEOLAR PRESSURE DURING POSITIVE PRESSURE BREATHING|
|TRANSALVEOLAR PRESSURE IS||THE DIFFERENCE BETWEEN ALVEOLAR PRESSURE AND PLEURAL PRESSURE DURING POSITIVE PRESSURE VENTILATION|
|NORMAL LUNGS NOT OVER DISTENDED IF TRANSALVEOLAR PRESSURE OS LESS THAT WHAT?||LESS THAN ABOUT 30CM H2O|
|PLATEAU PRESSURE REFLECTS||ALVEOLAR PRESSURE|
|LIMITING PLATEAU PRESSURE BELOW WHAT REDUCES RISK OF VENT INDUCED LUNG INJURY?||<30 CM H2O|
|PATIENTS WITH DECREASED LUNG COMPLIANCE MAY REQUIRE PLATEAU >30CM H2O WHY? WHAT KINDOF PT’S RE THESE?||1.BECAUSE OF DECREASE IN CHEST WALL COMPLIANCE. 2.OBESE, MASSIVE FLUID RESUSCITATION, ABDOMINAL DISTENTION, AND ELEVATED BLADDER PRESSURE.|
|LUNG INJURY IS CAUSED BY? WHAT CAN STABILIZE TO HELP PREVENT INJURY?||1.REPETITIVE OPENING AND CLOSING OF UNSTABLE LUNG UNITS. 2.PEEP STABILIZES IN OPEN POSITION REDUCING LIKELY HOOD OF INJURY|
|PHYSIOLOGIC GOALS OF VENT SUPPORT||1.SUPPORT/MANIPULATE GAS EXCHANGE 2.INCREASE LUNG VOL. 3.REDUCE OR MANIPULATE THE WOB 4.TO MINIMIZE CARDIOVASCULAR IMPAIRMENT|
|CLINICAL OBJECTIVES OF VENT SUPPORT||1.REVERSE HYPOXEMIA, AUTE RESP. ACIDOSIS, VENT MUSCLE DYSFUNCTION, AND ATELECTASIS 2.REDUCE ICP.3.RELIEVE RESP. DISTRESS 4.ALLOW SEDATION/NEURO BLOCK 5.DECREASE SYSTEMIC OR MYOCARDIAL O2 CONSUMPTION 6.MAINTAIN/IMPROVE CARDIAC OUTPUT 7.STABILIZE THE CHEST|
|HOW DO U CALCULATE MINUTE VENTILATION||VE=f X Vt|
|PACO2 TELLS WEATHER YOU ARE DOING WHAT?||VENTILATING|
|PAO2 WEATHER YOU ARE DOING WHAT?||OXYGENATING|
|WHAT IS PRESSURE CONTROL USED FOR?||used to keep pressure low for ARDS AND ALI.|
|WHAT ARE THE INITIAL SETTINGS THAT SHOULD BE SET FOR AN ARDS||Vt SET AT LESS THAT 8ML/KG IBW I:E OF 1:2 AND PEEP OF 10CM H2O.|
|WITH SMALL Vt, WHAT SHOULD BE MONITORED TO PREVENT WHAT?||MAINTAINING AN ADEQUATE VE AND PREVENT ACUTE SEVERE RESP. ACIDOSIS.|
|WHAT IS VOLUME CONTROL USED FOR?||HYPERCABIA (PACO2) AND TO CONTROL MINUTE VENTILATION|
|WHAT WILL AFFECT A PT’S I:E TIME?||HIGHER FLOW WILL (UP TO 100l/MIN) WILL INCREASE THE E TIME.|
|I FLOW SHOULD BE ADJUSTED TO ENSURE THAT?||THE FLOW PROVIDED MEETS OR EXCEEDS THE PT’S SPONTANEOUS I FLOW|
|ACUTE HYPOXIC RESP FAILURE FINDINGS (MILD TO MODERATE)||TACHYPNEA DYSPNEA PALENESS|
|ACUTE HYPOXIC RESP FAILURE FINDINGS (SEVERE0||SLOWED, IRREGULAR BREATHING, RESPIRATORY ARREST DYSPNEA CYANOSIS|
|PRESSURE TRIGGER RANGE||-0.5 TO -1.5 CM H2O|
|SENSITIVITY SHOULD BE ADJUSTED TO||-2 CM H2O|
|FLOW TRIGGER RANGE||1 TO 3ML|
|WHAT WE SET ON THE VENT||MODE, VT, RATE, PEEP, FIO2|
|WHAT IS FLOW RANGE||60 TO 80|
|PEEP DOES WHAT||INCREASE PAO2, INCREASE FRC, AND IMPROVES OXYGENATION|
|PT’S THAT WOULD BENIFIT FROM PEEP||ACURE RESTRICTIVE DISEASE, ALI, PNEUMONIA, PULMONARY EDEMA, AND ARDS|
|PT’S THAT WOULDN’T BENEFIT MUCH FROM PEEP||COPD PTS PR ACUTE ASTHMA. AUTO-PEEP IS USED TO OF SET AUTO-PEEP.|
|IF PAO2 IS LOW WHAT WILL HELP TO IMPROVE IT?||INCREASE PEEP BY 2 TO IMPROVE PAO2|
|HAZARDS OF MECH VENTILATION||DECREASED VENOUS RETURN, INCREASE WOB AND CARDIO OUTPUT DYSFUNCTION, VENT INDUCED LUNG INJURY NOSOCOMIAL INFECTION|
|VT TO START KIDS ON?||8-16YRS 8-10 0-8YRS 6-8|
|NVVP NOT USED FOR?||PT’S PRONE TO ASPIRATION, PT NEEDING HIGHER AIRWAY PRESSURE|
|PARTIAL VENT MODE USED FOR?||PT’S WITH DRIVE TO BREATH, BEING WEANED, OR TO MINIMIZE ADVERSE EFFECTS OF POSITIVE PRESSURE|
|NERO PT WITH ICP WE WANT TO?||HYPERVENTILATE 25-30|
|TITRATE FIO2 DOWN BY?||IF SPO2 IS GREATER THAT 97%, TITRATE DOWN EVERY 5 TO TEN MIN. IF .95% BUT LESS THAN 97% TITRATE BY .05 UP OR DOWN|
Egan’s Chapter 44 Practice Questions:
1. A 40-second I-pause in _____ is used for lung recruitment.: ARDS
2. ACUTE HYPOXIC RESP FAILURE FINDINGS (MILD TO MODERATE): TACHYPNEA, DYSPNEA, PALENESS
3. ACUTE HYPOXIC RESP FAILURE FINDINGS (SEVERE):: SLOWED, IRREGULAR BREATHING, RESPIRATORY ARREST, DYSPNEA, CYANOSIS
4. A brief inspiratory hold may improve:: distribution of ventilation and oxygenation.
5. CLINICAL OBJECTIVES OF VENT SUPPORT:: 1.REVERSE HYPOXEMIA, AUTE RESP. ACIDOSIS, VENT MUSCLE DYSFUNCTION, AND ATELECTASIS, 2.REDUCE ICP., 3.RELIEVE RESP. DISTRESS, 4.ALLOW SEDATION/NEURO BLOCK, 5.DECREASE SYSTEMIC OR MYOCARDIAL O2 CONSUMPTION, 6.MAINTAIN/IMPROVE CARDIAC OUTPUT, 7.STABILIZE THE CHEST
6. Determinants of PaC02:: PaC02= VC02/VA
7. Determinants of PaC02: ⇡VC02:: ⇡ Work, ⇡ Metabolism
8. Determinants of PaC02: ⇣ VA:: ⇣ VE, ⇣ RR, ⇣ Vt, ⇡ VD (without ⇡ VE)
9. Determinants of PaC02: Implication: Best way to ⇣ PaC02 is to _______ ________. Which will ⇣ _____ ___ _____ and ⇣ _______, even if Vt, VE and VA are constant.: ⇣VC02, WOB, PaC02
10. Determinants of PaC02: Implication: Vt falls because ____ encroaches on _____. Limiting the ability to ⇡ Vt with ____/_____.: FRC; TLC, MV/IPAP
11. Factors that can prolong ventilator response time:: Low trigger sensitivity, ABD-rib cage paradox, Auto-PEEP (dynamic hyperinflation), ⇡ tubing compliance, ⇡ circuit dead space, Transducer variability, ⇡ bias flow in the circuit, Unresponsive demand valves
12. FLOW TRIGGER RANGE:: 1 TO 3ML
13. Full vs. Partial ventilatory support:: Full support doesn’t require pt. work [A/C, P/C, SIMV; RR 12-16, Vt 8-12ml/kg of IBW; ARDS/ALI ⇡RR & ⇣Vt (6-8mL/kg)], Partial support does require pt. effort [SIMV(⇣set RR), PSV; useful for weaning; ⇡ WOB, watch for pt. fatigue with rapid shallow breathing and possible apnea]
14. HAZARDS OF MECH VENTILATION:: DECREASED VENOUS RETURN, INCREASE WOB AND CARDIO OUTPUT DYSFUNCTION, VENT INDUCED LUNG INJURY NOSOCOMIAL INFECTION.
15. How can MV help ICP?: By reducing the PaCO2 to 25-30 it can cause cerebral vasoconstriction and reduce ICP
16. HOW DO U CALCULATE MINUTE VENTILATION:: VE=f X Vt
17. How do you find optimal PEEP?: ⇡ PEEP by 2-3 Q 20 minutes, If static compliance ⇡ or stays the same, or SP02 and Pa02 ⇡, you know it’s working, Stop when static compliance ⇣
18. How do you know where to set the starting point on PS?: Calculate the pt.’s airway resistance and this is where you’ll set the PS on the vent (Raw=(PIP-Plat)/Flow L/sec)
19. I FLOW SHOULD BE ADJUSTED TO ENSURE THAT?: THE FLOW PROVIDED MEETS OR EXCEEDS THE PT’S SPONTANEOUS I FLOW
20. IF PAO2 IS LOW WHAT WILL HELP TO IMPROVE IT?: INCREASE PEEP BY 2 TO IMPROVE PAO2
21. Initial setup for trigger sensitivity:: Set to least possible while avoiding auto-cycling, Pressure trigger:0.5-1.5cmH2O, Flow trigger is generally more sensitive., Set based on specific ventilator, If leak is present, revert to pressure triggering to avoid auto-cycling.
22. Initial setup VC-A/C or V/C-SIMV:: Vt and RR, Initial Vt 8-12mL/kg IBW with RR 12-16., Vt 10-12mL/kg and RR 8-12 for pt.’s with NMD or normal lungs postoperatively., In all pt.’s ⇣ Vt PRN to keep Pplat <30cmH20, ⇡RR to maintain C02
23. In PCV, the vent gives the set _______ until the _____ set ends.: pressure; time
24. Inspiratory Flow, Time, and I:E ratio: Volume ventilation:: Most ventilators allow you to set either flow or IT (IT%), as well as VT, and RR: Whether with flow or IT control adjust to get. IT of ~0.8-1.2 seconds, I:E ratio of 1:2 or less, The above usually correspond with a peak flow of 40-80 L/min, Adjust flow to meet or exceed patients’ inspiratory flow requirements. Low flow tends to increase patient WOB.
25. Inspiratory hold or pause should be used with caution because:: an ⇡ing Paw may impede venous return.
26. Ipause is also used for an inspiratory ______ _________.: chest radiograph
27. An Ipause of ____-___ seconds is used to obtain Pplat.(to derive CL and Raw): 0.5-1
28. LIMITING PLATEAU PRESSURE BELOW WHAT REDUCES RISK OF VENT INDUCED LUNG INJURY?: <30 CM H2O
29. LUNG INJURY DURING MECH VENTILATION IS CAUSED BY?: ELEVATED TRANSALVEOLAR PRESSURE DURING POSITIVE PRESSURE BREATHING
30. LUNG INJURY IS CAUSED BY? WHAT CAN STABILIZE TO HELP PREVENT INJURY?: 1.REPETITIVE OPENING AND CLOSING OF UNSTABLE LUNG UNITS. 2.PEEP STABILIZES IN OPEN POSITION REDUCING LIKELY HOOD OF INJURY
31. Lung Protective Strategy is?: Is an approach to Mech Vent that includes the use of small tidal volumes and appropriate levels of peep and is usually used in patients with ALI or ARDS.
32. LUNG PROTECTIVE VENTILATORY STRATEGY IS?: A SMALL TIDAL VOL AND APPROPRIATE LEVELS OF PEEP
33. Mechanical Ventilation of COPD and Asthma exacerbations: Always put on ⇡ _____, and⇣ _____ _______ and ⇡ ________ _______ to improve FRC.: Flows, Tidal volumes, Respiratory Rate, (Adjust ventilator to the patient, not vice-versa)
34. MOST COMMON CAUSES OF ACUTE RESP. FAILURE REQURING MECHANICAL VENT:: 1. POST OP 2.SEPSIS 3.HEART FAILURE 4.PNEUMONIA 5.TRAUMA 6.ARDS 7.ASPIRATION
35. Most common diagnoses requiring mechanical ventilation:: 1. ACURE RESP. FAILURE 2. COPD EXACERBATION 3. COMA 4.NEUROMUSCULAR DISEASE
36. Negative Pressure Ventilation is?: Iron-Lung, Porta-Lung, etc, doesn’t need an artificial airway and is easy to use. It creates a negative pressure around the chest and causes the outside air to fill the lungs.
37. NERO PT WITH ICP WE WANT TO?: HYPERVENTILATE 25-30
38. Noninvasive Positive Pressure Ventilation (NPPV) is?: Uses masks and does not require intubation or trachs. CPAP BiPAP etc. Should be considered for COPD, Acute Cardiogenic Pulmonary Edema, premature extubation.
39. NORMAL LUNGS NOT OVER DISTENDED IF TRANSALVEOLAR PRESSURE OS LESS THAT WHAT?: LESS THAN ABOUT 30CM H2O
40. OTHER PHYSIOLOGIC OBJECTIVES OF MECH. VENT. MAY INCLUDE INCREASING OR MAINTAINING LUNG VOL WITH WHAT?: PEEP FOR PROMOTION IMPROVEMENT OR MAINTENANCE OF LUNG RECRUITMENT
41. Oxygen percentage(FI02): If unsure, start with _____% 02.: 100% 02 (Titrate rapidly on clinical progression and SpO2.)
42. Oxygen percentage(FI02): Previous gases,stable patients,diseases responsive to oxygen, start on ___-____% 02. What type of diseases or conditions would this setting of FI02 fall under?: 40-50% 02, Postoperative, COPD, Asthma (Monitor closely, particularly SpO2, adjust as required)
43. PACO2 TELLS WEATHER YOU ARE DOING WHAT?: VENTILATING
44. PAO2 WEATHER YOU ARE DOING WHAT?: OXYGENATING
45. PARTIAL VENT MODE USED FOR?: PT’S WITH DRIVE TO BREATH, BEING WEANED, OR TO MINIMIZE ADVERSE EFFECTS OF POSITIVE PRESSURE
46. Pathophysiology of Asthma/COPD exacerbations: Treatment:: Antibiotics, Reduce pt. anxiety (meds), Meet inspiratory demands(if RR 34 Vt 150, change to a ⇡ Vt and a ⇣RR but give the same minute ventilation), Oxygenation
47. Pathophysiology of Asthma/COPD exacerbations: When putting an Asthma/COPD pt. having an attack on the vent the RT should put them on a ______ Vt and RR until stable.: smaller
48. PATIENTS WITH DECREASED LUNG COMPLIANCE MAY REQUIRE PLATEAU >30CM H2O WHY? WHAT KIND OF PT’S REQUIRE THESE?: 1.BECAUSE OF DECREASE IN CHEST WALL COMPLIANCE. 2.OBESE, MASSIVE FLUID RESUSCITATION, ABDOMINAL DISTENTION, AND ELEVATED BLADDER PRESSURE.
49. PCV is typically used for _____ and ______ patients and target Vt is ___mL/kg and Pplat _____cmH20.: ALI and ARDS; 6mL/kg; <30cmH20 (with ⇣ Vt avoid acute ventilatory failure)
50. PCV is used initially when concerned about _____ or those requiring a ______ _____ or ⇡ _____ _____.: Pplat; long ITime; I:E ratio
51. PCV is usually used for:: those who have failed VC
52. PCV may protect lung if Pplat is kept at ______ cm H20.: <30 cm H20
53. PEEP/CPAP: After finding optimal PEEP: Do not ⇡ PEEP if systolic BP is ___ than ____. Also, keep mean airway pressure ____ than ____.: less than 90, less than 15
54. PEEP/CPAP: After finding optimal PEEP: If BP ⇣’s then set PEEP at:: the setting just prior to where the hazards of PEEP were shown.
55. PEEP/CPAP: consider use when using ____ FI02, Pa02 ___-____ mmHg.: High; 50-60 mmHg
56. PEEP/CPAP: Good monitoring of CO are:: BP, Paw (as Paw starts to rise, this can be an early indicator that CO is about to ⇣)
57. PEEP/CPAP: Higher PEEPs are used to improve/maintain ____ and _________.: FRC and oxygenation
58. PEEP/CPAP: In high FRC conditions PEEP/CPAP may be used to off set ____-_____ and ____ _______.: auto-PEEP and gas trapping. (Try to minimize auto-PEEP. Ensure that set PEEP does not ⇑auto-PEEP.)(COPD)
59. PEEP/CPAP: is also used in the treatment of:: ALI, ARDS, pulmonary edema, etc.
60. PEEP/CPAP: what is PEEP initially set at? “physiologic”: 5 cm H20
61. PEEP DOES WHAT?: INCREASE PAO2, INCREASE FRC, AND IMPROVES OXYGENATION.
62. pH of 7.30 put them on ________. (what ventilator mode?): A/C
63. PHYSIOLOGIC GOALS OF VENT SUPPORT:: 1.SUPPORT/MANIPULATE GAS EXCHANGE 2.INCREASE LUNG VOL. 3.REDUCE OR MANIPULATE THE WOB 4.TO MINIMIZE CARDIOVASCULAR IMPAIRMENT
64. Plateau Pressure is?: Palv during mechanical ventilation, limiting pressure to under 30 reduces likelihood of ventilator related lung injury
65. PLATEAU PRESSURE REFLECTS:: ALVEOLAR PRESSURE
66. Pressure Controlled Ventilation does what?: Ensures that pressure remains constant. Volume may vary if compliance changes.
67. Pressure Control Ventilation (PCV) does what?: May be triggered by time or patient and is pressure limited during the inspiratory phase and time cycled during the expiratory phase. PCV may be used as an A/C mode or with SIMV
68. Pressure Regulated Volume Control does what?: Patient breaths are delivered mandatorily to assure preset volumes, with a constant inspiratory pressure continuously adapting to the patient’s condition
69. Pressure Support Ventilation (PSV) does what?: Triggers off the patient breath and and is pressure limited during inspiration and flow cycled on expiration.
70. PRESSURE TRIGGER RANGE:: -0.5 TO -1.5 CM H2O
71. Primary indications for MV (The big four):: Apnea, Acute ventilatory failure( Severe hypoxemia, ⇡ Co2, ⇣pH)., Impending ventilatory failure(Mod-Severe hypoxemia, a ⇡Co2, and a ⇣pH- 7.30; Co2 and pH may be normal but heading in the wrong directions), Refractory hypoxemia( Shunt- Pa02 <45 and a Spo2 of 98% is the hallmark for a P.E.)
72. PSV assists __________ breaths to set PSV level,: spontaneous
73. PSV is used to ⇣ _____ ___ ________ for spontaneous breaths.: WOB
74. PSV may ⇣ _____ ___ _______ and improve _______-________ synchrony.: WOB; patient-ventilator
75. PSV suggested for all spontaneous breaths in SIMV typically ___-___cmH20: 5-10 cmH20
76. PT’S THAT WOULD BENEFIT FROM PEEP:: ACUTE RESTRICTIVE DISEASE, ALI/ARDS, PNEUMONIA, PULMONARY EDEMA
77. PT’S THAT WOULDN’T BENEFIT MUCH FROM PEEP:: COPD PTS PR ACUTE ASTHMA. AUTO-PEEP IS USED TO OF SET AUTO-PEEP.
78. SECONDARY TO HYPOXEMIA AND AN INCREASED WOB MECH VENT MAY ALSO REDUCE WHAT?: INCREASED MYOCARDIAL WORK
79. SENSITIVITY SHOULD BE ADJUSTED TO:: -2 CM H2O
80. TITRATE FIO2 DOWN BY?: IF SPO2 IS GREATER THAT 97%, TITRATE DOWN EVERY 5 TO TEN MIN. IF .95% BUT LESS THAN 97% TITRATE BY .05 UP OR DOWN.
81. TRANSALVEOLAR PRESSURE IS:: THE DIFFERENCE BETWEEN ALVEOLAR PRESSURE AND PLEURAL PRESSURE DURING POSITIVE PRESURE VENTILATION.
82. Trans-alveolar pressure is?: Palv – Ppleural
Normal lungs are not distended if this pressure is under 30 cm H2O
83. The use of Ipause is controversial with _______ ________.: Aerosol treatments
84. Volume Controlled Ventilation does what?: Ensures that a set volume is delivered. Pressure may vary depending on patients compliance.
85. Volume support does what?: Requires the patient to draw in a certain volume of air to trigger the ventilator.
86. What are the advantages of VC-CMV?: Ensure minimum safe level of ventilation, Q breath Vt is ensured, Pt. can ⇡ rate above that set, To ⇣ WOB, the RT must ensure sensitivity and flow are set adequately to meet the pt.’s needs
87. What are the Big 4 indications for MV?: Apnea, Acute Ventilatory Failure, Impending Ventilatory Failure, Severe Oxygenation Problems.
88. What are the goals of MV?: Maintain adequate alveolar ventilation, Maintain tissue oxygenation(FI02, PEEP, MAP), Restore acid-base balance, Reduce WOB and myocardial work with minimal side effects and complications., Lung protection strategy: Small Vt and appropriate PEEP levels(maintain Pplat <30cmH20); ARDS strategy is small Vt and ⇡RR
89. WHAT ARE THE INITIAL SETTINGS THAT SHOULD BE SET FOR AN ARDS: Vt SET AT
LESS THAT 8ML/KG IBW I:E OF 1:2 AND PEEP OF 10CM H2O.
90. What does IMV stand for? Describe the breaths that will be produced by placing a pt in this mode. (Egan’s pg.979): Intermittent Mandatory Ventilation: Breaths can be mandatory or spontaneous, Providing partial support, IMV allows or requires the patient to do part of the work., Rate sets the number of mandatory breaths, Patient-triggered mandatory breaths are called synchronized IMV or SIMV breaths., SIMV generally has a lower PAW than CMV, Studies suggest IMV weaning extends days on the ventilator.
91. WHAT IS FLOW RANGE?: 60 TO 80
92. What is optimal PEEP?: The best amount of oxygenation with the less hemodynamic effects.
(Best Pa02 and compliance)
93. WHAT IS PRESSURE CONTROL USED FOR?: used to keep pressure low for ARDS AND ALI.
94. What is the treatment for refractory hypoxemia?: treat the underlying problem and put on 02.
95. What is the trigger, cycle, and mode type used for A/C?: Patient-triggered or Time-triggered CMV, Volume cycled, Typically VC-CMV
96. What is the trigger, limit, and cycle variable in PCV?: Patient or time triggered, Pressure limited, Time cycled, Volumes vary with CL and Raw
97. What is the trigger, limit, and cycle variable used in PSV?: Patient triggered, pressure limited, flow cycled.
98. WHAT IS VOLUME CONTROL USED FOR?: HYPERCABIA (PACO2) AND TO CONTROL MINUTE VENTILATION
99. WHAT PT’S ARE LUNG PROTECTIVE VENT STRATEGY USED FOR?: ARDSALI BUT SHOULD BE USED FOR ALL REQUIRING VENT SUPPORT WITH ACUTE FAILURE
100.WHAT DOES THE RESPIRATORY THERAPIST SET ON THE VENT?: MODE, VT, RATE, PEEP, FIO2
101. WHAT WILL AFFECT A PT’S I:E TIME?: HIGHER FLOW WILL (UP TO 100l/MIN) WILL INCREASE THE E TIME.
102. When PEEP is too high, it tends to: Causing:: Put un-needed pressure on the heart., Cardiac output to ⇣
103. When using A/C, what will happen to the pt.’s Peak pressure when the pt.’s WOB ⇡?: The Peak pressure will also ⇡
104. When using VC-CMV the RT should adjust what to fix the PaC02?: The RT should change the Vt not the RR to improve Paco2 on VC-CMV
105. Why is Control ventilation not really used anymore?: because of the pt. can’t spontaneously breathe. They will only get the # of breaths set by the vent which, in turn, causes anxiety.
106. Why is SIMV good for weaning?: because it allows the patient to exercise their respiratory muscles.
107. WITH SMALL Vt, WHAT SHOULD BE MONITORED TO PREVENT WHAT?: MAINTAINING AN ADEQUATE VE AND PREVENT ACUTE SEVERE RESP. ACIDOSIS