Question Answer
Conditions associated with increased drive to breath Increased metabolic rate, metabolic acidosis, anxiety
Conditions associated with decreased drive to breath Sleep Apnea, hypothyriodism, stoke, neck trauma, depressant drugs
MEP (Max Expiratory Pressure) blow as hard as possible into manometer, measures strength of diaphragm, 100 = norm, <40 critical
NIF or MIP measures strength of diaphragm, suck back as hard as possible through manometer, -50 to -100 is norm, <-20 critical
Acute Respiratory Failure (ARF) pH < 7.35, PaO2 < norm for age on O2, PaCO2 >55 and climbing. Inability to keep pH, PO2, PCO2 at acceptable levels
Test which most reflects patient’s ventilation CO2
Diseases/disorders associated with increased WOB effusions, hemothorax, pneumothorax, clot, atalectasis, emphysema, ARDS, edema, fibrotic tissue, increased secretions, bronchoconstriction, flail chest, obesity
What is A-a gradient, how to calculate it increased with age, increases with increased FIO2, indicates amount of shunt. 7 X flow – CO2 = PAO2, then sub the PaO2 and the diff is the gradient. 5-15 is norm, >450 = critical
Causes and description of abnorm resp patterns Tumors, stroke or trauma. Cheyne-stokes = VT increase and then decrease and followed by apnea, associated with waxing and waning. Biot’s = RR changes but VT same. Can also affect the glottic response, so airway to be protected
Phase variable of a breath Triggering, Limiting and Cycling
Triggering pt attempts a spontaneous breath…cause breath to begin
Limiting places a maximum value on inspiration. P,V, time, or flow
Cycling Cause Inspiration to end
Most frequent methods of triggering Pressure – Neg P usually set to 1- to-2,Flow drop- flow going in, and time- mostly used in NEOS
Variables controlled by vent mode Triggering, Flow, V, NOT FIO2
Function of chest curasis and troubleshoot Look for leaks, Neg pressure vent, used in home on pts w/chest wall deformaties or neuromuscular probs.
Mandatory Breath Vent does all WOB
Troubles with transport of vented pts Accidental extubation, loss of IV, hypoxemia, hypervent by overbagging, loss PEEP, postion changes result in hypercarbia, hypoxemia, hypotension
Components of Compliance loop PEEP, V, P
What vents most commonly used in home CPAP, BiPAP, or the neg pressure ones, PONCHO, chest curasis, pneumosuit
Definition of controlled and how vents classified Can control P,V, flow and sometimes time of Inspiration
Volume Controlled Vent VT is constant and limited. RR is set. P and Time vary. Most common parameter found in adult ventilation. Most consistent ABGs
Pressure Controlled Vent P constant and limited. RR is set. V and flow vary. Used in acute lung injury to protect lungs.
Definition of Positive Pressure Ventilation to start breath, P is greater at the mouth than alveoli. P in alveoli builds. At end of I, P @ mouth = 0 and P in alveoli is greater creating at P gradient and the air flows out. Exhalation is Passive
Question Answer
What are the indications for artificial airways? Suction, Airway/Aspiration, Ventilation, Obstruction
What types of pts are NIFS & VCs commonly done on? SOB, muscular disease
What are Cheyne Stokes respirations? Vt gradually increases & decreases followed by brief apneic period.
What are Biot’s respirations? Respiratory rate changes but Vt stays the same
What are the methods of triggering inspiration? Pressure, Flow, Time
Things that increase a pt’s drive to breathe? Airway resistance, chest wall deformities, ARDS
Things that decrease a pt’s drive to breathe? Depressant drugs, brainstem lesions, hypothyroidism
What is positive pressure ventilation? Pressure at mouth is above ambient pressure causing air to rush into lungs – pushing air into lungs via the mouth.
What are the types of a breath? Mandatory, Assisted, & Spontaneous
What are the variable modes of ventilation? Volume, Pressure, Flow, Time
What is the factor that begins inspiration? Triggering
What is the factor that ends inspiration & begins exhalation? Cycling
Define respiratory failure pH < 7.25 and PaCO2 > 50
What is the normal A-a gradient range? 5-15 mmHg
What are the main waveforms monitored in mech. vent.? Pressure, Volume, Flow
What is compliance? Stretchability of lung tissue & thoracic wall
What are 2 goals of mechanical ventilation? Decrease WOB, restore normal acid-base balance
What is the normal Vd/Vt range? 0.20 – 0.40
What is mandatory breath? Vent is doing all the work of breathing
What is assisted breath? Pt begins breath, vent controls inspiratory phase & ends expiration.
What is spontaneous breath? Pt controls all phases of breathing
What is the normal range for airway resistance? 1-2 cmH2O/L/sec(not tubed), 5-7 cmH2O/L/sec(tubed)
The formula used to derive Vd? PaCO2 – PeCO2 / PaCO2
What is the #1 deadspace disease? Pulmonary Embolus
What is the normal & critical range for pH? Normal: 7.35-7.45, Critical: <7.25
What is the normal & critical range for PaCO2? Normal: 35-45, Critical: >50
What is the normal & critical range for Vd/Vt? Normal: .2 -.4, Critical: >.6
What is the normal & critical range for PaO2? Normal: 80 – 100, Critical: <70(on O2)
What is the normal & critical range for P(A-a)O2? Normal: 5 – 15, Critical: >450(on O2)
What is the normal & critical range for a/A O2? Normal: 0.75 – 0.95, Critical: <0.15
What is the normal & critical range for PaO2/FiO2? Normal: 475, Critical: <200
What is the normal & critical range for MIP/NIF cmH2O? Normal: -50 to -100, Critical: 0 to -20
What is the normal & critical range for MEP cmH2O? Normal: +100, Critical: <40
What is the normal & critical range for VC (ml/kg)? Normal: 65 to 75, Critical: <15
What is the normal & critical range for Vt (ml/kg)? Normal: 5 to 8, Critical: <5
What is the normal & critical range for RR/Frequency? Normal: 12-20bpm, Critical: >35bpm
What is the normal & critical range for FEV1 (ml/kg)? Normal: 50 to 60, Critical: <10
What is the normal range for Peak flow (L/sec)? Normal: 100 to 850 L/min
Question Answer
I am positive pressure above baseline during exhalation: PEEP
I reduce the WOB caused by airways & am also used w/ CPAP: PS(pressure support)
I am the type of vent used w/ a post arrest pt: Volume vent
I can cause auto cycling: Sensitivity too high (ex: -10)
I am the recommendation for Vt: 10-12 ml/kg
I am a mode that helps avoid barotraumas: PC(pressure control)
I can be used to improve I:E ratio: Increase flow, decrease rate – pressure – Vt
I am a complication of PEEP: Increased ICP, decreased BP – venous return – CO
I am the 1st thing you should check when you increase PEEP: BP, CO, ICP
I am what you do if a pt is showing adverse effects to increases in PEEP: Lower PEEP
I am the primary purpose of PEEP: Improved Oxygenation
I am what should be placed on a SIMV pt that has an increased WOB: PS(pressure support)
I am what you can do on a vent to increase PaO2: Increase PEEP or Increase FiO2
I am a vent setting that decreases shunting: PEEP
I am what you can do on a vent to lower the CO2: Increase Vt first then rate
I am the effect of PEEP on FRC: Increase or maintain FRC
I use Vt’s smaller than deadspace, rates greater than 60, & need special ET tubes: HFV(high frequ. vent.)
I am what will happen on a volume vent w/ bronchospasm: Increase in Peak pressure
I am what the distance between PEAK & PLAT airway pressures tell you: Airway resistance
I am another word for intrinsic PEEP: Auto-Peep
What mode is most likely used w/ decreased compliance: PC(pressure control)
I am the BiPAP adjustment that lowers CO2: The difference between IPAP & EPAP
I give the preset volume at the preset rate: VC(volume control) (maybe SIMV)
I give the preset pressure at the preset rate: PC(pressure control)
I augment/increase spontaneous Vt’s: SIMV-PS
I adjust my own flow to give the preset Vt at the lowest possible peak pressure: PRVC, VC+, Auto-flow
I am the accepted range for Vt: 10-12 ml/kg
I am the accepted range for rate: 8-12
I am how the initial FiO2 on a vent is determined: PaO2>60mmHg & SaO2>90%
I titrate/adjust the pressure support to give the Vt you want on spontaneous breaths: VS(volume support)
I am what would cause you to choose pressure control: Trauma or ARDS
I base my level of support on the settings for pt’s WOB: Proportional Assist
I determine how hard the pt has to work to get a breath: Sensitivity
I am the value that starts exhalation: Cycling
I mix oxygen & air to provide a specific FiO2: Blender
I save moisture for the pt’s next breath: HME
I am an immediate complication of oral intubation: Tooth trauma
I am ventilation w/o perfusion: Deadspace
I am the normal level of deadspace: Normal 20-40%, Critical > 60%
I am perfusion w/o ventilation: Shunt
I am a normal NIF: -50 to -100, Critical < -20 to 0
I am a normal MEP: Normal +100, Critical < +40
I am the minimal acceptable VC: 65-75 ml/kg, Critical < 10 ml/kg
I am a normal A-a gradient: 5-15 (on O2)
I am the types of ventilators: Pneumatic & electronic
I start inspiration: Triggering
I am the 3 types of things that are used for triggering: Pressure, Flow, Time
I am used for obstructive sleep apnea: CPAP
I am used to correct hypoxemia: PEEP or FiO2
I am a mode that gives the preset volume only when vent wants: Control
I give the preset volume, the pt can spontaneously breathe, but spont. breath will only be given @ the set Vt: VC(volume control), Assist Control
I time my breaths w/ the pt’s: SIMV
I am the types of laryngoscope blades: Macintosh & Miller
I am caused by too high a rate w/ too small a time to exhale: Auto/Intrinsic PEEP
I am the I:E ratio you should shoot for: Normal on RA: 1:4, 1:3 on vent
I am a complication of transporting a mechanically ventilated pt: Extubation, low O2
I am the difference between volume controlled & pressure controlled ventilation: VOL: vol stays same, pressure varies, set rate; PRESSURE: pressure stays same, vol varies, set rate.
I am the accepted Ve range: 5-8 L/m