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PHTH 564 > Mechanical Vent > Flashcards

Mechanical Vent Flashcards

1
Q

4 Main Types of conditions which would lead to mechanical ventilation

A
  • Depressed respiratory drive
  • Excessive ventilatory workload (increased work of breathing)
  • Failure of ventilatory pump (respiratory muscle failure)
  • Impending respiratory failure
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2
Q

What might cause a depressed respiratory drive

A
  • Drug overdose
  • Acute SCI
  • Head trauma
  • Sleep disorders
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3
Q

What might cause an excessive ventilatory workload

A
  • Airflow obstruction - COPD
  • Dead space ventilation - PE
  • Congenital heart disease - Pulmonary artery hypertension
  • Decreased lung compliance - ARDS, Pneumonia
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4
Q

What might lead to failure of ventilatory pump

A

Chest trauma

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5
Q

What are the two type of Clinical signs of impending respiratory failure

A
  1. Decreased PaO2

2. Decreased PaO2 and increased PaCO2

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6
Q

Features of decreased PaO2

A
  • Agitation
  • Cyanosis
  • Decreased SpO2
  • Air hunger
  • Tachycardia
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7
Q

Features of decreased PaO2 and PaCO2

A
  • Agitation
  • Cyanosis
  • Decreased SpO2
  • Air hunger
  • Tachycardia
  • Decreased LOC
  • Confusion
  • Rapid shallow breathing
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8
Q

2 types of mechanical ventilation?

A
  1. Positive pressure ventilation - pushing air into lungs
  2. Negative pressure ventilation - putting them in cavity with sub-atmospheric pressure surround lungs in turn allowing chest wall to expand and air to flow into lungs
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9
Q

Is positive pressure or negative pressure ventilation closer to normal lung physiology

A

Negative pressure

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10
Q

Is positive pressure or negative pressure ventilation the most common for of mechanical ventilation

A

positive pressure

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11
Q

Two methods for positive pressure ventilation

A
  • Invasive positive pressure ventilation

- non-invasive positive pressure ventilation

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12
Q

What are the pulmonary effects of mechanical ventilation that need monitoring

A
  • Increased V/Q and dead space/tidal volume ratio
  • Air trapping
  • Barotrauma leading to multisystem failure
  • Pneumothorax and subcutaneous emphysema
  • Increased work of breathing
  • Respiratory distress (narrow ETT tube, discomfort)
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13
Q

What are the Hemodynamic effects of mechanical ventilation that need monitoring

A
  • Decreased venous return
  • Decreased cardiac output (caused by decreased venous return)
  • Decreased BP (due to decreased CO)
  • Decreased renal perfusion (as a result of decreased BP)
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14
Q

In MV air flows in which way

A

Path of least resistance

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15
Q

What is the pump for the venous system (i.e heart is pump for arterial system)

A

The lungs!! they pull the blood back up to heart

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16
Q

Does prophylactic manual chest physio decrease the incidence of ventilatory associated pneumonia

A

no

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17
Q

Ventilator associated pneumonia is a pneumonia which starts after ____ hours of ventilation

A

> 48hours

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18
Q

What are some extra precautions taken when on a ventilator

A
  • Head of bed elevation
  • oral hygiene
  • DVT and peptic ulcer prophylaxis (prevention)
  • Daily sedation vacation
  • Reduced frequency of changing vent circuit
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19
Q

Contraindications + precautions of non-invasive ventilation

A
  • Facial trauma
  • Obstruction to upper airway
  • Hemodynamic instability & multi organ failure
  • Decreased LOC
  • Undrained pneumothorax
  • High risk of aspiration & vomiting
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20
Q

Do you want to put a patient with COPD on a ventilator

A

No - it is very hard to get them off

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21
Q

Patient interfaces for non-invasive MV

A
  • Face mask
  • Nasal mask
  • Nasaal Cannula
  • Full face mask
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22
Q

Patient interfaces for invasive MV

A
  • Oral endotracheal tube
  • Nasal endotracheal tube
  • Tracheostomy
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23
Q

When do you most often see a nasal endotracheal tube

A

in neonatal population or if there was an oral surgery

24
Q

How do you decide type of patient interface?

A

For NIV: Patient comfort is biggest player. Most often start with oronasal mask

For IPPV: Most adults intubated with a cuffed oral endotracheal tube.

25
Q

Why is a cuff an important part of a oral ET tube?

A

Cuff is there because high pressure air flow follows past of least resistance, in adults most of the air would come out of the mouth. Cuff seals up space around trachea and forces most the air down into the lungs

26
Q

Benefits of endotracheal tubes vs tracheostomies?

A

ET more easily inserted + removed

27
Q

Cons or ET vs tracheostomies

A

ET:

  • triggers gag
  • jaw open with OET
  • Sedation required
  • Pt can’t speak or swallow
  • Vocal cords abducted
  • Risk of subglottic stenosis
  • Increases dead space
28
Q

Cons of Trach vs ET

A

Leaves a scar when removed

Requires surgical/bedside procedure

29
Q

benefits of Trach vs. ET

A

Trach:

  • Does not trigger gag
  • Mouth closed at rest
  • less sedation required
  • Speaking + swallowing possible
  • Decreased dead space
30
Q

What does an ET tube increased dead space and a trach decrease it?

A

ET tube:
- Because of tubing

Trach:
- Has tubing but has bipassed all the upper airways

31
Q

MV Control parameters

A
  • Pressure or volume control
  • RR
  • Pressure support
  • positive end expiratory pressure
  • FiO2
32
Q

What is physiological PEEP? Therapeutic PEEP?

A
  • 5cmH2O

- 15-20cmH2O

33
Q

What is room air FiO2

A

21%

34
Q

Why do airways + lungs need a warm moist environment

A

Mucocilliary clearance

35
Q

What are 2 types of humidification

A

passive: HME Filter: Catches warmth and moisture as Pt breaths out and puts it back into air they are breathing in
- Active: Coils inside vent try and maintain heat

36
Q

3 types of non-invasive ventilation

A
  • CiPAP
  • BiPAP
  • Optiflow
37
Q

CPAP essentially only give Pt ____, and relieves ____

A

PEEP

Work of breathing

38
Q

Strongest evidence to support use of CPAP

A
  • acute cardiogenic pulmonary edema

- COPD

39
Q

What does BiPAP stand for

A

Bilevel positive airway pressure

40
Q

With BiPAP ___ and ___ are set

A

IPAP and EPAP

41
Q

What is optiflow?

A

High flow device which creates PEEP

42
Q

Does optiflow provide humidification

A

yes

43
Q

Advantages of Optiflow over CPAP

A
  • Communication
  • Sputum clearance
  • Comfort
  • nutrition
44
Q

Advantages of Optiflow over other high flow O2 devices

A
  • Less drying to airways
  • FiO2 and flow are independent of each other
  • Higher flow rates
45
Q

3 forms of invasive ventilation

A
  • Spontaneous & pressure support ventilation
  • Synchronized intermittent mechanical ventilation
  • Continuous mandatory ventilation
46
Q

Spontaneous & pressure support ventilation is similar to ___ and ___

A

BiPAP and CPAP

47
Q

Spontaneous & pressure support ventilation is used for ____

A

Weaning

48
Q

How is Spontaneous & pressure support ventilation used for weaning? What indicates weaning failure?

A

Via spontaneous breathing trials
- Patient left on enough support to overcome resistance of the circuit and ETT

Rapid shallow breathing index - RR/Tv >105

49
Q

Features of Synchronized intermittent mechanical ventilation

A
  • Involves periodic targeted breaths that occur at set intervals
  • Volume or pressure controlled
  • patient has a set rate
  • Patient can breath spontaneous b/w mandatory breaths
  • Baseline pressure between mandatory breaths can be set/adjusted to suit patient
50
Q

What are the triggering options for Continuous mandatory ventilation ? Which is most commonly used

A
  • Patient triggered - more common

- Time triggered

51
Q

When is time triggered used in Continuous mandatory ventilation

A

When patient is fully sedated and offer no spontaneous effort

52
Q

What is neurally adjusted ventilatory assist

A
  • Newer mode of ventilation

- breaths triggered by EMG of the diaphragm

53
Q

What type of condition may use high frequency oscillation

A

ARDS patients

54
Q

What does the ventilatory in proportional assist ventilation do?

A

Ventilator adjusts flow and volume based on a set minuet volume.
Calculates patients work of breathing

55
Q

What patients is proportional assist ventilation used for?

A

Difficult to wean patients

56
Q

What is the effect of nitric oxide? Who is it used in?

A
  • pulmonary vasodilator - Reduces shunt by causing pulmonary vasculature to vasodilate
  • In refectory hypoxemia and pulmonary artery hypertension
57
Q

What does helium do? who is it used in?

A
  • Reduces resistance to airflow

- Improves ventilation in acute asthma

PHTH 564 (5 decks)

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