PHTH 564 - ICU > Mechanical ventilation > Flashcards

Mechanical ventilation Flashcards

(68 cards)

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1
Q

4 clinical conditions leading to mechanical ventilation?

A
  1. depressed resp drive
  2. excessive ventilator workload
  3. failure of ventilatory pump
  4. impending resp failure
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2
Q

Type I resp failure = decreased ____

A

PaO2

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3
Q

Type II resp failure = increase ____ and decreased _____

A

PaCO2; PaO2

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4
Q

2 types of mechanical ventilation?

A
  1. positive pressure

2. negative pressure

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5
Q

Pt is ________ in negative pressure ventilation

A

immobilized

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6
Q

In negative pressure ventilation, ________ _____ is applied to the outside of the chest wall

A

subatmospheric pressure

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7
Q

In negative pressure ventilation, chest wall _____ and air flows into lungs, closer to normal lung physiology

A

expands

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8
Q

In + pressure ventilation, pressurized air is _____ into the lungs

A

pushed

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9
Q

2 methods of + pressure ventilation?

A
  1. IPPV

2. NIPPV/ NIV

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10
Q

Mechanical ventilation _____ and ______ effects require monitoring

A

pulmonary; hemodynamic

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11
Q

5 pulmonary effects due to mechanical ventilation requiring monitoring?

A
  1. increased V/Q and dead space/ tidal volume ratio
  2. air trapping
  3. barotrauma
  4. pneumothorax / subcutaneous emphysema
  5. resp distress
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12
Q

4 hemodynamic effects due to mechanical ventilation requiring monitoring?

A
  1. decreased venous return
  2. decreased CO
  3. decreased BP
  4. decreased renal perfusion
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13
Q

Does prophylactic chest physio decrease incidence of ventilator associated pneumonia (VAP)?

A

NOPE

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14
Q

5 methods to reduce incidence of VAP?

A
  1. HOB elevation
  2. oral hygiene
  3. DVT and peptic ulcer prophylaxis
  4. daily sedation vacation
  5. reduced frequency of changing vent circuit
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15
Q

Less invasive method of ventilation is always preferred over more invasive (T/F)

A

TRUE

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16
Q

6 CI’s and precautions to NIC?

A
  1. facial trauma
  2. obstruction to upper airway
  3. hemodynamic instability and multiple organ failure
  4. decreased LOC
  5. undrained pneumothorax
  6. high risk of aspiration and vomiting
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17
Q

4 non invasive patient interfaces?

A
  1. face mask
  2. nasal mask
  3. nasal cannula
  4. full face mask
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18
Q

3 invasive patient interfaces?

A
  1. oral endotracheal tube
  2. nasal endotracheal tube
  3. tracheostomy
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19
Q

Most patients start with ______ _____ if on NIV

A

oronasal mask`

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20
Q

What is biggest factor in choosing type of NIV?

A

patient comfort

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21
Q

In IPPV, most adults are intubated with a _____ ____ ______ tube

A

cuffed oral endotracheal

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22
Q

Most frequent type of IPPV in infants ?

A

nasal endotracheal tubes

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23
Q

Is pt able to speak with endotracheal tube?

A

No

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24
Q

More sedation is required for tracheostomies than endotracheal tubes (T/F)

A

FALSE - opposite

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25
Endotracheal tubes ____ dead space; tracheostomies _____ dead space
increase; decrease
26
6 control parameters in ventilation?
1. pressure 2. volume 3. RR 4. pressure support 5. PEEP 6. FiO2
27
You can only control pressure OR volume, not both (T/F)
TRUE
28
By controlling pressure and leaving volume variable, you risk ______ and ______
derecruitment; atelectasis
29
By controlling volume and leaving pressure variable, you risk ______
barotrauma
30
RR = ?
set rate + pt rate
31
Pressure support = pressure given to support _______ breaths
spontaneous
32
Physiological PEEP = __cmH2O
5
33
Therapeutic PEEP can be up to ___ - ___ cmH2O
15-20
34
Humidification is important for _______ clearance
mucociliary
35
Nasal passages act as ____ and ______ exchange
heat; moisture (HME)
36
_____ bypasses upper airway, whereas _____ delivers fast flowing dry gas which overwhelms normal HME mechanisms in upper airway
IPPV;NIV
37
______ = essentially only giving pt PEEP
CPAP
38
Strongest evidence to support CPAP use in which 2 conditions?
1. acute cardiogenic pulmonary edema | 2. COPD
39
CPAP improves FRC (T/F)
TRUE
40
In BiPAP =, _PAP and _PAP are set
I;E
41
BiPAP is more often used in settings that mimic _____ ______ ventilation
pressure support
42
_______ = high flow device that creates PEEP + has active humidification
optiflow
43
Big advantage of optiflow compared to other high flow O2 devices?
FiO2 and Flow are independent of each other
44
PEEP calculation = __cmH2O pressure for each __L/min flow increment
1; 10
45
_______ and ____ _____ ventilation = similar to BiPAP and CPAP with or without pressure support, is used for weaning
spontaneous & pressure support ventilation
46
_____ _____ trials = pt left on enough support to overcome resistance of the circuit and ETT
spontaneous breathing
47
Rapid shadow breathing index = ?
RR/Tv
48
Rapid shadow breathing index > ____ = indicative of weaning failure
105
49
_____ ______ ______ ventilation = periodic targeted breaths that occur at set intervals
synchronized intermittent mechanical (SIMV)
50
SIMV = ____ or ____ controlled
volume; pressure
51
With SIMV, pt can breathe spontaneously b/w mandatory breaths (T/F)
TRUE
52
______ ______ ______ = volume or pressure targeted and patient or time triggered
continuous mandatory ventilation (CMV)
53
Patient triggered CMV is also called _____ ____ and is most frequently used
assist control
54
Time triggered CMV is also called _____ ____ and is known as "full ventilation"
control mode
55
Neurally adjusted ventilatory assist (NAVA) = berths triggered by ____ of ______
EMG; diaphragm
56
In NAVA, the electrode is built into the ________ tube
nasogastric
57
High frequency oscillation = used in some centers for _____ pt's
ARDS
58
Proportional assist ventilation (PAV) = ventilator adjusts flow and volume based on a set _____ ______
minute volume
59
PAV shouldn't be used in difficult to wean pts (T/F)
FALSE
60
Protective lung ventilation is used for ___ tidal volumes and permissive ______
low; hypercapnia
61
Nitric oxide is a pulmonary ______
vasodilator
62
Nitric oxide is used in refractory ________ and pulmonary artery ______
hypoxemia; hypertension
63
_____ reduces resistance to airflow
helium
64
_____ improves ventilation in acute asthma
helium
65
Prolonged ventilation results in resp muscle ______
weakness
66
Important to work on resp muscle ____ and _____
strength; endurance
67
Resp muscle training = ______ training with sufficient _____ periods
submax; rest
68
Role of training with difficult to wean pts?
1. consider timing of rx, discuss with team | 2. specific IMT may be appropriate
PHTH 564 - ICU
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