CRNA Interview Prep > VENTS > Flashcards

VENTS Flashcards

(57 cards)

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1
Q

Oxygenation is a problem with…? Ventilation is a problem with…?

A

SpO2/PaO2, CO2

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2
Q

Oxygenation is affected by what two parameters..?

A

FiO2, PEEP

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3
Q

What is the goal of oxygenation within the lungs?

A

Alveolar recruitment & diffusion

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4
Q

If a pt has hypoxemia, what should be adjusted on the vent? What should not be adjusted?

A

FiO2, PEEP; Do not adjust RR

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5
Q

Ventilation is affected by:

A

RR, Vt, Vm (minute ventilation)

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6
Q

What is the goal of ventilation?

A

CO2 removal

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7
Q

If a pt is hypercapnic, what should be adjusted on the vent? What should not be adjusted?

A

Adjust RR or Vt, not FiO2

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8
Q

Why is mechanical ventilation initiated?

A

O2 failure, CO2 failure, or need for airway protection

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9
Q

Why intubate w HYPOXEMIC resp failure?

A

Refractory hypoxemia despite supp O2

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10
Q

Why intubate w HYPERCAPNIC resp failure?

A

↑d PaCO2 w resp acidosis, inadequate Vm

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11
Q

Why intubate w ↑d WOB?

A

Tachypnea, accessory muscle use, impending fatigue

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12
Q

Why intubate for airway protection?

A

Depressed mental status, airway protection

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13
Q

Why intubate w neurologic impairment?

A

AMS affecting ventilation, elevated ICP requiring PaCO2 control

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14
Q

Why intubate w hemodynamic instability?

A

High O2 demand, ↓ cardiopulm reserve

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15
Q

Define FiO2.

A

Fraction of inspired oxygen delivered.

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16
Q

Define VT

A

Volume of gas that enters and leaves the lungs with each normal passive breath. WNL 6-8mL/kg IBW. ARDS 4-6mL/kg IBW.

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17
Q

Define Vm

A

Total volume of gas delivered per minute. Minute ventilation = VT × RR. Normal is 5-8 L/min.

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18
Q

Define PEEP

A

PEEP is Positive End-Expiratory Pressure: pressure in alveoli @ end of expiration. PEEP improves oxygenation but may ↑intrathoracic pressure →↓venous return → ↓cardiac output.

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19
Q

Define auto/intrinsic PEEP

A

Trapped alveolar pressure from incomplete exhalation, common in COPD/asthma

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20
Q

Define inspiratory:expiratory (I:E) ratio

A

Ratio of time spent in inspiration versus expiration. Normal setting on the ventilator is 1:2.

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21
Q

Define mean airway pressure

A

Average airway pressure over the respiratory cycle and key driver of oxygenation

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22
Q

Define peak inspiratory pressure (PIP)

A

Maximum airway pressure during inspiration. ↑PIP can indicate airway resistance or ↓ compliance.
Examples of↑PIP: kinked ETT, secretions, mucus plug, bronchospasm, asthma, COPD and ↓
compliance seen in pulmonary edema, ARDS, pneumothorax.

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23
Q

Define plateau pressure (Pplat)

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A

Alveolar pressure measured during inspiratory pause. Keep < 30 cm H2O to prevent lung injury.

24
Q

Inspiratory Flow

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A

Average airway pressure over the respiratory cycle and key driver of oxygenation

25
Explain what mandatory/controlled modes of mech vent do.
the ventilator delivers all or most of the work of breathing; patient may trigger breaths but the ventilator controls key variables (VT or pressure)
26
What is the bottom line of volume-controlled mech vent?
Tidal volume is set, pressure varies
27
What is the bottom line of pressure-controlled mech vent?
Inspiratory pressure is set, tidal volume varies
28
What is the purpose of hybrid/adaptive modes of mech vent?
Combines safety of pressure control + guaranteed tidal volume
29
Explain the difference bt VC and AC-VC.
in VC, the vent delivers breaths at a set rate only (patient cannot trigger extra breaths); in AC-VC, the vent delivers breaths at set rate and allows patient-triggered breaths.
30
Explain the difference bt PC and AC-PC.
in PC, the vent delivers breaths at a set rate only (patient cannot trigger extra breaths); in AC-PC, the vent delivers breaths at set rate and allows patient-triggered breaths.
31
Explain how pressure-regulated volume control (PRVC) mech vent works.
Uses the lowest pressure necessary to achieve the target VT as patient lung compliance or resistance changes.
32
What is the bottom line of synchronized intermittent mandatory ventilation (SIMV)?
Ventilator delivers synchronized mandatory breaths at a set rate. The patient can breathe spontaneously between these breaths without full ventilator control.
33
What is the bottom line of pressure support vent (PSV) or CPAP?
Patient-intiated only
34
How does SIMV differ from AC-VC or AC-PC?
In AC-PC / AC-VC, with every patient-triggered breath → ventilator delivers full preset pressure or volume. In SIMV, when the patient breathes in between mandatory breaths → no guaranteed VT or pressure added (unless pressure support added)
35
How is SIMV sometimes used, but what must be considered?
SIMV was used as a weaning mode as it encourages spontaneous breathing. However, it can ↑work of breathing + lead to fatigue if mandatory rate is set too low.
36
Describe Pressure Support Vent (PSV) works
Inspiratory pressure assistance to augment VT and↓work of breathing often when weaning from extubation. Each patient-triggered breath receives a preset amount of pressure to overcome airway resistance and tube work. Limitation is no guaranteed respiratory rate.
37
Describe how CPAP works.
Continuous distending pressure throughout the respiratory cycle, keeps alveoli open to improve oxygenation. Limitation is the patient controls both the respiratory rate and tidal volume → CO2 may rise in hypoventilating patients
38
What must the patient have in order to use PSV or CPAP?
Intact respiratory drive
39
What is the goal of using mech vent w ARDS?
Lung protection
40
What is the main safety target in mech vent w ARDS?
Pplat <30cmH2O - accomplished w low Vt
41
What is the goal of mech vent with COPD or asthma? Through what parameter is this acheived?
↑ expiratory time to prevent hyperinflation and auto PEEP. RR 8-12 (COPD), 6-10 (asthma)
42
Describe 3 considerations of mech vent use w ARDS.
Goal: Lung protection; Pplat < 30cmH2O; Permissive hypercapnia bc ↑ VT or pressures to ↓ CO2 can ↑ lung injury
43
Describe 3 considerations of mech vent use with COPD.
Goal: ↑expiratory time (I:E 1:3-1:4); Careful ↑PEEP R/T auto PEEP; 88-92% R/T hypoxic drive
44
Describe 5 considerations of mech vent use with asthma.
Characterized by ↑resistance to airflow: Slow exhalation → Air trapping/auto PEEP;Goal: ↑expiratory time (I:E 1:3-1:4) + ↓ RR = ↓ dynamic hyperinflation and auto PEEP; Careful ↑PEEP R/T auto PEEP; ↑PIP R/T ↑airway resistance; ↑inspiratory flow rate helps ↓ inspiratory time and maximize expiratory time
45
Describe 4 considerations of mech vent use with neurologic injury.
Avoid hypercapnia: CO2 = potent vasodilator, increase PaCO2 → cerebral arteries dilate → increased cerebral blood flow → increased ICP; Keep PEEP low/mod: PEEP causes increase intrathoracic pressure → ↓ venous return from brain → increase ICP; High Pplat and peak pressures can indirectly increase ICP → ↓ venous return; Optimize pt positioning, sedation, avoid coughing
46
High pressure alarms are R/T...
Increased resistance
47
Low pressure or low volume alarms are a result of...
Possible leak or disconnection
48
High Vt or High Vm alarm is a result of...
Increased pt breathing
49
Apnea alarm is a result of...
No detected breath
50
Causes of high pressure alarm
Pt: Biting ETT, secretions, mucus plug, coughing; Lung: bronchospasm, asthma/COPD exacerbation, decrease lung compliance, pneumothorax, pulm fibrosis or restrictive lung disease; Circuit issue: kinked ETT, water in circuit tubing
51
Causes of low pressure/volume alarm
Pt: Insufficient effort to trigger breat in assist modes, hypoventilation from oversedation or fatigue; Circuit issue: disconnection; ETT cuff leak (air escapes around cuff), chest tube air leak
52
Causes of high Vt or Vm alarm
Anxiety, pn, agitation, fever, metab acid (drives hypervent), VT or RR set too high
53
Causes of apnea alarm
Over sedation or fatigue, neuromuscular blockade (no spontaneous effort), disconnection or leak, extubation
54
How to address high pressure alarm:
1.Assess patient (cough, bronchospasm, secretions, biting ETT) 2.Check the circuit 3.Suction airway 4.Administer bronchodilator if needed 5.Sedate if patient fighting ventilator 6.Disconnect only if you cannot resolve the pressure quickly AND the patient is in immediate danger (e.g., extreme PIP, ventilator malfunction, tension pneumothorax)
55
How to address low pressure/volume alarm:
1. Assess patient 2. Check circuit connections and ETT cuff 3. Reconnect / fix leak 4. Confirm ventilator function
56
How to address high Vt or Vm alarm
1.Assess patient effort, agitation, or pain 2.Reduce VT or RR as appropriate 3.Check for ventilator malfunction
57
How to address apnea alarm
1.Assess patient immediately → airway, breathing, oxygenation 2.Check trigger sensitivity on ventilator: if patient’s inspiratory effort is too weak to trigger the ventilator → apnea alarm sounds even though patient is trying to breathe 3.Check circuit connections 4.Provide backup ventilation if patient not breathing
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