Week 3- Mechanical Ventilation

Question 1

What is the purpose of mechanical ventilation?

Answer 1

Maintain homeostasis between gas concentrations Oxygen and CO2.

Question 2

Do all mechanical ventilation indications come from a pulmonary impairment?

Answer 2

No

Question 3

What are (5) indications for mechanical ventilation?

Answer 3

• Airway protection (Preventive measure)
• Cardiac arrest (Life saving measure)
• Management of ICP (Creation of alkalosis ->vasoconstriction ->dec cerebral blood flow/dec ICP)
• Airway obstruction (Maintenance of patent airway)
• Surgery or trauma (General anesthesia)

Question 4

Describe the mechanical ventilation vocabulary:

• FiO2
• Tidal Volume (TV)
• PEEP
• Flow
• Respiratory Rate

Answer 4

• FiO2: Fraction of inspired oxygen (%)
• Tidal Volume (TV): Normal amount of air ventilated at rest (mL)
• PEEP: Positive End Expiratory Pressure (cmH2O)
• Flow: L/min
• Respiratory Rate: breaths/min

Question 5

What are the 2 types of mechanical ventilation?

Answer 5

• Invasive

- Non-invasive

Question 6

With invasive mechanical ventilation, why would we use a nasotracheal tube instead of an endotracheal tube?

Answer 6

If someone has an obstruction in throat or swelling.

Question 7

What is a tracheostomy?

Answer 7

Invasive mechanical ventilation where tube is inserted straight into trachea.

Question 8

• What are 2 types of non-invasive mechanical ventilation?

- Often the last step before __________.

Answer 8

• BiPAP or CPAP

- intubation

Question 9

What is the difference between BiPAP and CPAP?

Answer 9

BiPAP (Bi-Level Positive Airway Pressure)

• BiPAP blows higher pressure while you breathe in. BiPAP blows lower pressure while you breathe out.
• Used for patients who have trouble exhaling.

CPAP (Continuous Positive Airway Pressure)
-CPAP blows constant pressure while you breathe in and out.

Question 10

Is BiPAP a contraindication to PT?

Answer 10

No. Need to know why, how much they are on, and are they medically stable on BiPAP.

Question 11

Is CPAP a contraindication?

Answer 11

No

Question 12

-With mechanical ventilation, there is a ______ at the end of the tube that helps to hold it in place.
What do we suspect if the patient is able to talk or audibe sounds are heard with a tube inserted?

Answer 12

• cuff

- cuff leak

Question 13

-The average person can be orally ventilated for ____ weeks. Why?

Answer 13

2, respiratory infection risk rises and it is not temporary anyways.

Question 14

• What is done if the patient is unable to be weaned from the ventilator after 2 weeks?
• What are some reasons a patient would go straight to a trachestomy?

Answer 14

• Tracheostomy

- Difficult intubation (severe morbid obesity), Airway blocked or obstructed (tumor, traumatic injury)

Question 15

What is a Passy Muir valve?

Answer 15

Valve put on the end of the tracheostomy to make it easier to talk.

Question 16

• Why do most rehab facilities not take people with tracheostomy?
• Where will most patients with a tracheostomy go?

Answer 16

• High level of care including cleaning tube, access to wall suction.
• Long term acute care

Question 17

• What is a second discharge option other than long term acute care?
• What are the requirements for them to be admitted here?

Answer 17

• rehab facility

- if they can be put on a trach collar and the percentage of O2 is 28% or less.

Question 18

MODES OF VENTILATION

Answer 18

MODES OF VENTILATION

Question 19

What are the main (7) modes of ventilation seen?

Answer 19

-Volume Control (VC)
-Pressure Control (PC)
-Assist Control (AC)
-Pressure Regulated Volume Control (PRVC)
-Synchronous Intermittent Mandatory Ventilation
(SIMV)
-Pressure Support Ventilation
-Volume Support (VS)
-Continuous Positive Airway Pressure (CPAP)

Question 20

Volume Control (VC):

• Preset _____ volume is delivered at a set ________ rate
• Used when patient has no __________ breathing
• Peak pressures can vary depending on patient’s lung __________ and ___________

Answer 20

• tidal, respiratory rate
• spontaneous
• compliance and resistance

Question 21

With volume control, pressure from ventilator will ________ if patient’s lung compliance decreases.

Answer 21

increase (stiff lung = increased resistance)

Question 22

Pressure Control (PC):

• Predetermined amount of _________ at a set rate
• Ventilator determines __________ time
• Patient has no __________ breathing
• ______ used to increase arterial oxygen, improve lung compliance (prevents collapse, makes lungs easier to inflate)

Answer 22

• pressure
• inspiratory
• spontaneous
• PEEP

Question 23

Assist Control (AC):

• Delivers a specific amount of ______ volume
• Forces air down into lungs
• ________ or ventilator can trigger when breaths are taken
• _____ level of respiratory support

Answer 23

• tidal
• patient
• high

Question 24

Pressure Regulated Volume Control (PRVC):

• Combines _______ and ______ controlled ventilation
• Preset tidal volume is delivered at set rate, but with ______ possible pressure
• Helps prevent __________

Answer 24

• pressure and volume
• lowest
• barotrauma

Question 25

Synchronous Intermittent Mandatory Ventilation (SIMV): - Used to assist patients who have some, but not sufficient breathing (Patients can breathe in between each machine assisted breath) - Used for __________ - Delivers certain number of breaths in coordination with respiratory effort of patient - Does have increased work of breathing

Answer 25

weaning

Question 26

Pressure Support Ventilation: - Small amount of pressure occurs on inspiration - _________ initiates all breaths (Assists patient in making a spontaneous breath) - Delivers a specific pressure - Ventilator assists, but ________ regulates the respiratory rate and tidal volume

Answer 26

- patient | - patient

Question 27

Volume Support (VS): - _______ volume and ______ are set - _________ initiates breathing - Ventilator delivers support in proportion to patient’s inspiratory effort and target volume

Answer 27

- tidal volume and PEEP | - patient

Question 28

Continuous Positive Airway Pressure (CPAP): - Continuous pressure is maintained in airways to prevent collapse - _________ regulates all other respiratory functions

Answer 28

-patient

Question 29

PART 3

Answer 29

PART 3

Question 30

Before you touch your patient who is on a vent, what do you look at?

Answer 30

- Mode of ventilator - RR - FiO2 - PEEP

Question 31

Do we need to document the ventilation settings in our PT notes?

Answer 31

Yes. Include mode, FiO2, PEEP

Question 32

What are the (3) main sedative drugs that patients on mechanical ventilation will be on?

Answer 32

- Propofol (Diprivan) - Precedex (Dexmedetomidine HCl) - Fentanyl

Question 33

What is propofol?

Answer 33

- Very strong anesthetic given by IV, has a rapid effect. | - Has a short half-life, can be reversible in a few minutes if patient needs to participate in PT.

Question 34

What is precedex?

Answer 34

- Baby propofol. | - Keeps people calmer, more interactive.

Question 35

What is fentanyl?

Answer 35

-Opiate analgesic used to treat severe pain, but also produces state of relaxation.

Question 36

Mechanical Ventilation Alarms: - What are the causes of RED alarms? (3) - What are the causes of YELLOW alarms? (4)

Answer 36

RED - high pressure - circuit disconnected - apnea YELLOW - low tidal volume - high respiratory rate - low minute ventilation - low inspiratory pressure

Question 37

Mechanical Ventilation: Weaning: - What is weaning? - Will PTs work with patients during this process?

Answer 37

- Process of decreasing or discontinuing mechanical ventilation - Yes

Question 38

What are the (5) major factors to consider during weaning?

Answer 38

- Respiratory demand and ability of neuromuscular system to cope with O2 demand. - Oxygenation - CV performance - Psychological factors - Adequate rest and nutrition

Question 39

Weaning Signs of Distress: - Tachypnea > __ breaths/min - Decreased pH < ____-_____ with increased PaCO2 - Paradoxical breathing patterns - O2 saturation < ___% - HR change of > ___ bpm - BP change > ___ mm Hg - Agitation, panic, diaphoresis, cyanosis, angina, or arrhythmias

Answer 39

- 30 breaths/min - 7.25-7.30 - 90% - >20bpm - >20mmHg

Question 40

What are the pros/cons to working with a patient on full mechanical ventilation support vs SBT?

Answer 40

- If working with someone on full mechanical support they breath less hard (longer endurance while working). - If someone is on SBT, they tend to be more awake and interactive, but are breathing on their own (less endurance).

Question 41

What are 2 common sedation scales that are used? (not by PTs)

Answer 41

- Richmond Agitation Sedation Scale (RASS) | - CPOT Pain Scale

Question 42

What is the goal score for patients on the RASS?

Answer 42

between -1 and -2

Question 43

PART 4: PT IMPLICATIONS

Answer 43

PART 4: PT IMPLICATIONS

Question 44

Contraindications: - _______/___________, does not follow commands** - Severe agitation/combativeness - PEEP > ___cm H2O or FiO2 > ____ - Uncontrolled active _______

Answer 44

- comatose/unresponsive - 10cm, 0.60 (60%) - bleeding

Question 45

Prolonged vent support may lead to what (3) things?

Answer 45

- skin breakdown (decubitus ulcers) - joint contractures - deconditioning