Mechanical Ventilation Chapter 6 Flashcards
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Questions and Answers

What is minute ventilation (VE)?

The total volume of gas entering (or leaving) the lung per minute.

What is the formula for minute ventilation?

(Tv) x respiratory rate

What is considered normal minute ventilation?

5 to 8 L per min

What is the ideal body weight (IBW) formula for men?

<p>106 + 6(H − 60)</p> Signup and view all the answers

What is the ideal body weight (IBW) formula for women?

<p>105 + 5(H − 60)</p> Signup and view all the answers

Adult lungs do NOT get larger as he or she gains weight.

<p>True</p> Signup and view all the answers

Initial VT of _____ mL/kg IBW and a rate of 10 to 20 breaths/min is generally accepted.

<p>6 to 8</p> Signup and view all the answers

What is the IBW in kg for a female patient who is 5 feet 6 inches?

<p>61.4 kg</p> Signup and view all the answers

What is the IBW in kg for a male patient who is 5 feet 6 inches?

<p>64.5 kg</p> Signup and view all the answers

An initial VT of 6 to 8 mL/kg IBW with a rate of _____ breaths/min is acceptable.

<p>8</p> Signup and view all the answers

In patients with chronic or acute restrictive disease, an initial VT of _____ mL/kg IBW with a rate of 15 to 25 breaths/min is indicated.

<p>4</p> Signup and view all the answers

As suggested in restrictive disease, lower VT and _____ rates are used.

<p>higher</p> Signup and view all the answers

What are the IBW, Vt, and Ve for a male patient who is 6 feet tall, using a RR of 10?

<p>80.9 kg, 566 mL, 5.6 L/min</p> Signup and view all the answers

When setting tidal volume and rate, what is the goal?

<p>to focus on settings that do not harm the patient</p> Signup and view all the answers

Maintaining plateau pressure lower than _____ cm H2O is optimal.

<p>30</p> Signup and view all the answers

PIP - PEEP less than _____ cm H2O is optimal.

<p>15</p> Signup and view all the answers

What does tubing compliance/system compressibility reflect?

<p>The volume of gas compressed in the ventilator circuit for every cm H2O generated by the ventilator during the inspiratory phase.</p> Signup and view all the answers

What does the formula CT = ΔV/ΔP in mL/cm H2O represent?

<p>The volume lost as a result of tubing compliance.</p> Signup and view all the answers

What is mechanical dead space (VDmech)?

<p>The volume of gas that is rebreathed during ventilation.</p> Signup and view all the answers

An example of VDmech is a 6-inch piece of corrugated tubing between the Y-connector and the tracheostomy tube connector; Y-connector between the ventilator and the patient may add about _____ mL.

<p>75</p> Signup and view all the answers

What is the equation for total cycle time and flow?

<p>TCT = TI + TE ; 60 seconds/TCT = f</p> Signup and view all the answers

If the rate is set at 10 breaths/min, the TCT is _____ seconds.

<p>6</p> Signup and view all the answers

If the TI is set at 2 seconds when the rate is 10 bpm, then the expiratory time is _____ seconds and the ratio is ____.

<p>4, 1:2</p> Signup and view all the answers

TI can be determined if VT and flow are known and the flow pattern is a constant or _____ waveform.

<p>square</p> Signup and view all the answers

What is the formula to determine VT when TI and flow are known and flow is constant?

<p>VT = flow × TI</p> Signup and view all the answers

_____ equals VT/TI.

<p>Flow</p> Signup and view all the answers

For a 63-year-old female patient who is 5'8'' with CO2 of 83 mm Hg, what is her IBW in kg and what should be her Vt using 6?

<p>66 kg, 396</p> Signup and view all the answers

With a flow of 0.5 L/s or 500 ml/s, what is the Ti for a 63-year-old female patient who is 5'8'' with CO2 of 83 mm Hg?

<p>0.8 sec</p> Signup and view all the answers

What is the TCT for 18 breaths per minute?

<p>3.33</p> Signup and view all the answers

What is the expiratory time (Te) for a TCT of 3.33 and Ti 0.8 sec, and what is the Ti/Te ratio?

<p>2.53 sec, 1:3</p> Signup and view all the answers

How fast is inspired gas delivered to a patient?

<p>Rate of gas flow</p> Signup and view all the answers

A good start for flow on inspiration is _____ second with a range of 0.8-1.2 seconds.

<p>1</p> Signup and view all the answers

Shorter I-times result in _____ peak pressures.

<p>higher</p> Signup and view all the answers

Slower flows may _____ peak pressures, improve gas distribution, and increase mean airway pressures and can be useful during ARDS.

<p>reduce</p> Signup and view all the answers

What does the most appropriate flow pattern depend on?

<p>Patient's lung condition</p> Signup and view all the answers

In a _____ flow, glow is greatest at start in inspiration when patient demand is greatest.

<p>descending</p> Signup and view all the answers

Constant flow patterns are called ____. Provides the shortest Ti of all available flow patterns with an equivalent peak flow rate setting.

<p>square</p> Signup and view all the answers

Flow produces a tapered flow at the end of the inspiratory phase, resulting in a _____ pattern.

<p>sine</p> Signup and view all the answers

____ ramp provides a progressive increase in flow and is only available on old vents.

<p>ascending</p> Signup and view all the answers

Select the effective flow patterns when ventilating patients with normal lung function:

<p>Descending = Effective for normal lung function Constant = Effective for normal lung function</p> Signup and view all the answers

A descending flow pattern may be beneficial for patients with ______ and ______ by maintaining low peak pressures and high airway pressures.

<p>hypoxemia, low lung compliance</p> Signup and view all the answers

A constant (rectangular) flow pattern produces a lower airway pressure when compared to a descending flow pattern and may be useful for patients with severe ______ and ______.

<p>hypotension, cardiac instability</p> Signup and view all the answers

For patients with high Raw, a _____ pattern is more likely to deliver a set VT at a lower pressure.

<p>descending</p> Signup and view all the answers

_____ is influenced by the condition of the patient's lungs and conductive airways, and the patient's changing metabolic needs.

<p>Minute ventilation</p> Signup and view all the answers

Inspiratory pause - A plateau pressure (Pplat) is also called _________

<p>end</p> Signup and view all the answers

What maneuver is performed by preventing the expiratory valve from opening at the end of inspiration?

<p>Pplat</p> Signup and view all the answers

A patient can be actively breathing so a stable pressure reading can be obtained, which is why we perform the pause at the end of inspiration.

<p>False</p> Signup and view all the answers

PEEP of 3-5 maintains ____.

<p>FRC</p> Signup and view all the answers

Low level of PEEP is good for _____ who would normally pursed-lip breathe.

<p>COPD</p> Signup and view all the answers

Determining _____ in pressure ventilation involves measuring Pplat and baseline pressure after initial volume-targeted breath.

<p>VT</p> Signup and view all the answers

Initial settings for PSV done during _____: Set level equal to PIP - Pplat.

<p>weaning</p> Signup and view all the answers

What is the goal for PSV?

<p>Help increase Vt (4-8 mL/kg) and decrease respiratory rate to less than 30 breaths/min.</p> Signup and view all the answers

Use backup ventilation mode if PSV is being used by itself.

<p>True</p> Signup and view all the answers

IPAP of _____ cm H2O should be increased in increments of 3 to 5 until a rate of 25 breaths/min or lower is achieved.

<p>5 to 10</p> Signup and view all the answers

EPAP (PEEP) is started at _____ cm H2O and increased in increments of 3 to 5.

<p>2 to 5</p> Signup and view all the answers

Adjust IPAP and EPAP (PEEP) until Vt of _____ mL/kg or more is achieved.

<p>4 to 8</p> Signup and view all the answers

Hypoxemic respiratory failure will need a higher _____ of at least 5 cm H2O.

<p>PEEP</p> Signup and view all the answers

In PVRC, remember the vent progressively adjusts the _____ level until the set Vt is achieved.

<p>pressure</p> Signup and view all the answers

PVRC refers to what type of mode?

<p>Pressure-limited, time-cycled mode that uses the set VT as feedback control.</p> Signup and view all the answers

In PVRC, cough or bucking the vent won't let pressure exceed limit.

<p>True</p> Signup and view all the answers

Volume support is what type of breathing mode?

<p>Spontaneous</p> Signup and view all the answers

In volume support mode, the set Vt is the minimum Vt, but the patient can obtain a higher Vt if they want.

<p>True</p> Signup and view all the answers

Study Notes

Minute Ventilation (VE) and Tidal Volume (Tv)

  • Minute ventilation (VE) represents total gas exchanged in the lungs per minute.
  • Formula for minute ventilation: VE = Tv x respiratory rate.
  • Normal minute ventilation ranges from 5 to 8 L/min.

Ideal Body Weight (IBW)

  • IBW for men: 106 + 6(H − 60).
  • IBW for women: 105 + 5(H − 60).
  • Example calculations:
    • Female patient at 5'6" has an IBW of 61.4 kg.
    • Male patient at 5'6" has an IBW of 64.5 kg.

Ventilation Settings

  • Initial tidal volume (VT) recommended: 6 to 8 mL/kg of IBW, respiratory rate of 10 to 20 breaths/min.
  • For patients with airway obstruction, use initial VT of 6 to 8 mL/kg with a rate of 8 breaths/min.
  • In chronic or acute restrictive diseases, aim for an initial VT of 4 mL/kg with a rate of 15 to 25 breaths/min.

Pressure Goals

  • Maintain plateau pressure (Pplat) below 30 cm H2O.
  • Optimal peak inspiratory pressure (PIP) minus PEEP should be under 15 cm H2O.

Mechanical Dead Space

  • Mechanical dead space (VDmech) is the volume of gas rebreathed due to ventilator circuit design.
  • Example of VDmech: 6-inch corrugated tubing adds approximately 75 mL.

Total Cycle Time and Flow

  • Total cycle time (TCT) equation: TCT = TI + TE; inverse for flow rate: 60 seconds/TCT = f.
  • For a rate of 10 breaths/min, the TCT equals 6 seconds.

Flow Patterns

  • Flow influences inspiratory time (TI) and tidal volume (VT).
  • Constant (square) flow patterns are most familiar and provide shortest TI.
  • Descending flow patterns are beneficial for hypoxemia and low lung compliance, delivering VT at lower pressures.
  • Constant flow patterns are suitable for patients with hypotension or cardiac instability.

Pressure Ventilation Concepts

  • Pplat is obtained by holding the inspiratory valve closed at the end of inspiration.
  • PEEP levels of 3-5 are essential to maintain functional residual capacity (FRC).
  • Low levels of PEEP are advantageous for patients with COPD.

Weaning and Pressure Support Ventilation (PSV)

  • Initial PSV settings: level set equal to PIP - Pplat.
  • Goals for PSV: increase VT to 4-8 mL/kg, lower respiratory rate to under 30 breaths/min, and reduce work of breathing (WOB).
  • Backup ventilation is recommended during the use of PSV.

Settings for IPAP and EPAP

  • Start IPAP at 5-10 cm H2O, increasing incrementally until achieving a rate of 25 breaths/min or lower.
  • EPAP (PEEP) begins at 2-5 cm H2O with similar increments in management.

Volume Support Mode

  • In volume support, the set VT represents the minimum, allowing patients to achieve higher VT.
  • This mode operates under spontaneous breathing conditions with preset sensitivity and pressure limits.

General Principles

  • Minute ventilation is affected by lung conditions and metabolic needs.
  • Use of high PEEP is indicated for hypoxemic respiratory failure.
  • The ventilator adjusts pressure progressively to achieve the set VT.

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Test your knowledge with these flashcards on Mechanical Ventilation from Chapter 6. Each card covers important concepts such as minute ventilation, tidal volume, and ideal body weight formulas. Perfect for students and professionals in respiratory care.

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