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Questions and Answers
Which of the following is a primary objective when initiating mechanical ventilation?
Which of the following is a primary objective when initiating mechanical ventilation?
- Providing complete respiratory support to take over the work of breathing. (correct)
- Administering aerosolized medications more effectively.
- Enhancing the patient's ability to engage in spontaneous breathing trials.
- Supplementing the patient's respiratory effort without complete support.
A patient with a severe traumatic brain injury requires mechanical ventilation. What is the MOST important consideration when choosing ventilation settings?
A patient with a severe traumatic brain injury requires mechanical ventilation. What is the MOST important consideration when choosing ventilation settings?
- Maintaining a high tidal volume to prevent atelectasis.
- Employing permissive hypercapnia to reduce lung injury.
- Using pressure-controlled ventilation to ensure consistent gas exchange.
- Limiting airway pressures to avoid increasing intracranial pressure. (correct)
A patient on mechanical ventilation is diagnosed with pneumonia. Which intervention is MOST appropriate to facilitate pulmonary toileting?
A patient on mechanical ventilation is diagnosed with pneumonia. Which intervention is MOST appropriate to facilitate pulmonary toileting?
- Implementing a high tidal volume strategy.
- Using mucolytics in conjunction with airway suctioning. (correct)
- Administering neuromuscular blocking agents.
- Increasing the FiO2 to 100%.
What is the underlying rationale for limiting FiO2 to less than 50% after 24 hours of mechanical ventilation?
What is the underlying rationale for limiting FiO2 to less than 50% after 24 hours of mechanical ventilation?
Which pathophysiological process is LEAST associated with oxygen toxicity?
Which pathophysiological process is LEAST associated with oxygen toxicity?
In a patient on mechanical ventilation, what is the rationale for setting tidal volume based on ideal body weight rather than actual body weight?
In a patient on mechanical ventilation, what is the rationale for setting tidal volume based on ideal body weight rather than actual body weight?
In the context of mechanical ventilation, what is the primary function of positive end-expiratory pressure (PEEP)?
In the context of mechanical ventilation, what is the primary function of positive end-expiratory pressure (PEEP)?
What is the primary role of the 'sensitivity' setting on a mechanical ventilator?
What is the primary role of the 'sensitivity' setting on a mechanical ventilator?
Which of the following scenarios would MOST likely warrant an increase in the high-pressure limit setting on a mechanical ventilator?
Which of the following scenarios would MOST likely warrant an increase in the high-pressure limit setting on a mechanical ventilator?
What does the term 'minute volume' represent in the context of mechanical ventilation?
What does the term 'minute volume' represent in the context of mechanical ventilation?
In continuous mandatory ventilation (CMV), what determines whether a breath is classified as 'assist' or 'control'?
In continuous mandatory ventilation (CMV), what determines whether a breath is classified as 'assist' or 'control'?
What is a principal disadvantage of prolonged use of continuous mandatory ventilation (CMV)?
What is a principal disadvantage of prolonged use of continuous mandatory ventilation (CMV)?
Why is Assist Control (AC) ventilation often chosen over other modes for patients newly initiated on mechanical ventilation?
Why is Assist Control (AC) ventilation often chosen over other modes for patients newly initiated on mechanical ventilation?
In Assist Control (AC) pressure ventilation, what determines the tidal volume delivered to the patient?
In Assist Control (AC) pressure ventilation, what determines the tidal volume delivered to the patient?
How does Pressure Regulated Volume Control (PRVC) differ from traditional Assist Control (AC) volume ventilation?
How does Pressure Regulated Volume Control (PRVC) differ from traditional Assist Control (AC) volume ventilation?
Which statement accurately describes Synchronized Intermittent Mandatory Ventilation (SIMV)?
Which statement accurately describes Synchronized Intermittent Mandatory Ventilation (SIMV)?
What is the primary function of Continuous Positive Airway Pressure (CPAP) in the context of mechanical ventilation?
What is the primary function of Continuous Positive Airway Pressure (CPAP) in the context of mechanical ventilation?
A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation. Which strategies should be prioritized to minimize ventilator-induced lung injury?
A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation. Which strategies should be prioritized to minimize ventilator-induced lung injury?
What is 'permissive hypercapnia,' and in which clinical scenario might it be considered an acceptable strategy?
What is 'permissive hypercapnia,' and in which clinical scenario might it be considered an acceptable strategy?
Which of the following interventions is MOST appropriate for a patient on mechanical ventilation who exhibits signs of increased work of breathing, such as accessory muscle use and paradoxical abdominal movement?
Which of the following interventions is MOST appropriate for a patient on mechanical ventilation who exhibits signs of increased work of breathing, such as accessory muscle use and paradoxical abdominal movement?
A patient on mechanical ventilation develops subcutaneous emphysema. What is the MOST likely cause, and what initial intervention is warranted?
A patient on mechanical ventilation develops subcutaneous emphysema. What is the MOST likely cause, and what initial intervention is warranted?
A patient on mechanical ventilation has copious, thick secretions. What intervention should be implemented FIRST?
A patient on mechanical ventilation has copious, thick secretions. What intervention should be implemented FIRST?
What is the MOST reliable indicator of readiness to wean a patient from mechanical ventilation?
What is the MOST reliable indicator of readiness to wean a patient from mechanical ventilation?
A patient is being mechanically ventilated and requires frequent suctioning. What strategies can best prevent complications associated with suctioning?
A patient is being mechanically ventilated and requires frequent suctioning. What strategies can best prevent complications associated with suctioning?
Which strategy is MOST effective in preventing ventilator-associated pneumonia (VAP)?
Which strategy is MOST effective in preventing ventilator-associated pneumonia (VAP)?
A patient on mechanical ventilation develops sudden-onset agitation and a drop in oxygen saturation. What intervention is MOST appropriate?
A patient on mechanical ventilation develops sudden-onset agitation and a drop in oxygen saturation. What intervention is MOST appropriate?
What is the significance of the I:E ratio setting on a mechanical ventilator, and how does altering it affect ventilation?
What is the significance of the I:E ratio setting on a mechanical ventilator, and how does altering it affect ventilation?
A patient on mechanical ventilation is suspected of having auto-PEEP. What ventilator adjustments should be considered?
A patient on mechanical ventilation is suspected of having auto-PEEP. What ventilator adjustments should be considered?
Which mode of mechanical ventilation is MOST appropriate for a patient with a stable respiratory drive who requires assistance to overcome airway resistance?
Which mode of mechanical ventilation is MOST appropriate for a patient with a stable respiratory drive who requires assistance to overcome airway resistance?
A patient on mechanical ventilation is receiving neuromuscular blocking agents. Which parameter is ESSENTIAL to monitor to ensure adequate ventilation?
A patient on mechanical ventilation is receiving neuromuscular blocking agents. Which parameter is ESSENTIAL to monitor to ensure adequate ventilation?
What is the primary benefit of using a heat and moisture exchanger (HME) in a mechanically ventilated patient?
What is the primary benefit of using a heat and moisture exchanger (HME) in a mechanically ventilated patient?
When should the high-pressure alarm on a ventilator be activated?
When should the high-pressure alarm on a ventilator be activated?
What is the primary disadvantage of negative pressure ventilation?
What is the primary disadvantage of negative pressure ventilation?
How would you manage suspected aspiration pneumonia in a patient on mechanical ventilation?
How would you manage suspected aspiration pneumonia in a patient on mechanical ventilation?
What is the most important consideration for mechanical ventilation in patient with status asthmaticus?
What is the most important consideration for mechanical ventilation in patient with status asthmaticus?
Which sign may imply a pneumothorax when ventilating a patient?
Which sign may imply a pneumothorax when ventilating a patient?
Flashcards
Purpose of Ventilation
Purpose of Ventilation
Mechanical ventilation delivers air, it doesn't handle gas exchange itself.
Ventilation system types
Ventilation system types
Volume cycled ventilation delivers a set volume of air; pressure cycled delivers air until a set pressure is reached.
Indications for ventilation
Indications for ventilation
Conditions like CNS depression and specific diseases like pneumonia can indicate ventilation.
What is FiO2?
What is FiO2?
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Risk of High FiO2
Risk of High FiO2
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Tidal Volume (VT)
Tidal Volume (VT)
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Respiratory Rate (f)
Respiratory Rate (f)
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Positive End Expiratory Pressure (PEEP)
Positive End Expiratory Pressure (PEEP)
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Pressure Support (PS)
Pressure Support (PS)
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I:E Ratio
I:E Ratio
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Ventilator Sensitivity
Ventilator Sensitivity
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High Pressure Limit
High Pressure Limit
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Patient TV
Patient TV
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Minute Volume
Minute Volume
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Peak Inspiratory Pressure
Peak Inspiratory Pressure
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Continuous Mandatory Ventilation (CMV)
Continuous Mandatory Ventilation (CMV)
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Assist Control (AC)
Assist Control (AC)
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Assist Control Volume
Assist Control Volume
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Assist Control Pressure
Assist Control Pressure
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Synchronized Intermittent Mandatory Ventilation (SIMV)
Synchronized Intermittent Mandatory Ventilation (SIMV)
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Continuous Positive Airway Pressure (CPAP)
Continuous Positive Airway Pressure (CPAP)
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Study Notes
- The material addresses respiratory concepts, specifically mechanical ventilation.
Conceptual Basis and Indications
- Mechanical ventilation provides ventilation, not respiration.
- Systems can be pressure-driven or volume-driven.
- Volume-cycled systems deliver a set volume of gas
- Pressure-cycled systems deliver gas until a set pressure is reached
- Negative pressure systems applies negative pressure to the patient
- Mechanical ventilation protects the airway and helps patients with CNS depression
- Mechanical ventilation facilitates pulmonary toileting (removal of secretions).
- It is used in treating specific conditions, including increased ICP, hypoxemia/acute respiratory failure, pneumonia/aspiration pneumonia, PE, surgery, and status asthmaticus.
FiO2 - Oxygen Concentration
- FiO2 represents fraction of inspired oxygen.
- Room air FiO2 is 0.21.
- FiO2 should not exceed 50% for more than 24 hours due to oxygen toxicity risks.
Oxygen Toxicity
- Increased pulmonary capillary permeability due to injury.
- Type II cells injured by O2 free radicals cause increased pulmonary capillary permeability
- Influx of plasma proteins into tissues inhibits surfactant function.
- Bleeding between alveoli results in "gummy" consistency.
- Scar tissue forms which destroys alveoli and capillaries.
- Nitrogen washout can occur.
- Factors influencing oxygen toxicity include FiO2, length of exposure, nutritional deficiencies, sepsis, and blood transfusions.
- Signs and symptoms include substernal irritation, uncontrollable cough, burning sensation, dyspnea at rest, and pleuritic pain.
Ventilator Settings - Tidal Volume
- Tidal Volume(VT or Vt) represents the volume of gas delivered during each breath.
- The tidal volume is set based on ideal body weight, typically 6-10 ml/kg.
- For ARDS patients, a lower tidal volume of 4-8 ml/kg is recommended.
Ventilator Settings
- Respiratory Rate (f): The number of breaths delivered per minute, usually 8-20 breaths/min.
- Positive End Expiratory Pressure (PEEP): Pressure applied at the end of expiration, usually 3-10 cm H2O.
- Pressure Support (PS): Positive pressure used to augment inspiratory effort, typically 5-10 cm H2O.
- I:E Ratio: The ratio of inspiration to expiration duration, a normal rate is 1:2 to 1:1.5 unless inverse ratio is desired.
- Sensitivity determines how much effort the patient must exert to trigger a ventilator breath.
- High Pressure Limit: Regulates the maximum pressure the ventilator can generate, terminating the breath and releasing undelivered volume if the limit is reached.
Ventilator Patient Readings
- Patient TV: Patient's actual tidal volume received.
- Minute Volume: Total tidal volume delivered over one minute.
- Peak Inspiratory Pressure: The highest proximal airway pressure reached during inspiration, should target < 35.
Modes
- Continuous Mandatory Ventilation (CMV): Also known as Assist-Control; includes Pressure Control (PC) and Volume Control (VC).
- Pressure Regulated Volume Control: A combination of volume and pressure control.
- Synchronized Intermittent Mandatory Ventilation (SIMV): Ventilator delivers synchronized breaths and allows patient to breathe spontaneously.
- Continuous Positive Airway Pressure (CPAP): Continuous positive pressure during spontaneous breaths.
Continuous Mandatory Ventilation (CMV) or Assist Control (AC)
- CMV delivers gas at a preset tidal volume or pressure that responds to patient's inspiratory effort.
- Each breath is either assisted (patient initiated) or controlled (ventilator initiated) with guaranteed TV.
- Full ventilator support is provided for all breaths.
- Prolonged use may weaken respiratory muscles.
Assist Control Ventilation
- Assist Control Volume: The patient gets a set tidal volume with each breath, whether assisted or controlled.
- Assist Control Pressure: Combines both volume and pressure features.
- Assist Control Pressure uses the lowest possible airway pressure to deliver tidal volume and delivers the breath until the set pressure is reached.
- Tidal Volume (TV) varies with lung compliance, limiting peak inspiratory pressure and ensuring airway pressure does not exceed the preset maximum.
Pressure Control - Example Settings
- Peak Pressure: 24 cm H2O
- RR (Respiratory Rate): 12 breaths/min
- FiO2: 40%
- PEEP: 5 cm H2O
PRVC, SIMV and CPAP modes
- Pressure Regulated Volume Control (PRVC): A variation of AC combines volume and pressure features and delivers a preset TV using lowest possible airway pressure with adjustments based on airway and respiratory system compliance.
- Synchronous Intermittent Mandatory Ventilation (SIMV): Delivers gas at preset tidal volume or pressure and rate which allows the patient to breathe spontaneously, while ventilator breaths are synchronized to patient's respiratory effort.
- Continuous Positive Airway Pressure (CPAP) AKA Spontaneous: Applies positive pressure during spontaneous breaths where rate, inspiratory flow, and tidal volume are controlled by the patient, often which is used is a weaning mode.
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