Mechanical Ventilation Overview

Study Notes

Mechanical Ventilation

CPAP stands for Continuous Positive Airway Pressure.
Mechanical ventilation during spontaneous breathing assists patients by providing pressure to prevent alveolar collapse and improve oxygenation.
Pressure gradients for pulmonary ventilation are created by air flowing from the higher pressure atmosphere into the lower pressure lungs.
When targeting a return volume with lower lung compliance in volume control, risks include barotrauma (lung injury from excessive pressure) and pneumothorax.
Non-invasive ventilation is indicated for conditions like COPD and cardiogenic pulmonary edema.
The goal of volume-targeted ventilation is to deliver an adequate tidal volume to the patient to provide sufficient ventilation.
Before initiating mechanical ventilation, especially invasive ventilation, consider factors such as:
- Respiratory drive
- Airway protection
- Reversibility of respiratory failure
- Arterial blood gas (ABG) values
- Lung compliance and resistance
Transairway pressure is the difference between airway pressure and alveolar pressure.
Transpulmonary pressure is the difference between alveolar pressure and pleural pressure.
Transthoracic pressure is the difference between alveolar pressure and body surface pressure.
Transrespiratory pressure is the difference between airway pressure and body surface pressure.
Mandatory breath preset values include pressure, volume, and time.
Alternatives to mechanical ventilation prior to intubation include:
- Non-invasive ventilation
- Oxygen therapy (e.g., nasal cannula)
- Patient positioning
- Medications
Pressure support ventilation can be used with SIMV to decrease work of breathing (WOB) during spontaneous breathing.
Non-invasive ventilation should not substitute for invasive ventilation in cases of:
- Unprotected airway
- Altered mental status
- Hemodynamic instability
- Severe hypoxemia
Ventilation modes include:
- Assist control (AC)
- Synchronized intermittent mandatory ventilation (SIMV)
- Continuous positive airway pressure (CPAP)
- Pressure support (PS)
- Pressure regulated volume control (PRVC)
- Volume-limited assist control (VAC)
- Pressure-limited assist control (PAC)
- APRV
Full ventilatory support involves the ventilator performing 100% of breathing for the patient while maintaining good alveolar ventilation (greater than 8).
Pressure support ventilation helps decrease muscle fatigue, provides inspiratory support, and enables patients to breathe spontaneously during mechanical ventilation.
BIPAP (Bi-level positive airway pressure) is indicated for conditions like:
- CHF
- Pulmonary edema
- Worsening pneumonia
- High WOB or respiratory muscle weakness
- COPD
Breaths delivered during mechanical ventilation can be mandatory or spontaneous.
Measuring and monitoring compliance during mechanical ventilation is important because it provides information about lung elasticity and helps ensure appropriate settings to prevent lung injury.
Partial ventilator support means the patient can take spontaneous breaths while the ventilator assists with respiratory effort.
Sensitivity settings can help improve patient effort and prevent asynchrony with the ventilator.
The four phases of a breath are:
- Trigger
- Limit
- Cycle
- Expiratory
In pressure-controlled targeted ventilation, patient inspiratory effort affects the volume delivered.
Transairway pressure describes the airway movement in conductive airways that generate pressure due to resistance and gas flow.
In spontaneous mode, patients can trigger breaths.
Advantages of non-invasive ventilation include:
- Decreased risk of infection
- Patient comfort
Time constants refer to how quickly the lungs can fill and empty, influenced by airway resistance.
Indications for invasive mechanical ventilation include:
- Acute respiratory failure
- Risk of aspiration
- Respiratory arrest
- Myocardial infarction
- Upper airway obstruction
- Inability to clear secretions

Description

This quiz covers essential concepts related to mechanical ventilation, including CPAP, pressure gradients, and volume-targeted ventilation strategies. It addresses the clinical implications of mechanical ventilation in various respiratory conditions and outlines factors to consider before initiating treatment.

Mechanical Ventilation Overview

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Questions and Answers

What is the main purpose of pressure support ventilation?

What does partial ventilator support allow for a patient?

Which of the following would NOT provide an indication for invasive mechanical ventilation?

What factors primarily affect the time constant of the lungs?

Which phase is NOT one of the four phases of a breath during mechanical ventilation?

What does CPAP stand for in a medical context?

What is a major risk when lowering lung compliance while targeting a return volume in volume control?

What is the primary purpose of mechanical ventilation during spontaneous breathing?

Which of the following is NOT a question to consider before starting mechanical ventilation?

What should be avoided when considering non-invasive ventilation substitution for invasive ventilation?

What is the Transpulmonary Pressure defined as?

Which of the following is NOT a mode included in mechanical ventilation?

What is the goal of volume-targeted ventilation?

Study Notes

Mechanical Ventilation

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