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Questions and Answers
Which change is observed after switching from PPV with PEEP to PC-IRV?
What is an observed change after switching from PPV to PC-IRV?
In Pressure Support Ventilation mode, which of the following can the patient control?
What is NOT a disadvantage of PC-IRV mode?
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Which of the following is not a characteristic of A/C mode?
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Which mechanism is NOT achievable by conventional ventilation with PEEP?
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Which is NOT an indication for BiPAP mode?
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What is the primary purpose of permissive hypercapnia during mechanical ventilation?
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In the context provided, what would be an appropriate action to improve a hypoventilating patient's alveolar ventilation?
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Why is an endotracheal tube sometimes cut shorter?
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In Pressure Support Ventilation mode when used with SIMV, what effect does it have on the patient's work of breathing?
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Which of the following variables cause a ventilator to change from expiration to inspiration?
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Which of the following is NOT true for the estimated physiologic shunt equation?
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What happens in pressure-controlled ventilation if the patient's compliance is decreased or airway resistance is increased?
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For a desired I:E ratio of 1:3, what percentage should be the Inspiratory time (I time %)?
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What is the minimum flow rate required for a minute volume of 12 L/min and an I:E ratio of 1:4?
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When setting up a ventilator for a postoperative patient using volume-controlled ventilation, what should be the initial tidal volume and frequency for a 35-year-old patient weighing 132 lb?
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Which type of mask covers only the nose and rests on the upper lip, sides of the nose, and nasal bridge?
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Which type of mask fits inside the mouth between the teeth and lips and has a tongue guide to prevent obstruction of the airway passage?
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Which of the following conditions is NOT a disadvantage of AC mode?
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What method is used to achieve an elevated expiratory baseline in a patient on a mechanical ventilator?
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In which of the following clinical conditions would airway resistance NOT be increased?
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Static compliance is primarily influenced by the patient's:
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Dynamic compliance is mainly affected by the patient's:
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What is the term for a mechanical breath delivered by the ventilator in response to the patient's inspiratory effort?
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Study Notes
Ventilation Modes
- PC-IRV mode leads to a decrease in mean airway pressure, central venous pressure, and pulmonary artery pressure.
- PPV with PEEP may lead to an increase in PEEP requirement, peak airway pressure, and cardiac output.
Disadvantages of PC-IRV
- Incidence of barotrauma
- Higher rate of transvascular fluid flow that may induce or worsen preexisting pulmonary edema
- Patients may require sedation and neuromuscular blocking agents to facilitate ventilation
Conventional Ventilation with PEEP
- Can achieve reduction of intrapulmonary shunting, improvement of V/Q matching, decrease of deadspace ventilation, and increase of mean airway pressure.
BiPAP Mode Indications
- Preventing intubation of the end-stage COPD patient
- Supporting patients with severe hypoxemia
- Restrictive chest wall disease
- Neuromuscular disease
- Nocturnal hypoventilation
Ventilator Modes Characteristics
- A/C mode: each breath, assist or control delivers a mechanical tidal volume, may be patient-triggered or time-triggered, inspiration is terminated by the delivery of a preset tidal Vt, and provides partial ventilator support to the patient.
- Pressure Support Ventilation: increases the patient's spontaneous VT, decreases the patient's spontaneous RR, and the patient has control over the tidal volume, length of inspiration, and termination of inspiration.
Pressure Support Ventilation
- The primary purpose of permissive hypercapnia is to reduce the patient's minute ventilation during mechanical ventilation.
Endotracheal Tube
- A shorter ET tube increases the mechanical deadspace volume and facilitates airway management and secretions removal.
IMV Mode
- The ventilator delivers a tidal volume at a pre-set respiratory rate if the patient-triggered breath is below the pre-set rate and the ventilator controls all mechanical breath.
Ventilator Settings
- Time, compliance, and volume cause a ventilator to change from expiration to inspiration.
- Dynamic compliance decreases with bronchospasm, kinking of ET tube, airway obstruction, and atelectasis.
Indications for Mechanical Ventilation
- Physiological changes like deterioration of lung parenchyma, diseased states like chest trauma, medical and surgical procedures like post-operative recovery, and ventilatory failure.
PEEP
- Decreases the expiratory baseline pressure below ambient, is not a stand-alone mode but rather applied in conjunction with other modes, and is indicated for intrapulmonary shunt and refractory hypoxemia.
Physiologic Shunt Equation
- Does not require a mixed venous blood sample from the pulmonary artery and is non-invasive.
Compliance and Airway Resistance
- Compliance is increased or airway resistance is decreased in pressure-controlled ventilation, the delivered volume is increased when the patient's compliance is increased or airway resistance is decreased.
- In volume-controlled ventilation, the peak inspiratory pressure increases when the patient's compliance is decreased or airway resistance is increased.
Ventilator Settings Calculations
- If the desired I:E ratio is 1:3, the I time % is 25%.
- The minimum flow rate for a minute volume of 12 L/min and an I:E ratio of 1:4 is 60 L/min.
Initial Ventilator Settings
- For a 35-year-old postoperative patient who weighs 132 lb (60 kg), the initial tidal volume should be 600 mL and the frequency should be 12/min.
Mask Types
- Nasal mask: covers the nose only and rests on the upper lip, the sides of the nose, and the nasal bridge.
- Oral mask: fits inside the mouth between the teeth and lips and has a tongue guide to prevent the tongue from obstructing the airway passage.
Disadvantages of AC Mode
- Tachypnea, hypocapnia, respiratory alkalosis, and muscle atrophy.
Elevated Expiratory Baseline
- CPAP and PEEP are methods of attaining an elevated expiratory baseline whenever a patient is hooked on a mechanical ventilator.
Airway Resistance
- May be increased in airway obstruction, endotracheal tube with small internal diameter, and condensation in the ventilator circuit.
Compliance
- Static compliance is primarily affected by a patient's elastic properties of the lungs.
- Dynamic compliance is primarily affected by a patient's elastic properties of the lungs and airway resistance.
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Description
Test your knowledge on mechanical ventilation by answering questions about the characteristics of A/C mode and Pressure Support Ventilation. Analyze the given statements and select the correct answers.
