Podcast
Questions and Answers
Which change is observed after switching from PPV with PEEP to PC-IRV?
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?
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?
In Pressure Support Ventilation mode, which of the following can the patient control?
What is NOT a disadvantage of PC-IRV mode?
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?
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?
Which mechanism is NOT achievable by conventional ventilation with PEEP?
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Which is NOT an indication for BiPAP mode?
Which is NOT an indication for BiPAP mode?
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What is the primary purpose of permissive hypercapnia during mechanical ventilation?
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?
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?
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?
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?
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?
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?
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 %)?
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?
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?
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?
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?
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?
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?
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?
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:
Static compliance is primarily influenced by the patient's:
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Dynamic compliance is mainly affected by the patient's:
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?
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.
