Mechanical Ventilation Quiz: PC vs VC

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Questions and Answers

What is the main aim of pressure-controlled ventilation (PC) in terms of airway management?

To control airway pressure while allowing tidal volume to vary based on lung compliance.

Why might volume-controlled ventilation (VC) lead to lung injury?

Because it guarantees tidal volume but can result in high lung pressures that may cause barotrauma.

In what clinical conditions is pressure-controlled ventilation particularly useful?

In severe asthma, COPD, and salicylate toxicity.

How does the inspiratory flow behavior differ between pressure-controlled and volume-controlled ventilation?

<p>PC allows for variable inspiratory flow, while VC typically uses a predetermined inspiratory flow pattern.</p> Signup and view all the answers

What is a significant drawback of using volume-controlled ventilation in terms of assessing lung pressure?

<p>End-inspiratory alveolar pressure cannot be reliably estimated and must be measured directly using plateau pressure.</p> Signup and view all the answers

For which patient population might you choose volume-controlled ventilation over pressure-controlled ventilation?

<p>Patients with ARDS, obesity, or severe burns.</p> Signup and view all the answers

What role does PEEP play in pressure-controlled ventilation?

<p>PEEP helps maintain airway pressure during expiration, improving oxygenation and preventing alveolar collapse.</p> Signup and view all the answers

How does lung compliance affect tidal volume in pressure-controlled ventilation?

<p>Tidal volume is inversely related to lung compliance; lower compliance results in lower tidal volume.</p> Signup and view all the answers

What are the key parameters set by the clinician for assist-control volume control (AC-VC) in ventilation?

<p>Tidal volume, inspiratory flow, PEEP, and respiratory rate (RR).</p> Signup and view all the answers

In the context of assist-control pressure control (AC-PC), what primary target does the clinician set?

<p>Target pressure and inspiratory time.</p> Signup and view all the answers

Identify a clinical scenario where synchronized intermittent mandatory ventilation (SIMV) is preferred.

<p>Patients with regular but poor spontaneous respiratory effort.</p> Signup and view all the answers

What type of patients benefit from pressure-support ventilation (PSV)?

<p>Spontaneously breathing patients requiring minimal ventilatory support.</p> Signup and view all the answers

What distinguishes Continuous Positive Airway Pressure (CPAP) from Bi-level Positive Airway Pressure (BL-PAP)?

<p>CPAP provides a consistent pressure, while BL-PAP uses two levels of pressure (IPAP and EPAP).</p> Signup and view all the answers

What is a classic indication for the use of CPAP in patients?

<p>Chronic obstructive pulmonary disease (COPD) and acute cardiogenic pulmonary edema (ACPE).</p> Signup and view all the answers

In which scenario is assist-control ventilation most likely to lead to hyperventilation?

<p>When used in paralyzed or deeply sedated patients.</p> Signup and view all the answers

What parameter needs to be set higher in deeply sedated patients receiving SIMV?

<p>The backup respiratory rate (RR).</p> Signup and view all the answers

What are the main parameters set by the clinician in Continuous Spontaneous Ventilation (CSV)?

<p>Mainly PEEP and pressure support level for PSV and CPAP settings.</p> Signup and view all the answers

What role does PEEP play in ventilatory strategies?

<p>PEEP helps maintain positive airway pressure at the end of expiration.</p> Signup and view all the answers

What are the potential complications of Assist-Control (A/C) Ventilation related to patient-initiated breaths?

<p>Complications include hyperventilation, air trapping, hypotension, and poor ventilator synchrony.</p> Signup and view all the answers

What is the primary function of CPAP in noninvasive ventilation?

<p>CPAP provides constant positive pressure throughout the respiratory cycle.</p> Signup and view all the answers

How does Intermittent Mandatory Ventilation (IMV) differ from Assist-Control (A/C) ventilation?

<p>IMV provides both mandatory and spontaneous breaths, while A/C delivers a preset number of breaths and prioritizes patient-initiated ones.</p> Signup and view all the answers

How does BiPAP differ from CPAP in terms of pressure application?

<p>BiPAP alternates between higher pressure during inspiration (IPAP) and lower pressure during expiration (EPAP).</p> Signup and view all the answers

What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in invasive mechanical ventilation?

<p>PEEP maintains positive airway pressure after exhalation to improve oxygenation and increase functional residual capacity (FRC).</p> Signup and view all the answers

What are the key characteristics of Continuous Spontaneous Ventilation (CSV) mode?

<p>CSV provides no mandatory breaths and augments patient-initiated breaths via pressure support during inhalation.</p> Signup and view all the answers

Explain the role of PEEP in the context of BiPAP.

<p>PEEP, or positive end-expiratory pressure, is used in BiPAP to maintain functional residual capacity and assist with alveolar recruitment.</p> Signup and view all the answers

What are the theoretical benefits of High-Flow Nasal Cannula (HFNC) in supporting patients?

<p>Benefits include high flow rates matching inspiratory demands, washing out dead space, titration of FiO2, and humidification.</p> Signup and view all the answers

What distinguishes Positive End-Expiratory Pressure (PEEP) from intrinsic PEEP (iPEEP)?

<p>PEEP is applied deliberately to improve ventilation, while intrinsic PEEP arises from inadequate time for complete exhalation.</p> Signup and view all the answers

In what clinical scenario is Continuous Spontaneous Ventilation (CSV) most beneficial?

<p>CSV is most beneficial for awake and interactive patients who need temporary airway protection.</p> Signup and view all the answers

What flow rates are typical for HFNC, and why are they significant?

<p>HFNC typically delivers flow rates exceeding 60 L/min, which is significant for matching patients' inspiratory needs.</p> Signup and view all the answers

Why might patients under Assist-Control (A/C) ventilation experience complications despite being well-sedated?

<p>Patients may still initiate breaths that are not proportional to their effort, leading to ventilation issues.</p> Signup and view all the answers

Identify one indication and one contraindication for using HFNC.

<p>An indication for HFNC is acute hypoxemic respiratory failure, while a contraindication is a patient without a patent upper airway.</p> Signup and view all the answers

In what way does HFNC help with the management of anatomical dead space?

<p>HFNC replaces anatomical dead space with oxygen, potentially improving gas exchange.</p> Signup and view all the answers

Discuss the significance of humidification and heating in the HFNC system.

<p>Humidification and heating enhance patient comfort and prevent airway irritation during oxygen delivery.</p> Signup and view all the answers

What might be the implications of facial injury in a patient requiring oxygen support?

<p>Facial injury could contraindicate the use of HFNC due to difficulties in maintaining a patent upper airway.</p> Signup and view all the answers

Why is it important to titrate FiO2 and flow rates appropriately in HFNC?

<p>It is important to titrate FiO2 and flow rates to address hypoxemia and dyspnea effectively.</p> Signup and view all the answers

What are the primary scenarios where noninvasive positive-pressure ventilation (NPPV) is considered first-line therapy?

<p>Exacerbations of chronic obstructive pulmonary disease (COPD) and acute cardiogenic pulmonary edema (ACPE).</p> Signup and view all the answers

Describe the pressure settings typically used for BiPAP in patients needing ventilatory support.

<p>The inspiratory pressure should start at 10 cm of Hâ‚‚O and expiratory pressure at 5 cm of Hâ‚‚O.</p> Signup and view all the answers

What distinguishes pressure-controlled ventilation (PC) from volume-controlled ventilation (VC)?

<p>PC delivers breaths at a pre-determined pressure with variable volume, while VC delivers a predetermined inspiratory volume with variable pressure.</p> Signup and view all the answers

Why is ongoing dynamic monitoring important after intubation in invasive mechanical ventilation?

<p>It ensures appropriate ventilation and correlates with oxygen saturation and end-tidal COâ‚‚ monitoring.</p> Signup and view all the answers

What should plateau pressure be maintained below during mechanical ventilation, and why?

<p>Plateau pressure should be maintained below 30 cm Hâ‚‚O to prevent complications such as ventilator circuit obstruction.</p> Signup and view all the answers

What is the recommended target score on the Richmond Agitation-Sedation Scale (RASS) for sedating mechanically ventilated patients?

<p>A target score of -2 to 0 is recommended.</p> Signup and view all the answers

How does positive-pressure ventilation (PPV) impact hemodynamics, especially in hypovolemic patients?

<p>PPV decreases venous return and cardiac output, which can lead to hypotension.</p> Signup and view all the answers

In what circumstances should NPPV generally be avoided?

<p>NPPV should generally be avoided for definitive management in pneumonia or ARDS unless there is clear improvement.</p> Signup and view all the answers

Explain the difference between assist-control ventilation (A/C) and synchronized intermittent mandatory ventilation (SIMV).

<p>A/C delivers a set number and volume of breaths per minute, while SIMV synchronizes mandatory breaths with spontaneous breaths.</p> Signup and view all the answers

What is the physiological basis for the transition from negative-pressure breathing to positive-pressure ventilation?

<p>Positive-pressure ventilation replaces negative intrathoracic pressure with positive pressure, impacting cardiovascular and pulmonary dynamics.</p> Signup and view all the answers

Flashcards

Pressure-controlled ventilation (PC)

A type of mechanical ventilation that sets a target pressure for each breath, allowing the volume of air delivered to vary based on lung compliance.

Volume-controlled ventilation (VC)

A type of mechanical ventilation that sets a specific volume of air to be delivered with each breath.

End-inspiratory alveolar pressure

The pressure within the alveoli at the end of inspiration.

Lung Compliance

A measurement of how easily the lungs expand and contract.

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Acute respiratory distress syndrome (ARDS)

A condition characterized by inflammation and fluid buildup in the lungs, making it difficult to breathe.

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Chronic obstructive pulmonary disease (COPD)

A respiratory disorder that causes airflow obstruction and lung damage.

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Salicylate toxicity

A condition where the patient experiences respiratory distress due to high levels of salicylic acid in the blood.

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Peak inspiratory pressure (PIP)

The highest pressure reached during inspiration.

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CPAP

A type of noninvasive ventilation that delivers constant positive pressure throughout the respiratory cycle.

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BiPAP

A type of noninvasive ventilation that cycles between higher inspiratory pressure (IPAP) and lower expiratory pressure (EPAP).

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High-Flow Nasal Cannula (HFNC)

Noninvasive oxygen delivery system using high-pressure oxygen and air, delivered via a gas blender, humidifier, and large-diameter tubing.

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FiO2

The fraction of inspired oxygen, representing the percentage of oxygen in the air breathed in.

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Alveoli

An area in the respiratory system where gas is exchanged with the blood.

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Noninvasive Ventilation (NPPV)

A noninvasive method that uses positive pressure to open airways, maintain lung volume, and reduce the work of breathing.

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Continuous positive airway pressure (CPAP)

A type of noninvasive ventilation that delivers a continuous positive pressure through a mask worn over the nose and/or mouth.

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Bi-level positive airway pressure (BiPAP)

A type of noninvasive ventilation that combines continuous positive airway pressure with additional pressure during inspiration.

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Volume-controlled ventilation

A type of mechanical ventilation where the machine delivers a set volume of air with each breath, regardless of the patient's effort.

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Pressure-controlled ventilation

A mode of mechanical ventilation where the ventilator delivers a set pressure for each breath, allowing the volume of air to vary based on the patient's lung compliance.

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Assist-Control Ventilation (AC)

A type of mechanical ventilation where the patient initiates breaths and the ventilator assists by providing additional pressure or volume support, ensuring adequate breaths.

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Assist-control volume control (AC-VC)

A type of AC ventilation where the ventilator delivers a set volume of air for each breath, but only if the patient initiates the breath.

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Assist-control pressure control (AC-PC)

A type of AC ventilation where the ventilator delivers a set pressure for each breath, allowing the volume to vary based on the patient's lung compliance.

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Intermittent Mandatory Ventilation (IMV)

A type of mechanical ventilation where the ventilator delivers breaths at a set rate, regardless of the patient's effort.

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Synchronized Intermittent Mandatory Ventilation (SIMV)

A type of IMV where the ventilator delivers breaths that are synchronized with the patient's spontaneous breaths, making it more comfortable.

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Continuous Spontaneous Ventilation (CSV)

A type of mechanical ventilation where the ventilator provides continuous support for each breath, relying on the patient to initiate each breath.

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Pressure-support ventilation (PSV)

A type of CSV where the ventilator provides a set amount of pressure support for each breath, helping the patient to maintain adequate ventilation.

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Assist-Control (A/C) Ventilation

A/C mode delivers breaths at a set frequency, allowing the patient to initiate breaths if needed. The ventilator prioritizes these patient breaths. It can use volume-controlled or pressure-controlled breaths.

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Positive End-Expiratory Pressure (PEEP)

PEEP maintains positive airway pressure even after exhalation. This increases lung capacity, improves oxygenation, and reduces lung collapse.

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Noninvasive Positive-Pressure Ventilation (NPPV)

NPPV delivers CSV through a mask, allowing the patient to breathe naturally while receiving additional pressure support.

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Intrinsic PEEP (iPEEP or auto-PEEP)

Intrinsic PEEP occurs unintentionally when there's not enough time to exhale completely, leading to higher pressure at the end of exhalation. This can affect airway clearance.

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Air Trapping

Air trapping is the buildup of air in the lungs that's hard to exhale. This can happen in A/C ventilation when the patient struggles to exhale fully.

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Study Notes

Table 2.1 Features of Pressure Control Versus Volume Control

  • Pressure-controlled ventilation (PC):

    • Set Parameters: Pressure target, inspiratory time, RR, PEEP
    • Variable Parameters: Tidal volume, inspiratory rate
    • Clinical Implications: Controls airway pressure, but tidal volume becomes a function of lung compliance (no guaranteed tidal volume or minute ventilation). Allows estimation of end-inspiratory alveolar pressure based on ventilator settings. Variable inspiratory flow helpful for patients with high respiratory drive
    • Clinical Conditions: Severe asthma, COPD, salicylate toxicity

  • Volume-controlled ventilation (VC):

    • Set Parameters: Tidal volume, RR, inspiratory pattern, inspiratory time
    • Variable Parameters: PIP, end-inspiratory alveolar pressure
    • Clinical Implications: Guaranteed delivery of tidal volume, but may result in high or injurious lung pressures. End-inspiratory alveolar pressure cannot be reliably estimated and must be measured (plateau pressure)
    • Clinical Conditions: ARDS, obesity, severe burns

  • ARDS: Acute respiratory distress syndrome; COPD: chronic obstructive pulmonary disease; PIP: peak inspiratory pressure; PEEP: positive end-expiratory pressure; RR: respiratory rate.

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