Podcast
Questions and Answers
Which of the following is a potential risk of using high PEEP during continuous positive airway pressure (CPAP) mode?
Which of the following is a potential risk of using high PEEP during continuous positive airway pressure (CPAP) mode?
- Decreased functional residual capacity of the lungs
- Decreased minute volume
- Increased respiratory muscle fatigue
- Left ventricular dysfunction upon extubation (correct)
What is the normal PaO2/FiO2 ratio?
What is the normal PaO2/FiO2 ratio?
- 75
- 476 (correct)
- 100
- 150
Which of the following techniques provides continuous pressure support and may increase the functional residual capacity of the lungs?
Which of the following techniques provides continuous pressure support and may increase the functional residual capacity of the lungs?
- Pressure Support Ventilation
- T-Tube Trial
- Continuous Positive Airway Pressure (CPAP) Mode (correct)
- Automatic Tube Compensation
What is the goal respiratory rate during spontaneous breathing trials (SBT)?
What is the goal respiratory rate during spontaneous breathing trials (SBT)?
What are the readiness criteria for weaning from ventilator support?
What are the readiness criteria for weaning from ventilator support?
Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?
Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?
What is the PaO2/FiO2 ratio in the example of poor ratio provided in the text?
What is the PaO2/FiO2 ratio in the example of poor ratio provided in the text?
Which mode of ventilation is also referred to as CMV?
Which mode of ventilation is also referred to as CMV?
When is the Assist-control (A/C) mode commonly used?
When is the Assist-control (A/C) mode commonly used?
What is the potential complication of using Assist-control (A/C) mode?
What is the potential complication of using Assist-control (A/C) mode?
What is the total minute volume if a patient on Assist-control (A/C) mode does not breathe and has a tidal volume of 500ml and a respiratory rate of 12 breaths per minute?
What is the total minute volume if a patient on Assist-control (A/C) mode does not breathe and has a tidal volume of 500ml and a respiratory rate of 12 breaths per minute?
What is the total minute volume if a patient on Assist-control (A/C) mode breathes at a rate of 30 breaths per minute with a tidal volume of 500ml?
What is the total minute volume if a patient on Assist-control (A/C) mode breathes at a rate of 30 breaths per minute with a tidal volume of 500ml?
What is the main difference between Assist-control (A/C) mode and Synchronized Intermittent Mandatory Ventilation (SIMV) mode?
What is the main difference between Assist-control (A/C) mode and Synchronized Intermittent Mandatory Ventilation (SIMV) mode?
What is a potential advantage of using Synchronized Intermittent Mandatory Ventilation (SIMV) mode?
What is a potential advantage of using Synchronized Intermittent Mandatory Ventilation (SIMV) mode?
Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Which mode is used in conjunction with SIMV mode, but applies a pressure goal instead of volume?
Which mode is used in conjunction with SIMV mode, but applies a pressure goal instead of volume?
Which mode is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
Which mode is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
Which mode is used when ARDS is untreatable with more conventional modes?
Which mode is used when ARDS is untreatable with more conventional modes?
Which mode is used with airtight mask to administer two different pressure support levels, one for inspiration and one for expiration?
Which mode is used with airtight mask to administer two different pressure support levels, one for inspiration and one for expiration?
Which mode is used to assist spontaneous breathing by increasing end-expiratory pressure to improve oxygenation?
Which mode is used to assist spontaneous breathing by increasing end-expiratory pressure to improve oxygenation?
Which mode is a noninvasive method to administer positive-pressure ventilation, often used with obstructive sleep apnea (OSA)?
Which mode is a noninvasive method to administer positive-pressure ventilation, often used with obstructive sleep apnea (OSA)?
During extubation, what should be done after deflating the cuff?
During extubation, what should be done after deflating the cuff?
What is the recommended duration of voice rest after extubation?
What is the recommended duration of voice rest after extubation?
What is the treatment for post-extubation stridor?
What is the treatment for post-extubation stridor?
What is the appropriate action to take when a patient self-extubates?
What is the appropriate action to take when a patient self-extubates?
What are the barriers to ventilator weaning in the elderly?
What are the barriers to ventilator weaning in the elderly?
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
Which of the following is NOT a criterion for the diagnosis of ARDS?
Which of the following is NOT a criterion for the diagnosis of ARDS?
What is the greatest risk factor for the development of ARDS?
What is the greatest risk factor for the development of ARDS?
What is the characteristic feature of ARDS on chest x-ray?
What is the characteristic feature of ARDS on chest x-ray?
Which stage of ARDS is characterized by diffuse alveolar damage and increased interstitial and alveolar edema?
Which stage of ARDS is characterized by diffuse alveolar damage and increased interstitial and alveolar edema?
What is the main cellular change that occurs during Stage 2 of ARDS?
What is the main cellular change that occurs during Stage 2 of ARDS?
Which of the following is a characteristic of Stage 3 of ARDS?
Which of the following is a characteristic of Stage 3 of ARDS?
What is the term used to describe perfusion without ventilation in the lungs?
What is the term used to describe perfusion without ventilation in the lungs?
What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?
What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?
Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?
Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?
What is the goal of the renal system when there is a problem with the respiratory system?
What is the goal of the renal system when there is a problem with the respiratory system?
What is a disease process that manifests as 'Dead Space' in the lungs?
What is a disease process that manifests as 'Dead Space' in the lungs?
What is a potential complication of ARDS?
What is a potential complication of ARDS?
What is the purpose of PEEP in mechanical ventilation?
What is the purpose of PEEP in mechanical ventilation?
What is the recommended range for PaO2 in a patient with ARDS?
What is the recommended range for PaO2 in a patient with ARDS?
What are the sources of acids in the body?
What are the sources of acids in the body?
What is the main difference between metabolic acidosis and respiratory acidosis?
What is the main difference between metabolic acidosis and respiratory acidosis?
Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?
Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?
What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?
What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?
In SIMV mode, if a patient takes a breath above the preset tidal volume, what happens?
In SIMV mode, if a patient takes a breath above the preset tidal volume, what happens?
Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?
Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?
What is the purpose of PEEP in mechanical ventilation?
What is the purpose of PEEP in mechanical ventilation?
What is the recommended range for PaO2 in a patient with ARDS?
What is the recommended range for PaO2 in a patient with ARDS?
Which mode of ventilation is used in patients with worsening hypoventilation and hypercapnia to prevent intubation?
Which mode of ventilation is used in patients with worsening hypoventilation and hypercapnia to prevent intubation?
What is the pressure support level provided during the inspiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?
What is the pressure support level provided during the inspiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?
What is the pressure support level provided during the expiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?
What is the pressure support level provided during the expiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?
Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?
What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?
Which mode of ventilation is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Which mode of ventilation is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?
What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
What is the recommended duration of voice rest after extubation?
What is the recommended duration of voice rest after extubation?
What is the recommended range for PaO2 in a patient with ARDS?
What is the recommended range for PaO2 in a patient with ARDS?
What are the readiness criteria for weaning from ventilator support?
What are the readiness criteria for weaning from ventilator support?
Which of the following is a common bronchodilator used to open airways in patients with respiratory distress?
Which of the following is a common bronchodilator used to open airways in patients with respiratory distress?
What is the purpose of sedatives in the treatment of respiratory distress?
What is the purpose of sedatives in the treatment of respiratory distress?
What is the recommended positioning strategy for patients with respiratory distress?
What is the recommended positioning strategy for patients with respiratory distress?
Which positioning strategy is recommended for patients with respiratory distress?
Which positioning strategy is recommended for patients with respiratory distress?
What is the purpose of using vasopressors in ARDS therapy?
What is the purpose of using vasopressors in ARDS therapy?
What is the purpose of using steroids in ARDS therapy?
What is the purpose of using steroids in ARDS therapy?
Which of the following is a recommended therapy for ARDS?
Which of the following is a recommended therapy for ARDS?
Which of the following is a protective lung strategy for ARDS?
Which of the following is a protective lung strategy for ARDS?
Which medication is used to reduce inflammation in ARDS therapy?
Which medication is used to reduce inflammation in ARDS therapy?
Flashcards
CPAP effect on lungs
CPAP effect on lungs
Increases lung volume at end-expiration.
Normal PaO2/FiO2
Normal PaO2/FiO2
Ratio is around 300 mmHg.
Vent Weaning Readiness
Vent Weaning Readiness
Stable hemodynamics, minimal vent settings.
SBT Failure Signs
SBT Failure Signs
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Poor PaO2/FiO2 Ratio
Poor PaO2/FiO2 Ratio
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A/C Mode Use
A/C Mode Use
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A/C Mode Risk
A/C Mode Risk
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SIMV Advantage
SIMV Advantage
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Pressure-Controlled Ventilation
Pressure-Controlled Ventilation
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Pressure Support Benefit
Pressure Support Benefit
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BiPAP pressures
BiPAP pressures
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CPAP Function
CPAP Function
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NIPPV Use
NIPPV Use
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Post-Extubation
Post-Extubation
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Stridor Treatment
Stridor Treatment
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Self-Extubation
Self-Extubation
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ARDS Risk Factors
ARDS Risk Factors
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ARDS Chest X-Ray
ARDS Chest X-Ray
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ARDS Stage 2 cells
ARDS Stage 2 cells
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"Shunt" Meaning
"Shunt" Meaning
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Kidney Response
Kidney Response
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'Dead Space' Condition
'Dead Space' Condition
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PEEP Purpose
PEEP Purpose
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ARDS PaO2 goal
ARDS PaO2 goal
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Metabolic Acidosis Cause
Metabolic Acidosis Cause
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Protective Lung Strategies
Protective Lung Strategies
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ARDS Therapies
ARDS Therapies
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Vasopressors Role
Vasopressors Role
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Steroids Role
Steroids Role
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Pressure support
Pressure support
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Study Notes
Ventilation and Respiratory Support
- High PEEP during CPAP can risk potential barotrauma and decreased cardiac output.
- Normal PaO2/FiO2 ratio is approximately 300 mmHg.
- Continuous positive airway pressure methods increase functional residual capacity of the lungs.
- Goal respiratory rate during spontaneous breathing trials (SBT) is around 12-30 breaths per minute.
- Readiness criteria for weaning from ventilator support include stable hemodynamics and minimal ventilatory settings.
- Early signs of failure during SBT can include increased heart rate and decreased oxygen saturation.
- A poor PaO2/FiO2 ratio example shows values less than 200 mmHg.
- Controlled Mandatory Ventilation (CMV) is also known as Assist-Control (A/C) mode.
- A/C mode is applied commonly for patients with poor respiratory drive or when sedation is used.
- Potential complications of A/C mode include respiratory alkalosis due to overventilation.
- Total minute volume in A/C mode without patient breaths at 500 mL tidal volume and a rate of 12 is 6000 mL.
- In A/C mode at 30 breaths per minute and 500 mL tidal volume, the total minute volume is 15000 mL.
- A/C mode provides mandatory breaths, while Synchronized Intermittent Mandatory Ventilation (SIMV) allows for spontaneous breaths in between.
- An advantage of SIMV mode is that it may improve patient-ventilator synchrony.
- Mode used to control plateau pressures in ARDS or Pulmonary Fibrosis is Pressure-Controlled Ventilation.
- Pressure-Supported Ventilation is often used alongside SIMV to apply pressure support for spontaneous breaths.
- Assist-control mode is beneficial for spontaneous breaths during weaning trials by providing pressure to offset tube resistance.
- When ARDS is severe and unresponsive to standard therapies, High-Flow Nasal Cannula or ECMO may be employed.
- Bi-level positive airway pressure (BiPAP) uses two pressure levels, higher for inspiration and lower for expiration.
- Continuous Positive Airway Pressure (CPAP) assists spontaneous breathing by increasing end-expiratory lung volume.
- Noninvasive Positive Pressure Ventilation (NIPPV) is effective for patients with obstructive sleep apnea.
Post-Extubation Management
- After cuff deflation during extubation, ensure the patient’s airway is clear and assess the need for supplemental oxygen.
- Recommended duration of voice rest after extubation is 24-48 hours.
- Treatment for post-extubation stridor often includes corticosteroids and nebulized epinephrine.
- If a patient self-extubates, reassess breathing stability and readiness for reintubation if necessary.
Acute Respiratory Distress Syndrome (ARDS)
- Mortality rate of ARDS is approximately 30-40%.
- Notable diagnostic criteria for ARDS includes acute onset within 1 week of a known insult.
- Greatest risk factor for ARDS development is sepsis and pneumonia.
- Chest X-ray of ARDS typically shows bilateral infiltrates.
- Stage 1 of ARDS features minimal alveolar damage, while Stage 2 shows diffuse alveolar damage with increased edema.
- Main cellular change in Stage 2 is the presence of alveolar macrophages and neutrophils.
- Characteristic of Stage 3 includes severe hypoxemia and visual consolidation on imaging.
- The term "shunt" describes perfusion without ventilation in the lungs.
- A PaO2:FiO2 ratio indicative of more than 20% intrapulmonary shunt in ARDS is ≤200 mmHg.
Acid-Base Balance and Ventilation
- In the case of respiratory problems, the renal system aims to manage acid-base balance by retaining bicarbonate.
- Conditions that manifest as 'Dead Space' in the lungs include Pulmonary Embolism.
- Possible complications of ARDS include pulmonary fibrosis and chronic respiratory impairment.
- Purpose of Positive End-Expiratory Pressure (PEEP) in mechanical ventilation is to maintain alveolar recruitment and improve oxygenation.
- Recommended PaO2 range for ARDS patients is 55-80 mmHg.
- Sources of acids in the body include metabolic processes and carbon dioxide from respiration.
- Difference between metabolic acidosis and respiratory acidosis: metabolic acidosis results from increased acid production or decreased bicarbonate, while respiratory acidosis stems from inadequate ventilation.
- Assist-Control (A/C) mode allows the patient to breathe above the preset rate, adjusting tidal volume based on effort.
Strategies and Therapies for ARDS
- Purpose of adding pressure support during spontaneous breaths in SIMV mode is to reduce the work of breathing.
- In SIMV, if a patient exceeds the preset tidal volume, the machine allows for spontaneous larger breaths without penalization.
- Special ventilation strategies such as protective lung strategies advocate low tidal volume settings for ARDS management.
- Recommended therapies for ARDS may include lung-protective ventilation, prone positioning, and corticosteroids.
- Vasopressors in ARDS therapy support hemodynamic stability in hypotensive patients.
- Steroids are used in ARDS management to reduce inflammation.
- Common bronchodilators for respiratory distress may include albuterol.
- Sedatives help to manage anxiety and reduce respiratory distress during mechanical ventilation.
- Recommended positioning for respiratory distress includes sitting up or in a semi-Fowler’s position for enhanced lung expansion.
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