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14 Cards in this Set
- Front
- Back
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Controlled ventilatory support |
•Ventilator does all the WOB |
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Assisted ventilatory support |
•Ventilator and patient share WOB |
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Assist-control(A/C) ventilation |
•Delivers preset VT at preset frequency When patient initiates a spontaneous breath, preset VT is delivered Can breathe faster but not slower Allows some control over ventilation Riskfor hypoventilation or hyperventilation Continuous monitoring required |
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•Synchronized intermittent mandatory ventilation (SIMV) |
•Delivers preset VT at preset frequency in synchrony with patient’s spontaneous breathing Between ventilator-delivered breaths, patient is able to breathe spontaneously Patient receives preset FIO2 but self-regulates rate and volume of spontaneous breaths Potential benefits: Improved patient-ventilator synchrony Lower mean airway pressure Prevention of muscle atrophy |
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•Pressure support ventilation (PSV) |
Positive pressure applied to airway only during inspiration in conjunction with spontaneous respirations Machine senses spontaneous effort and supplies rapid flow of gas at initiation of breath Patient determines inspiratory length, VT, and respiratory rate Advantages ↑ Patient comfort ↓ WOB ↓ Oxygen consumption ↑ Endurance conditioning |
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•Airway pressure release ventilation (ARPV) |
•Permits spontaneous breathing Preset CPAP with short timed pressure releases VT varies Patients with ARDS who need high pressure levels |
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•Positive end-expiratory pressure (PEEP) |
Positive pressure applied to airway during exhalation, preventing alveolar collapse ↑ Lung volume and functional residual capacity (FRC) improves oxygenation Maintain or improve oxygenation while limiting risk of O2toxicity Optimal or best PEEP---PEEP titrated to point oxygenation improves without compromising hemodynamics Contraindications: Patients with highly compliant lungs, Low cardiac output |
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•Physiologic PEEP |
•5cm H2O Replaces glottic mechanism, helpsmaintain normal FRC, and prevents alveolar collapse |
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•Auto-PEEP |
•Result of inadequate exhalation time Additional PEEP over what is set Results: •↑ WOB•Barotrauma•Hemodynamic instability Interventions to Limit Auto-PEEP •Provide sedation and analgesia Use large-diameter ET tube Administer bronchodilators Set short inspiratory times ↓ Respiratory rate ↓ Water accumulation in ventilator tubing |
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•Continuous positive airway pressure (CPAP) |
•Restores FRC Similarto PEEP Pressure delivered continuously during spontaneous breathing •Used to treat obstructive sleep apnea Administered noninvasively by mask, ET, or tracheal tube ↑ WOB: use with caution in patientswith myocardial compromise |
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•Automatic tube compensation (ATC) |
•Used to overcome WOB associated with artificial airway ↑ During inspiration and ↓ during expiration Set by entering internal diameter of patient’s airway and desired % of compensation |
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•Bilevel positive airway pressure |
•Delivers oxygen and two levels of + pressure support •Higher inspiratory positive airway pressure Lower expiratory positive airway pressure Noninvasive via tight-fitting face mask, nasal mask, or nasal pillows Patient must be able to breathe spontaneously and cooperate |
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•High-frequency oscillatory ventilation |
•Delivery of a small VT at rapid respiratory rates •Used for refractory hypoxemia and ARDS •Must sedate and paralyze patient |
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Extracorporeal Membrane Oxygenation (ECMO) |
•Alternative form of pulmonary support •Partially remove blood from patient, infuse O2,return blood back to patient Intensivetherapy It is used more frequently in the pediatric and neonatal populations but is increasingly being used in adults. ECMO is a modification of cardiac bypass and involves partially removing blood from a patient with large-bore catheters, infusing O2, removing CO2, and returning the blood back to the patient. This intensive therapy requires systemic anticoagulation Time-limited intervention |
