Resp. Monitoring In Icu

Front 1

What is the normal and critical value for Tidal Volume

Back 1

normal: 5-8 ml/kg IBW
critical: <4-5 "" or <300 ml

Front 2

What is the normal and critical value for RR

Back 2

normal: 12-20 breaths/min
critical: >30-35

Front 3

What is the normal and critical value for RSBI

Back 3

normal:
critical: >105 wo PS or CPAP

Front 4

What is the normal and critical value for Deadspace/tidal volume ratio

Back 4

normal: 25 -40% (0.25-0.40)
critical: >60%

Front 5

What is the normal and critical value for Minute volume

Back 5

normal: 5 -6 L/min
critical: >10 L/min

Front 6

What is the normal and critical value for vital capacity

Back 6

normal: 65 -75 ml/kg
critical: <10 ml/kg

Front 7

What is the normal and critical value for Maximum inspiratory pressure

Back 7

normal: -80 to 100 cmH2O
critical: 0-20 cmH2O

Front 8

4 reasons to monitor lung volumes

Back 8

1. they affect gas exchange
2. reflect changes in clinical status of pt.
3. indicate response to therapy
4. indicate problems w/pt to ventilator interface

Front 9

Give four reasons to monitor lung volumes

Back 9

1. affect gas exchange
2. reflect change in clinical status
3. indicate response to tx
4. signal problems w/vent to patient interface

Front 10

what conditions can cause the tidal volume to be reduced in a patient

Back 10

pneumonia, atelectasis, post-op, chest trauma, acute exacerbation of chronic COPD, CHF, pulmonary edema, ARDS, neuromuscular diseases, CNS depression

Front 11

what conditions can cause the tidal volume to be increased in patients?

Back 11

metabolic acidosis, sepsis or severe nuerologic injury

Front 12

what does rapid and shallow breathing indicate in a critically ill patient

Back 12

impending respiratory failure

Front 13

explain volutrauma

Back 13

volutrauma occurs as a result of over distention of the terminal resp. units

Front 14

to reduce the risk of ARDS, air trapping or dynamic hyperinflation what should the general ventilator settings be

Back 14

tidal volume of 6-8 ml/kg with a higher RF

Front 15

what can cause discrepancies between set tidal volume and measured tidal volume in a CMV pt.

Back 15

pneumothorax, leak in circuit, leaky ET cuff, dynamic hyperinflation

Front 16

give ways to increase expiratory time during MV

Back 16

reducing RF (if Ti remains same)
increase flow rate
decrease Ti

Front 17

what should be monitored during an SBT

Back 17

gas exchange
respiratory distress
hemodynamic stability

Front 18

What criteria defines failure of a SBT

Back 18

20% increase or decrease in BP or HR
SpO2 =/less than 85-90%
RR >35
change in mental status
accessory muscle use
onset of diaphoresis

Front 19

what does minute ventilation reflect

Back 19

the amount of gas inspired or exhaled in a one minute period

Front 20

what factors are used to evaluate the efficiency of ventilation?

Back 20

the relationship of minute ventilation to PaCO2 indicates the efficiency of ventilation

Front 21

a minute ventilation of 6 L/min is associated with what level of PaCO2 in a healthy person w/normal metabolic rate

Back 21

VE of 6 L/min should give a
PaCO2 of around 40 mmHg

Front 22

What does an increased VE with a normal PaCO2 level indicate if metabolic rate is normal

Back 22

high VE w/normal PaCO2 is indicative of an increase in wasted or deadspace ventilation (hypovolemia, PE)

Front 23

define vital capacity

Back 23

the maximum volume of gas that can be exhaled following maximal inspiration

Front 24

the VC is a good indicator of

Back 24

ventilatory reserve, respiratory muscle strength, volume capacity,

Front 25

give 3 examples of weaning indices

Back 25

RSBI, VC and tidal volume

Front 26

define FRC

Back 26

FRC is the volume of gas remaining in the lungs after a normal passive exhalation

Front 27

what is the normal FRC

Back 27

normal FRC = 40 ml/kg IBW or about 35-40% TLC

Front 28

Give 5 reasons its important to monitor airway pressures

Back 28

1. determine need for MV or readiness to wean
2. help determine site & thereby cause of impedance to MV
3. evaluate recoil and complicance of thorax
4. estimate amt of P transmitted to heart
5. assess resp. muscle strength

Front 29

what is PIP (peak inspiratory pressure)

Back 29

PIP is the maximum P attained during the inspiratory phase of MV

Front 30

what does PIP reflect

Back 30

the amount of force needed to overcome opposition to airflow into the lungs

Front 31

what are some causes of an increase in PIP

Back 31

vent circuit, pt airways and elastic recoil of thoracic cage and lungs

Front 32

define plateau pressure

Back 32

plateau pressure is the P required to maintain a delivered Vt in the lungs during a period of no gas flow

Front 33

what is Paw or mean airway pressure

Back 33

Paw or mean airway pressure is the average pressure recorded during one respiratory cycle

Front 34

when is MV indicated in a patient with neuromuscular disease?

Back 34

when serial measurements of VC <10 ml/kg or 1L and NIF or max. insp. P is -20 cmH20 or less

Front 35

what ventilator graphics can give indication of auto PEEP

Back 35

flow time waveform; if expiratory flow does not return to baseline before next breath, auto PEEP is present

Front 36

what are some ways to reduce auto PEEP in the MV patient

Back 36

bronchodilator tx, decreased Ti, lower RF have been shown to reduce the amount of auto PEEP

Front 37

what factors can influence Auto PEEP

Back 37

time allowed for exhalation, elastic recoil of lung, Raw, ET tube, and exhalation valve may cuase auto PEEP to vary

Front 38

What is the most effective way to reduce auto PEEP during CMV

Back 38

reduction of VE is the most effective way to recude auto peep during conventional MV

Front 39

define compliance

Back 39

compliance is volume change per unit of pressure change