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19 Cards in this Set
- Front
- Back
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Indications for Mechanical Ventilation (9) |
Hypoxemia PaO2 </= 60 despite 100% FiO2 Hypercapnia >/= 50 Respiratory Distress (muscle fatigue due to increased work of breathing; sepsis, ketoacidosis) Atelectasis Respiratory Muscle fatigue (neuromuscular disease) Sedation/Neuromuscular blockade Elevated ICP (hyperventilation reduces ICP) Severe metabolic acidosis Airway protection- cannot swallow or cough effectively |
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Major roles of mechanical ventilation? |
Improve oxygenation; PaO2 Improve ventilation: pH, PaCO2 |
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Types of mechanical ventilation (2)? |
invasive and non-invasive (airway not instrumented) |
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Most common form of mechanical ventilation used in hospitals? |
positive pressure ventilation (invasive or non-invasive) |
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Characteristics of Volume controlled ventilation? |
Pressure varies flow rate is set vent delivers set volume |
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What type of volume control ventilation is most commonly used? |
assist control |
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What is the function of assist control? |
gives a minimum amount of fixed volume breaths, but allows the patient to initiate extra assisted breaths
EVERY breath is supported regardless if patient initiated or not |
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What is included in a "vent order?" |
FiO2 PEEP RR TV Mode of ventilation |
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What is the beginning setting for FiO2? |
100% to ensure end organ perfusion, wean to 40% by monitoring ABG |
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What is the goal of FiO2 setting? |
to ensure PO2 of >60 while ensuring SaO2 of >90% |
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What Tidal Volume should be used (important)? |
6-8 ml/ kg lean body mass |
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What is PIP? |
peak inspiratory pressure: represents the compliance of the lungs + chest wall as well the resistance of the airways
should be <35 cm/ H20 |
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What is plateau pressure? |
the pressure that represents just the compliance of the lungs and chest wall. Measured at end inspiration.
There is no airflow when measured, so omits resistance of airways
should be <30 cm/H20
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What is respiratory rate for most patients? |
10-12
increased during respiratory acidosis and decreased during COPD (need more time for expiration |
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How much PEEP should be given? |
begin at 5 cm H20 and increase in increments of 2.5 cm H2O |
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How should you "check your work" |
-Does the patient look comfortable? Is there patient-ventilator synchrony? Sedation adequate? -PIP <35, Plateau pressure <30? -Check ABG after 20-30 min on vent: PaO2 should be >60; pH 7.35-7.4 -recheck ABG 30 minutes later |
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What should be adjusted if PaO2 is low? |
FiO2 or PEEP |
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What should be adjusted if pH is too high/low? |
respiratory rate or TV |
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Complications associated with mechanical ventilation? |
-tube misplacement -airway: glottic edema, vocal cord erosions, stenosis -Barotrauma: pneumothorax, subcutaneous emphysema (keep plateau pressure <30) -O2 toxicity -Increasing PEEP decreases venous return -prolonged neuromuscular blockade -ventilator assisted pneumonia |
