Rosen's Chapter 2 - Mechanical Ventilation

Front 1

Explain the difference between spontaneous respiration and mechanical ventilation

Back 1

Spontaneous respiration is based on initiation of negative intrathoracic pressure while invasive and noninvasive mechanical ventialtion are based on delivery of positive pressure

Front 2

List the cardiopulmonary physiological differences between spontaneous breathing and mechanical ventilation

Back 2

1. Decreased venous return/preload

2. Decreased cardiac output

3. Decreased pressure gradient between left ventricle and aorta (afterload)

 

May result in relative hypotension

Front 3

Define the following:

1. Inspiratory Time

2. Inspiratory Flow rate

3. Peep

4. Auto-Peep

Back 3

1. The amount of time over which a breath is delivered

2. The rate at which air travels through the circuit

3. Positive End Expiratory Pressure (maintenance of positive airway pressure at the completion of passive exhalation)

4. (intrinsic PEEP). Incomplete exhalation

Front 4

Explain the difference between pressure controlled ventilation and pressure controlled ventilation

Back 4

1. In PCV a set amount of pressure is applied to expand the lungs. Pressure and inspiratory time are set while tidal volume and inspiratory flow vary. 

 

2. In VCV a set tidal volume is delivered. Inspiratory flow and tidal volume are fixed while peak inspiratory pressures will vary. 

Front 5

Define Continuous Mechanical Ventilation (CMV)

Back 5

Pressure or volume controlled assisted ventilation. Full ventilator support used in patients with little or no spontaneous respiratory activity. Will deliver a preset number of breaths in addition to breaths in response to patient effort. Can result in hyperventilation, breath stacking and poor ventilator synchrony in poorly sedated patients.

Front 6

Define Intermittent Mechanical Ventilation (IMV) or SIMV (synchronous intermittent mechanical ventilation)

Back 6

Mandory ventilation given at a set respiratory rate, but synchornized with patient's spontaneous effort. Additional breaths beyond set rate will commensurate with respiratory effort. Helps to attenuate air trapping/hyperventilation. Most useful in patients with regular but poor spontaneous respiratory effort.

Front 7

Define Continous Support Ventilation (CSV) or Pressure Support Ventilation (PSV)

Back 7

Delivers breath only on patient initiated trigger, and supports breath by deliverying an applied pressure to the airway. Used in spontaneously breathing patients with good respiratory effort requiring minimal support to promote patient comfort.

Front 8

List the risks and benefits of PEEP

Back 8

Risks

- Decreased cardiac output

- Lung over-distension

- Pneumothorax

 

Benefits

- Improved oxygenation

- Decreased intrapulmonary shunt

- Reduction in non-aerated lung (decreased ventilator induced lung injury)

Front 9

Define Non-invasive Positive Pressure Ventilation (NIPPV)

Back 9

Delivery of continuous support venitlation via a sealed mask. CPAP (continuous positive alveolar pressure) vs. BiPAP (bilevel positive alveolar pressure)

Front 10

Define IPAP and EPAP

Back 10

IPAP - Inspiratory positive alveolar prssure which helps augment patient respiratory effort

 

EPAP - Expiratory positive alveolar pressures which maintains FRC and alveolar recruitment

Front 11

List Contraindications to NIPPV (6)

Back 11

1. Need for immediate intubation

2. Decreased Level of Consciousness

3. Lack of Respiratory Drive

4. Increased Secretions

5. Hemodynamic Instability

6. Facial Trauma

Front 12

List the standard initial ventilator settings in a newly intubated patient

Back 12

A/C Mode

Vt 6-8 mL/kg IBW

RR 12-14 bpm

FiO2 100%

PEEP 5