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Mechanical Ventilation

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giwisuwu's version from 2017-03-05 15:26

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Question Answer
Nasal CannulaEasily tolerated, O2 mixes with atmosphere (room air= 21%), titratable; 1 – 2L = 24 – 30%; 3 – 4L = 30 – 35%; 5 – 6L = 38 – 44%; >6L - no change in FIO2; Never exceed 6 liters/min
Simple Face MaskRequires high flow to prevent CO2 rebreathing; 75% inspired volume from Room Air; Short Term Use – generally < 12hr; Flow: 8 – 12L = 35%; used in ER before oxygenation status known
Venturi MaskAmount of O2 adjustable (Able to Titrate); FiO2 depends on adapter and oxygen flow; Minimizes CO2 buildup; Flow: Variable (4 – 10L/min) = 24 – 50%; Mixes room air with oxygen (use dial on mask to open the slat more or less depending how much oxygen needed)
NonrebreatherHas one-way valves to prevent exhaled air from returning to bag; Used for rapid desaturation; Flow 10 – 15L/min = 95 – 100%; Used for situations of high-acuity; Do not rebreath expired CO2; Not 100% but as close as possible (not a sealed mechanism); If sats are in the mid 80s go straight to nonrebreather (or if the saturation changes quickly)
Early symptoms of hypoxia (A-T-R-I-A)Anxiety; Tachycardia; Restlessness; Irritability; Apprehensive
Late symptoms of hypoxiaSeizures; Coma; Cyanosis; Loss of consciousness; Can cause brain injury, MI, kidney failure—low oxygen can decrease perfusion in kidneys and result in failure; Oxygen below 90 (in ICU)—intervene
PEEPamount of oxygen that stays in lungs after expiration; everyone has 5 of PEEP; atmospheric pressure keeps it at 5
Non-Invasive Mechanical VentilationCPAP or BiPAP; Used instead of intubation for certain cases, ex: if CHF patient has fluid in lungs and can treat it with medication to rid the lungs of fluid, so use this until lungs are treated; Not long term like intubation; The nose only mask only works if the mouth is closed
Bipap(Bi-level Positive Airway Pressure) Provides different levels of pressure during inhalation and exhalation; Better method for—CHF, Neuromuscular diseases, COPD. Adds pressure during expiration and inspiration (2 pressures)
Cpap(Continuous Positive Airway Pressure) Provides continuous air pressure at a medically suggested level to treat various types of respiratory diseases; Better method for—Moderate to severe sleep apnea. One pressure; positive airway pressure
Inhalenegative thoracic pressure
Exhalepositive thoracic pressure
Positive Pressure in Ventilatorduring exhale (negative thoracic pressure)
Negative pressure in the ventilatorduring inhale (positive thoracic pressure)
Positive pressure in the ventilatorduring exhale (negative thoracic pressure)
PIP (Peek Inspired Pressure)the amount of resistance to the air being blown into the lungs (normal around 15); gives an idea of the compliance of the lungs, the higher the PIP the lower the compliance (less stretch in the lungs). If the PIP gets too high will cause the lungs to tear creating a pnuemothorax
Assist Volume Control (A/C)A controlled mode delivers a preset RR and preset TV, each additional breath will be delivered a preset TV. Used in patient with full ventilatory support. No spontaneous breathing (always ventilated even when breath is initiated by patient)
Synchronous Intermittent Mandatory Ventilation (SIMV)Mode that has preset RR and preset TV. Patient can trigger a breath and have spontaneous TV. Ventilator breaths are synchronized with pt’s respiratory effort. Used in patients that have some ability to breathe spontaneously but are not able to maintain an adequate minute ventilation. Usually used to wean pts from mechanical ventilation. Spontaneous tidal volume and breath (can spontaneously breath as many times as pt wants, but ventilator breaths a certain number of times per minute (pt can breathe in between those ventilated breaths though). Can sense when a spontaneous breath is being produced to avoid stacking breaths (pt breathing and then ventilator breathing at same time) can cause lung rupture.
Continuous Positive Airway Pressure (CPAP)This is not really a mode of ventilation. The RR and TV are function of patient effort. The patient is breathing spontaneously with a positive pressure applied throughout the respiratory cycle. CPAP is PEEP applied of a patient who is breathing spontaneously. Used in patients that are breathing spontaneously and need to improve oxygenation. Continuation of weening pts off ventilator. No ventilated breaths
Bi-Level/ APRVContinuous positive airway pressure is applied to inflate the lungs; Alternate between two levels of CPAP; Time cycled mode of ventilation (not respiratory rate dependent); Pressure controlled mode of ventilation. Pressure high (P-1) and pressure low (P-2); Time high (T-1) and time low (T-2); P-1 results in alveolar recruitment for better gas exchange; P-2 allows the airway pressure to drop, gas to leave the lungs, and CO2 to be removed; T-1 and T-2 determine time spent at each level. Time cycled mode of ventilation. Cycles independently of respiratory effort by the patient. CPAP levels allow spontaneous respirations. gives the patient the sensation that they are breathing at a normal as opposed to an inverse I:E ratio. Better V/O matching (favors distribution of ventilation to dependent and poorly aerated but perfused lung zones). Improved PaO2/FIO2 ratios due to alveolar recruitment. Hold the air in the lungs longer allowing for more oxygen to cross the alveoli
High pressure alarmsstops ventilation once pressure goes over what has been set (which means pt is no longer being ventilated! Need to fix asap)
Low pressure alarmsgoes off when there is a disconnect in tubing
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