Ventilators.txt

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MagusB81
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137701
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Ventilators.txt
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2012-02-25 20:19:00
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Vents
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Vents
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  1. is defined as a change of volume divided by a change in pressure.
    Compliance
  2. the stiffness or elasticity of the respiratory system is expressed as?
    elastic or compliance resistance
  3. An increase of compliance does what to elastance?
    decreases it
  4. Normal compliance is?
    100cc/cmH2O
  5. What are the complainces of the respiratory system.
    Compliance of te respiratory system (CRS), Lung compliance (CL), Chest wall (CW)
  6. What types of compliances are measured mechanically?
    Dynamic compliance and static compliance
  7. What are the types of resistance associated with the rrespiratory system?
    Total respiratory resistance (Rrs), pulmonary resistance, Airway resistance (Raw), Lung tissue resistance (Rti), Chest wall restance (Rw)
  8. What is the formula for time constance?
    Compliance X Resistance
  9. Vents can be identified by their power source. What are th epower sources used?
    Anhydrous and oil free compressed medical gasses, Electricty, and combination of pneumatic and electric power sources
  10. Vents can control only one of the primary four variables at any given time during inspiration. What are the four variables?
    Volume, Presssure, flow, and time
  11. vent surpport can be divided into four distinct phases. What are they?
    Expiration to inspiration (trigger on), inspiration, inspiration to expiration (Turn off), expirationion (baseline variable)
  12. The variables that are controlled during the expiratory phase. What are they?
    PEEP and cPAP (aka pressure), and time
  13. Control mode of ventilation. Supports a PT in respiratory failure, determines when and how much gas is given according to controls, the PT is not able to initiate inspiration.
    CMV (Continuouse Mandatory Ventilatiion)
  14. Mode of ventilation, with proper seting of sensitivity or an assist system that will respond to the PT's inspiratory effort, the PT will be provided a mandatory breath. There is a BUR, control variable will be pressure or flow/volume.
    (A/C) Assist Control
  15. In CMV what are the control, trigger, limit, and cycle variables?
    Control= pressure or flow/vol., Trigger = Time, Limit= Pressure or flow/vol, and cycle = time, pressure, or flow/vol.
  16. In A/C what arethe control, trigger, limit, and cycle variables?
    Contorl=pressure or flow/vol., trigger = time, pressure, flow/vol., limit- pressure, time, flow/vol., and cycle = pressure, time, flow/vol.
  17. is a variation of the A/C mode, but has not BUR (back up rate). Should not be ran with out the BUR. (That's what the slide said)
    Assisted mechanical ventilation (AMV)
  18. In AMV what are the control, trigger, limit, and cycle variables?
    Control = pressure or flow/vol., trigger = pressure or flow/vol., limit = pressure or vol/flow, cyclee = time, pressure, or flow/vol.
  19. Provides mandatory ventilaion. PT can take spontaneous breaths. Blow-by is not supportedm abd kinked with cPAP on the node sselecton Switch, dial or keypad.
    (IMV) Intermittent Mandatory Ventilation
  20. In IMV what are the control, trigger, limit, and cycle?
    Control = pressure flow/vol, trigger = time, limit and cycle is pressure (flow, pressure, time is spontaneous breath is pressure supported)
  21. provides mandatory breaths that are synchronized to the patient�s respiratory effort. If the patient does not make the necessary effort a time triggered mandatory breath will be delivered. This mode was developed to prevent breath stacking.
    SIMV
  22. In SIMV what is the control, trigger, limit, and cycle?
    Control = pressure or flow/vol., trigger = time, pressure, vol./flow, limit = pressure, cycle = pressure (flow pressure or time if the spontaneous breath i spressure supported)
  23. is the application of positive airway pressure during both the insp\iratory and expiratory phases. is purely a spontaneous breathing mode (CSV) so only that portion is classified.
    cPAP
  24. In cPAP wwhat iss the control, trigger, limit, and cycle?
    Control = pressure, trigger = pressure, floe/vol., limit = pressure, cycle = pressure, flow/time if the breath is presssure suppuport "assisted"
  25. provides pressure augmentation during spontaneous breathing. provides pressure augmentation during spontaneous breathing. refered to as inspiratory assist, inspiratory pressure support, spontaneous pressure support, and inspiratory flow assist.
    Pressure Support Ventilation (PSV)
  26. In PSV what is the control, limit, trigger, anc cycle?
    Control= pressure, triggered = flow/vol., limit = pressure, and cycle = pressure pr flow/vol.
  27. is a form of PCV in which no patient triggered breaths are permitted (CMV). Additionally, the inspiratory time is longer than the expiratory time (inverse ratio), resulting in I:E ratios varying between 4:1 and 1.1:1. The inverse I:E ratio results in gas trapping, which causes an increase in the baseline pressure above ambient pressure
    Pressure controlled, inverse ratio ventilation (PCIRV)
  28. combines two separate levels of CPAP. The patient may breathe spontaneously from both CPAP levels (IMV). The higher CPAP level provides for volume augmentation. Periodically, pressure is dropped to the lower level for ventilation. This time is usually very short so as not to let FRC drop too low. So this means that in this mode of ventilation I:E ratios are inverse like in PCIRV. In this mode, the mandatory (machine breaths) are those in which the pressure rises to the higher CPAP level
    Airway Pressure Release Ventilation (APRV)
  29. PEEP increases?
    • FRC
    • A pressure controller iss unaffected by changes in the PT's?
    • compliance or resistance
  30. is actually the name brand of a ventilator. is designed to provide CPAP in which both expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) are adjustable. was specifically designed to provide partial ventilatory support using a nasal or oronasal mask, particularly in patients with obstructive sleep apnea.
    BiPAP
  31. What is the control, trigger, limit, and cycle for BiPAP?
    Control = Pressure, Trigger = time, Limit = pressue, cycle = time and flow
  32. is like APRV except the I:E ratios are more normal. This will eliminate the need for paralytic drugs and give a greater chance for spontaneous ventilation at lower levels of CPAP. The Nellcor Puritan Bennett 840 ventilator has this mode of ventilation
    BiLevel (PEEPH and PEEPL)
  33. automatically adjusts minute ventilation based upon the patient�s spontaneous ventilation. The practitioner selects the minute ventilation that is desired for the patient and adjusts the ventilator�s tidal volume and flow to accomplish it. If the patient�s spontaneous ventilation meets or exceeds the set mandatory ventilation, no supported breaths are delivered. If the opposite happens the ventilator will makeup the volume with mandatory breaths.
    Mandatory Minute Ventilation (MMV)
  34. In MMV what is the control, trigger, limit, anc cycle?
    control= vol/flow, trigger=time, limit-pressure, cycle=flow, time, pressure
  35. simply means that the ventilator changes its output based on a measured input variable.
    Closed-loop
  36. MMV is the first of the modes that can be considered
    Closed-loop mode
  37. requires the clinician to set RR, peak flow, PEEP, FIO2, trigger sensitivity, pressure support, and minimum desired tidal volume. Inspiration is patient or time triggered and if the desired tidal volume is met the breath is a pressure support breath. That is, the breath is pressure limited at the pressure support setting and flow cycled. If the minimum tidal volume is not met the flow will not be allowed to decay pass the set flow and inspiratory time will be extended allowing pressure to raise above the set pressure support setting until the desired volume is met. This changes the breath from a pressure controlled to a flow/volume controlled breath.'
    Dual Control Within With in a Breath (Volume-Assured Pressure Support or Pressure Augmentation)
  38. This is simply pressure support with desired tidal volume as the goal (CSV). Once the desired tidal volume is set, the ventilator will adjust the pressure support level, based on total system compliance, to achieve desired tidal volume. This is called volume support on the Siemens 300 and variable pressure support on the Venturi ventilator.
    Dual Control Breath to Breath � Pressure Limited, Flow Cycled Ventilation (Volume Support or Variable Pressure Support)
  39. This is simply pressure limited, time cycled ventilation with desired tidal volume as the goal (CMV). Once the desired tidal volume is set, the ventilator will adjust the pressure limit level, based on total system compliance, to achieve desired tidal volume. This is called pressure regulated volume control on the Siemens 300, variable pressure control on the Venturi ventilator, adaptive pressure ventilation on the Hamilton Galileo, and Auto flow on the Drager Evita 4
    Dual Control Breath to Breath � Pressure Limited, Time Cycled Ventilation (Pressure Regulated Volume Control, Adaptive Pressure Ventilation, Auto Flow, and Variable Pressure Control)
  40. combines dual control breath to breath time cycled breaths with dual control breath to breath flow cycled breaths (IMV). Desired tidal volume is set and maintained by adjustment of the pressure limit during both types of breaths. If the ventilator is in the pressure limit, time cycled mode and the patient makes two consecutive efforts to breathe, the ventilator will switch to the pressure limited flow cycled mode. When the switch occurs the same pressure limit is used which is based on the patient�s total system compliance
    Auto mode
  41. is a mode that combines the dual control breath to breath time cycled and flow cycled breaths (IMV) and allows the ventilator to choose the initial ventilator settings based on the clinician input of ideal body weight and percent minute volume. This is the most sophisticated of the closed loop techniques, allowing the ventilator to choose set RR, tidal volume, pressure limit of mandatory and spontaneous breaths, and, when spontaneous breathing is absent, I:E ratio.
    Adaptive Support Ventilation (ASV)
  42. is a technique of ventilator operation that uses the known resistive characteristics of the artificial airways to overcome the imposed work of breathing caused by those airways. This is a technique used by the Drager Evita 4 ventilator. This technique is used on pressure limited, flow cycled breaths (CSV). The pressure limit is adjusted according to artificial airway resistance and patient flow demand. The operator inputs the type of tube, endotracheal or tracheostomy, and the percentage of compensation desired (10 - 100%).
    Automatic Tube Compensation (ATC)
  43. allows the ventilator to change the pressure output (pressure control) breath to breath depending on elastance, resistance and flow demand.is set to overcome 80% of the elastic and resistive loads using the percent volume assist and percent flow assist keys. The only other settings required are FIO2 and PEEP.
    Proportional Assist Ventilation (PAV)
  44. How to calcu;ate the I:E ratio.
    Count #bpm. Totalbmp/60 = time 1 breath. Time length of inspiration. - inspratory time from the total time to get expiratory. divide E by I to get I:E Ex. I:E = 1.4/4.5 = 1/3
  45. What is the formula for inspiratory flow time?
    Ti (sec)= (60/f(min))/(I+E)
  46. Formula for Tital volume.
    VT= flow X inspiratory time
  47. Formula for predicted inspiratory flow.
    Flow = tidal volume/inspiratory time
  48. How to calc the ball park figure of Vt?
    10-12cc x ideal body weight. * use 4-8 cc with low compliance and 8-10cc for obstructive PTs.
  49. What is the formula for idea body weight?
    106 + (6 x inchs about 5 feet) = males 105 + (5 X inchs above 5 feet) = females
  50. Ball park calc for flow rate
    inspiratory time divided into Vt multiplied by 60
  51. Ball park rate setting
    Control mode (CMV) = 12-14 bpm A/C = 8-10bpm SIMV = 10-12 bpm
  52. Ball park setting for sensitivity
    -1 to -2 cm H2O
  53. Ball Parlk setting for FiO2
    Unstable 100% Stable 40%
  54. High pressure limit setting.
    10 cmH2O above peak airway pressure
  55. Low inspiratory pressure alarm
    set at 5-10 cmH2O below the peak airway pressure.
  56. Low PEEP/CPAP alarm
    set at 2-3 cmH2O below PEEP/CPAP level.
  57. Low exhaled tidal volume alarm
    set at 200-300 cc�s below the set mandatory breath volume. With some ventilator modes the low exhaled tidal
  58. volume alarm
    100-200 cc�s below the patient�s exhaled spontaneous tidal volume.
  59. Low exhaled minute volume alarm
    set at 2.0 to 3.0 liters below the patient�s total minute volume.
  60. High respiratory rate
    set at 5 to 10 bpm above the patients total respiratory rate.
  61. Low respiratory rate
    set at 5 to 10 bpm below the set frequency.
  62. Sigh parameters
    set sigh volume at 1.5 times the set tidal volume, set sigh high pressure alarm at 10 cmH2O above sigh peak airway pressure, set sigh rate at 1 every 15 mins. and multi-sigh at 1.
  63. Study Graphs that were emailed.
    Great!

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