INTRO TO MECHANICAL VENTILATION

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Meezy
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19890
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INTRO TO MECHANICAL VENTILATION
Updated:
2010-05-25 13:54:37
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respiratory failure
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intro to mechanical ventilation
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  1. Number one reason for Mechanical Ventilation:
    RESPIRATORY FAILURE
  2. WHAT IS RESPIRATORY FAILURE:
    FAILURE OF OXYGENATION, VENTILATION, OR BOTH
  3. WHAT IS THE TYPICAL PaO2 and PaCO2 at RA for CO2 Retainers?
    PaO2<60 and PaCO2>50
  4. 3 TYPES OF RESPIRATORY FAILURE:
    1. TYPE 1 ACUTE HYPOXEMIC RESPIRATORY FAILURE

    2. TYPE 2 ACUTE HYPERCAPNIC RESPIRATORY FAILURE

    3. TYPE 3 CHRONIC RESPIRATORY FAILURE
  5. PRIMARY CAUSES OF TYPE 1 A HYPOX RF(6 causes)
    • 1. v/q mismatch
    • 2. shunt
    • 3. alveolar hypoventilation
    • 4. difusion impairment
    • 5. perfusion/diffusion impairment
    • 6. decreased inspired O2
  6. INDICATIONS/SYMPTOMS OF V/Q MISMATCH
    • hypoxemia
    • dyspnea
    • tachycardia
    • accessory muscles
    • abnormal bs: wheezing, dim, unilateral abnormalities
    • whiteout or blackout on cxr
  7. WHAT PERCENTAGE SHUNT IS NORMAL IN THE BODY?
    physiological shunt is 3-5%
  8. What is a PATHOLOGICAL SHUNT?
    abnormal shunts caused by right to left blood fow through holes, or where pulmonary vasculature may be deformed.
  9. What are examples of Pathological Shunts?
    av septal defects, fistulas, atelectatic aveoli
  10. What is REFRACTORY to supplemental oxygen?
    Shunt due to exudate filled alveoli; alveoli not workable. V/Q mismatch WILL respond to oxygen
  11. What is Alveolar Hypoventilation?
    • assoc with Type 1 Hypoxemia
    • pt goes into RF and the PCO2 significantly rises to displace the alveolar PaO2 leading to hypoxemia
    • drop in RR leads to CO2 increase
  12. What is Diffusion Impairment:
    • assoc with Type1 hypoxemia
    • common in pt's where interstitial wall is abnormally thickened which increases diffusion time
    • common in emphysema, pt's with abnormal pulmonary vasculature, anemia, pulmonary HTN, pulm edema
  13. What is Perfusion/Diffusion Impairment:
    • assoc with Type 1 hypox
    • liver disease, ascites, jaundice, digital clubbing
    • platypnea-dyspnea on moving upright from supine
  14. What is Decreased Inspired Oxygen:
    • assoc with Type 1 hypox
    • can occur at high altitudes
    • barometric pressures decreases which lowers the PaO2-O2
    • oxy tank runs out
  15. What is TYPE2 ACUTE HYPERCAPNIC RF:
    • VENTILATORY FAILURE
    • abg: Uncompensated Resp Alk
    • elevated CO2 displaces alveolar oxygen so hypoxemia may accompany AH RF
  16. 3 MAJOR DISORDERS THAT CAUSE ACUTE HYPERCAPNIC RF:
    • Decreased Ventilatory Drive
    • Respiratory Muscle Fatigue or Failure
    • Increased WOB
  17. What is Decreased Ventilatory Drive:
    • Assoc with Type 2 Hypercapnia
    • anything that disrupts the cns breathing mechanisms i.e the spinal cord, phrenic nervers, central and peripheral chemoreceptors.
  18. Causes of Decreased Ventilatory Drive:
    • too much O2 in a CO2 retainer
    • drugs/narcotics
    • brainstem lesion
    • hypothyroidism
    • obesity/sleep apnea
    • *most causes are REVERSIBLE
  19. What is Respiratory Muscle Fatigue/Failure:
    • caused by neuromuscular diseases such as ALS, MG, GB, polio, MS
    • may be reversible or terminal depending on the cause
  20. Symptoms of Respiratory Muscle Fatigue/Failure:
    • drooling
    • weakness
    • resp fatigue
  21. What is Increased WOB and is symptoms:
    • assoc with Type2 AC Hypercapnia
    • caused by copd, asthma excaberations, pneumothorax, rib fxs(broken ribs), pleural effusion, extensive burns
    • irritability, mental confusion, *dim bs in young asthmatic may be a bad sign*
  22. What is Type3 CHRONIC RESPIRATORY FAILURE: A
    CO2 RETAINER
  23. WHAT IS TYPE3 CHRONIC RESPIRATORY FAILURE: B
    • 'ACUTE ON CHRONIC'
    • CO2 RETAINER WITH AN EXCABERATION
  24. 3 main factors to look for when considering MECHANICAL VENTILATION(intubation):
    • 1. ventilatory mechanics (of pt)
    • 2. ventilation
    • 3. oxygenation
  25. What is MIF/NIF/MIP:
    • max insp force/neg insp force/max insp press **all the same**
    • -20 is the red flag: anything less is bad and needs intubation
  26. INDICATIONS TO INTUBATE:
    • MIP< -20
    • VC<15 ML/KG OF IBW
    • VT<5 ML/KG OF IBW
    • RR>30
    • VE>10 L
  27. What levels of CO2 and PH indicate RF:
    • CO2 >55 and rising and PH< 7.25 and decreasing
    • **can either be acute hypoventilation or acute hypercapnia
  28. What is the NORMAL PaO2 and the CRITICAL VALUE requiring intubation?
    • NORMAL: 80-100
    • CRITICAL: <60 with supplemental oxygen
  29. What is the NORMAL P(A-a)O2 Gradient and what is the CRITICAL VALUE when on supplemental oxygen:
    • NORMAL: 2-30 mmhg on RA
    • CRITICAL: >450 mmhg on supplemental
  30. How can PaO2 and Aa gradient indicate shunting, diffusion defects, or v/q mismatch?
    When PaO2 is LOW and Aa Gradient is high: indicates gas exchange is not occurring even though a strong gradient is present; find cause of decreased gas exchange
  31. What is the NORMAL and CRITICAL VALUE of PaO2/PAO2 Ratio:
    • NORMAL: 75-95% DIFFUSION
    • CRITICAL: <15%
  32. WHAT IS THE NORMAL FOR A PERSON ON 100% OXY(NRB) AND THE CRITICAL VALUE OF PaO2/FIO2 Ratio:
    • 100%: 476
    • CRITICAL: <200
  33. What is MECHANICAL VENTILATION:
    Using a machine to effective protect the airway and manage ventilation and or oxygenation for PT's unable to do so normally
  34. 3 basic types of negative pressure ventilation:
    Iron Lung

    Cuirass

    Body Suit
  35. 3 Methods of Noninvasive Ventilation:
    neg pressure devices

    BiPAP

    NIPPV
  36. BiPAP delivers 2 levels of pressure:
    IPAP on inspiration(ventilation)

    EPAP on expiration(oxygenation)
  37. Causes of Pressure Rise During Volume Ventilation:
    1. Decreasing compliance

    2. Increased resistance i.e obstruction in airway, secretions, sputum, blockage in tubing

    3. Increased flowrates: HIGH FLOW = HIGH PRESSURE

    4. higher set Vt: PRESSURE = VOLUME
  38. Assist Control Ventilation:
    Vent delivers a pre-determined Vt with each inspiratory effort generated by the PT

    Uses a sensitivity control(similar to IPPB) set a -2 cmhg

    A backup frequency is set to insure a minimum minute volume

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