CP 2013 Vivia

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Author:
jessiekate22
ID:
222501
Filename:
CP 2013 Vivia
Updated:
2013-06-05 07:06:27
Tags:
Mechanical Ventilation
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Description:
Week 6 L2
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  1. How do you manage acute respiratory failure?
    • - alleviate hypoxaemia- give O2- treat this first as it kills faster
    • - alleviate hypercapnia- increase MV= RR + TV
    • - treat cause
    • - intubation and mechanical ventilation
  2. What is mechanical ventilation?
    - mechanical support of the respiratory function
  3. What are some examples of non invasive ventilation?
    • - BiPAP
    • - CPAP
  4. Where is mechanical ventilation used?
    • - intensive care
    • - high dependency
    • - emergency departments
    • - OT
    • - retrieval (when a team goes out and picks up someone from another hospital and brings them back)
  5. What are the indications for mechanical ventilation?
    • - airway management
    • - respiratory failure- type 1 and 2
  6. WHat are the clinical indications for mechanical ventilation?
    • - RR> 35bpm
    • - TV < 5ml/kg
    • - VC< 10ml/kg
    • - negative inspiratory force (MIP) < 25cmH2O
    • - MV < 10L/min
    • - rise in PaCO2> 10mmHg (eg 52)
    • - A-a gradient > 450
    • - PaO2 with supplemental O2 < 5mmHg
  7. What were the first type of ventilators used?
    • - negative pressure ones
    • - sucks the ribs out to bring air in- 1950s/60s
  8. How do ventilators of today ventilate their pt?
    - through the use of positive pressure
  9. What are important concepts of positive pressure ventilation?
    • - modes of ventilation
    • - PEEP
    • - gas mixing
    • - flow patterns
    • - humidification
    • - alarms
    • - assessing adequacy of ventilation
    • - weaning
    • - physiological effects
    • - physiotherapy management
  10. Terms to know about mechanical ventilation
    • - MV= RR x TV
    • - machine breaths
    • - spontaneous breaths- breaths initiated by pt and supported by ventilation
    • - triggering- ventilator senses something happening with a pt like a breath and gives a breath
    • - circuit- how everything is connected between pt and machine
  11. When a machine provides gases what is it aiming for?
    - a volume or pressure
  12. Do mechanically ventilated pts have active or passive expiration?
    • - passive
    • - expired gas goes back into the machine
  13. What are the types of positive pressure ventilation?
    • - controlled mandatory ventilation (CMV)
    • - intermittent mandatory ventilation (IMV)
    • - Synchronised intermittent mandatory ventilation  (SIMV)
    • - pressure support (PS)
  14. WHat do positive pressure machines do and what can be set?
    • - machine reports what it does and what the pt does
    • - FiO2 (lowest 21%)
    • - TV- needs to be 8-10ml/kg
    • - Pi- inspiratory pressure
    • - RR
    • - PS- pressure support (25)
    • - PEEP
  15. What is controlled mandatory ventilation and what does it do?
    • - pt needs to be paralysed 
    • - inspiration is terminated when a set volume, pressure or time is reached
    • - if pt wakes up it wouldnt 
    • - only used in theatre now
    • - certain TV and RR set
    • eg RR= 12, Vt (TV)- 500ml. So every 5 sec pt gets 500ml
  16. What is intermittent positive pressure ventilation?
    • - not used anymore- uncomfy and can result in breath stacking
    • - developed in the 80s
    • - pt initiated breaths allowed
    • - set IMV rate is superimposed on pts own efforts and delivered at regular intervals
  17. What is SIMV?
    • - form of positive pressure ventilation
    • - synchronised intermittent mandatory ventilation
    • - works with pts efforts
    • - still makes sure pt receives a certain number of breaths/ min
    • - used even with non- breathing patients
  18. What are the benefits of SIMV?
    • - more comfortable
    • - less sedation
    • - faster weaning
    • Note used in combination with other modes
  19. What are the two types of SIMV?
    • - Pressure control 
    • - Volume control (PSV)
    • Both work generally the same, will differ with different pathology
  20. When is pressure conto SIMV used?
    - used when barotrauma/ volutrauma is a possibility eg poorly compliant lungs eg ARDS
  21. What is pressure support ventilation (PSV)?
    And decribe how it worl
    • - similar to PSV
    • - pt breaths on their own
    • - fully pt controlled
    • - every breath gets a bit of pressure 
    • - pt triggers a breath and the machine provides a flow of gas at a pressure for the pt to breath in- augments inspiration 
    • - the machine terminated the inspiratory pressure once the flow rate drops (end of inspiration)
  22. What are normal pressure support values?
    10-20cmH2O
  23. What is PEEP?
    - positive end expiratory pressure
  24. How does PEEP work?
    - it increases the amount of alveolar pressure above atmospheric pressure at the end of expiratory imposed by the machine
  25. What is the idea of PEEP?
    - to help keep the alveoli open
  26. What are the benefits of PEEP?
    • - helps the pt overcome the resistance in the machine circuit
    • - increase FRC
    • - helps recruit collapsed lung
    • - improves oxygenation
    • - may redistribute lung water from the alveoli to the interstitium (eg pulmonary odema)
  27. What are the side effects of PEEP?
    • - haemodynamic instability
    • - lung damage
    • - ? effect on ICP
    • - ? may worsen oxygenation in focal lung pathology
    • - heart has to push harder against pressure as there is an increase pressure in the lungs
  28. What are the types of non invasive ventilation?
    • - CPAP
    • - BiPAP
    • - NIPPV
  29. What is NIV?
    • - close fit mask over the nose ormouth
    • - increase MV
    • - gas blown through mask at high flow rates, expiratroy PEEP valve provides expiratory pressure
    • - decrease WOB
  30. What are the aims of NIV?
    • - splint open airways
    • - increase lung volumes
    • - increase alveolar ventilation
    • - reduce WOB
  31. Pictures of NIV
  32. What is CPAP?
    - Continuous positive airway pressure
  33. What type of ventilation is CPAP?
    - can be both invasive and non invasive
  34. What does CPAP do?
    • - increase FRC
    • - maintenance of continuous positive airway pressure throughout the respiratory cycle
    • - increase ventilation
    • - spontaneous mode of ventilation
    • - decrease WOB
  35. What are the normal levels of CPAP?
    5-20cmH2O
  36. What type of SIMV is best for pneumonia?
    • - PCV
    • - <40 best
    • - poor compliant lungs
  37. What is BiPAP?
    - bi- level (biphasic) positive airway pressure
  38. What does BiPAP do?
    • - like CPAP but allows different inspiratory and expiratory pressures
    • - spontaneous mode of ventilation
    • - allows pt to be more supported in inspiration that CPAP
  39. Note most ventilators have the ability to deliver CPAP and BiPAP

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