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Define volume ventilator
A preset VT is delivered to the patient in each machine breath and once delivered inspiration ends
What is volume-limited
inspiration pressure maintains the preset VT when changes in airway resistance and compliance occur
Preset inspiratory pressure is delivered to PT once it is reached inspiration ends
In a pressure cycled ventilator what effects the VT?
It is unknown, it varies with changes in airway resistance and compliance. Volume varies pressure is constant.
On a pressure cycled vent what happens to TV when lung compliance decreases?
VT decreases as the PT's lungs become stiffer and harder to ventilate
On a pressure controlled vent when inspiratory pressure is increased what happens to the VT?
On PCV if the target TV is not reached what should be done to PIP
Increase the PIP to increase TV
What does it mean when a patient is on PCV and the exhaled VT decreases with no change in vent settings
Either compliance has decreased or airway resistance has increased
How are Bi-PAP's inspirations triggered?
either time triggered or patient triggered
what is auto peep
gas trapped in alveoli at end expiration
Pressure support Ventilation how is it used; indications
- Can be used alone or with SIMV.
- PT assisted
- pressure generated
- flow cycled breath
- used to overcome resistance from ET tube
- PT initiates Insp; preset pressure is reached and held constant until Insp flow is reached then pressure terminated
What are the parameters for determining VT for:
PT's with ARDS
PT's with COPD
- most pt=8-12 ml/kg ibw
- ARDS= 5-6 ml/kg ibw
- COPD= 8-10 ml/kg
What is the threshold for static pressure in order to avoid over distention of alveoli and lung damage?
Less than 35 cm H2O
What is the most effective way to improve alveolar ventilation and decrease PaCO2?
By increasing TV NOT by increasing Vent rate
What are two solutions to vent pt with high PaCO2?
Increase the VT and increase the RR.
How does adjusting the RR effect the I:E ratio?
It effects the expiratory time. Increasing RR decreases E time; decreasing the RR increases the I time
How does adjusting the RR effect the minute volume?
Increasing the rate increases the minute volume; decreasing the rate decreases the minute volume.
How is the PaCO2 most effectively controlled on PT's using controlled ventilation or SIMV? Why?
On controlled or SIMV PaCO2 is most effectively controlled by altering the rate. Because the Patient's RR is dependent and controlled by the vent. So changing the rate changes the PaCO2
What is the most effective way to control PaCO2 when the PT is on Assist/control? Why?
When on Assist/control the pt may obtain as many breaths as needed no matter the rate so the most effective way to adjust PaCO2 is by adjusting TV
What is the normal setting for Inspiratory flow control?
How does adjusting the flow rate alter the I:E ratio?
- It alters the Inspiratory time
- increasing flow rate decreases I time
- decreasing flow rate increases I time
How do you alter the Inspiratory time and the Expiratory time on the I:E ratio
- Altering the flow adjusts the inspiratory time
- Altering the rate adjusts the expiratory time
- Altering the VT adjusts the inspiratory time
What are the 2 ways to control PaCO2?
adjusting TV or Flow rate
What portion of the I:E ratio controls PaCO2?
What is the difference between adjusting flow rate and Tidal Volume
The flow rate is how fast air gets to lungs tidal volume is the amount that the lungs receive
How does altering the TV change alter the I:E ratio
- increasing TV increases I time (makes longer)
- decreasing TV decreases I time (makes shorter)
What are the parameters for the sensitivity control?
-0.5 to -2.0
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