Critical care

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  1. What is ventilation?
    Ability to move air in and out of lungs.
  2. What is Respiration?
    Gas exchange at the cellular level. o2 in and co2.
  3. Reasons for ventilation support:
    • Acute ventiatory failure
    • -acute respiratory acidosis
    • -increased CO2
    • -decrease pH
    • Hypoxemia-shunting
    • -cannot get O2across membrane
    • Pulmonary mechanics
    • -Obstruction
    • -decrease compliance
    • Other
    • -neuro, diaphragm paralysis
  4. Post intubation
    • Secure ET tube
    • document placement
    • Ausculate bialteally
    • End tidal CO2-measures co2 exhaled through breath-assures that gas exchange is taking place
    • always do an xray
  5. Tracheostomy
    • Used for prolonged need for ventilation and artificial airway
    • Usually if needed for more than 2-3 weeks
    • Can improve weaning
  6. Negative pressure ventilation
    • We all have negative pressure to suck air in.
    • Diaphram moves down and lungs expand causing negative pressure
  7. Positive Pressure Ventilation
    • Pushing air in.
    • Volume cycled delivers a present volume of air to lungs¬† -This is the most common mode
    • Pressure cycled-delivers a preset gas pressure
    • Time cycled - preset inspiration time
    • Flow cycled- pressure augmentation during insp, decreases work of breathing.
  8. Tidal Volume
    • Amount of air delivered to the lungs in one breath.
    • Normal TV = 5-12ml/kg (500-800ml)
    • Complications of high TV-Barotrauma - gross damage to alveolar
    • Consider lung compliane- avoid high volume
  9. Fracion of inspired Oyxgen (FIO2)
    • Percentage of Oxygen of inspired gas
    • Range 0.21-1.0(21%-100%)
    • Use the lowest possible level to avoid oxygen toxicity
    • Oxygen Toxicity-damages endothelial lining-decreases mucous and surfactant protection -COPD patient
  10. Rate
    • Number of breaths /minutes delivered to patient
    • Normal range = 6-20 individualized per pateint
    • In some ventilator modes, can be controlled by patient
  11. PEEP
    Positive End Expiratory Pressure
    • Keeps alveoli inflated during expiration
    • Physiologic Peep 3-5 cm H2O
    • Primary use: Refractory hypoxemia-prevents atelectasis
    • Auto PEEP - building of pressure leading to air trapping
    • Complications : Barotrauma, decreased CO
  12. Peak Airway Pressure
    (Peak Inspiratory Pressure)
    • Pressure required to deliver volume of air
    • Healthy lungs =20cm H2O
    • Goal <40cm
    • Increased ->decreasing lung compliance -worsening pulmonary status (ARDS)-coughing, and need for suctioning
    • Decreased = improving status
  13. Ventilation Modes
    • Assist control (AC)
    • Synchronous Intermittent Mandatory Ventilation (SIMV)
    • Continuous Positive Airway Pressure (CPAP)
  14. Assist control
    Continuous Mandatory ventilation
    • Pateint gets set number of guaranteed breaths/min at a set TV
    • Additional inspiratory breaths are assisted at set TV
    • Advantages-allows resp muscles to rest
    • Disadvantages - High rsp rates will cause hyperventilation-become alkalosis (blowing off too much co2
    • Assists the patient is pt tries to breath but if pt does not breath then the machine will breath for him.
  15. Synchronous Intermettent mandatory Ventilation (SIMV)
    • Patient get set number of guaranteed breaths/min at set TV
    • Pt sets own TV and will only get what they can breath on their own
    • Advantages-forces exerciser of resp muscles
    • Disadvantages -potential for fatique
    • Used for weaning-will decrease breaths per minute to make patient want to breath
  16. Continuous Positive Airway (CPAP)
    • No tidal volume or resp rate
    • Patient generates their own resp rate and TV
    • Used as a weaning mode
    • Often used in conjunction with psv
    • Patient is breathing on their own- this is just a source of O2
  17. Pressure Support Ventilation (PSV)
    • Overcomes increased airway resistance
    • Assists with weaning
    • Decreases work of breathing
    • Triggered by spontaneous breath
    • 5-15cmH2O
  18. High Pressure
    • Indicates resistance in circut
    • Secretions
    • coughing
    • tube kinked or patient biting on tube
    • High lung compliance
    • poor synchronization
  19. Low Pressure
    • indicates a disconnection or leak in system
    • Check patient tubing and connections
  20. Major complications of Mechanical Ventilation
    • Cardiovascular- decreased CO, preload, sv
    • Air in chest cavity causes heart not able to expand
    • Pulmonary - changes flow of gas, oxygen, toxicity, risk of VAP, barotrauma
    • Renal- decreased perfusion
    • GI - Stress Ulcer
    • Neurovascular- decreased flow to head, venous return from head (Increase ICP)
  21. Oxygen Toxicity
    • 80%FiO2 for 48 hours or longer
    • Damages endothelium
    • Nonspecific symptoms
    • Use minimum oxygen level to obtain acceptable paco2
    • Peep increases gas exchange so o2% can be decreased-so adding peep helps prevent Oxygen toxicity
  22. Ventilator Bundle
    • A group of interventions designed to prevent complications of mechanical ventilation
    • head of bed elevate 30
    • prevention of stress ulcers - PPI (Protonixs)
    • DVT Prophylaxis (Heparin, compression stockings)
    • Sedation vactions¬† (wake once a day to check neuro)
    • Oral care q4hrs- reduces bacteria load in the mouth
    • Consider weaning trial-assess ability to wean daily
  23. Ineffective Airway Clearance
    • Lose effective cough
    • suction only when needed -hyperoxygenate- suction and reassess- return patient to vent
    • Inline suctioning is used
    • Suction for 5-10 seconds max
  24. Weaning
    • Assess Readiness to Wean (RTW)
    • All patient parameters must be optimized
    • FIO2 <50%
    • PEEP<5
    • Nutriton optimized
    • Afebrile
    • NO GI bleed-stable H&H
    • Stable hemodynamics-adequate bp
    • Mental status-good level of conciousness
  25. Weaning Modes -
    CPAP Weaning
    • Patient remains attached to ventilator
    • ventilator provides oxygenated air
    • Patient does all the work of breathing
    • May have psv added
  26. Weaning Mode
    • Patient starts off with high number of guaranteed breaths
    • Over time guaranteed breaths are reduced, forcing patient to do more work of breathing
    • builds endurance of resp muscles
    • Often used with difficult wean patients.
  27. Signs that they are not tolerating wean:
    • increase BP
    • increase HR
    • increase CO2
    • decrease pulse ox
Card Set:
Critical care
2014-01-14 17:46:03
Mechanical Ventilation
Term 2
test 1
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