ventilator management

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  1. CPAP is the maintenance of:
    positive pressure throughout the whole respiratory cycle (inspiration and 
expiration), when breathing spontaneously
  2. indications for CPAP:
    • Sleep apnea
    • Being weened from PEEP to obtain re-opening of atelectasis
    • Hypoxic following extubation
    • Hypoxic but not exhausted
  3. Pressure for CPAP:
    • 1 set pressure (cm H2O)
    • 5-20 cm H2O
  4. BIPAP is the maintenance of:
 set positive pressure during inspiration and a lower set pressure during exhalation

    • higher pressure- insp
    • lower pressure- exhale
  5. Benefits of BIPAP:
    • Maintains patency of airways and alveoli
    • Improves gas exchange
    • Improves delivery of bronchodilators
    • Moves extracellular fluid into vasculature
    • Reduces work of breathing
  6. indications for BIPAP:
    • Non-tolerance of CPAP
    • COPD exacerbation
    • Respiratory failure--hypercapnea and hypoxemia
    • Hypoxic following extubation
  7. Pressure for BIPAP:

    to improve ventilation:
    to improve oxygenation:
    • IPAP: 10-20 cm H2O
    • EPAP: 5-10 cm H2O

    • to improve ventilation: IPAP- blow off CO2
    • to improve oxygenation: EPAP
  8. when using PAP, what occurs during inspiration:
    what occurs in the alveoli?
    • IPAP forces air into the lungs, therefore, less work is required from the respiratory muscles
    • this decreases the work of breathing
    • The alveoli and bronchioles are prevented from collapsing at the end 
of expiration = less pressure needed to re-expand them.
  9. CI for CPAP/BIPAP:
    • 1. Recurrent pneumothoraces / untreated pneumothorax
    • 2. Severe post-operative pulmonary air leak
    • 3. Central Apnea
    • 4. Vomiting/Secretions
    • 5. Any condition where an elevated Intracranial Pressure is undesirable or 
where reduction in cerebral blood flow is inappropriate
    • 6. Any situation where there is already significant lung over-distension
    • 7. Unstable facial fractures, extensive facial surgery or lacerations and facial 
    • 8. Laryngeal trauma, recent tracheal anastamosis
    • 9. Recent ear, nose and throat surgery
    • 10. Inability to maintain their own airway
  10. Complications:
    • Inadequate ventilation/oxygenation
    • Congestion
    • Nasal dryness
    • Rhinorrhea (runny nose)
    • Chest discomfort
    • Induced central apnea
    • Conjuctivitis (eye infection)
    • Skin rash
    • Pressure sores
    • Claustrophobia
    • Anxiety
  11. Which PAP needs to be higher?
    IPAP or EPAP
    IPAP needs to be HIGHER than EPAP
  12. what is a good PAP starting ratio?
  13. what do you do if no improvement in O2?
    increase EPAP
  14. what do you do if no improvement in CO2?
    increase IPAP
  15. why do you need a good ratio btwn IPAP and EPAP?
    • a good ratio allows for exhalation
    • a poor ratio can cause air trapping
    • want 4 or 5 gradient btwn IPAP and EPAP
  16. indications for mechanical ventilation?
    • Failure to adequately ventilate
    • Failure to adequately oxygenate
  17. what are some concerning findings with mechanical ventilation?
    • Respiratory rate > 35/min or less than 6/min
    • Inability to maintain arterial O2 saturation > 90% with fractional 
inspired O2 (Fio2) > 0.60
    • PaCO2 > 55 mm Hg with pH < 7.25
    • Vital capacity < 15 ml/kg in adults and 10 ml/kg in children
  18. why is it imp to look at pH when looking at PaCO2?
    • bc a low PaCO2 could be their norm. The pH tells you whether or not the body is compensating
    • (good or bad)
    delivers pressure 
regardless of patient's own inspiratory efforts
pressure in response to the patient's inspiratory effort, but will initiate the breath if the patient does not do so within a preset amount of time
  21. Pressure Regulated Volume Controlled (PRVC)-
    • a form of A/C, breaths can be ventilator or patient initiated. 
    • A constant pressure is applied throughout inspiration.
    • Ventilator adjusts pressure from breath to breath to deliver a set tidal volume
    • delivers the preset volume and preset respiratory rate while allowing the patient to breathe spontaneously.
    • The vent initiates each breath in synchrony with the patient's breaths
    • Same as EPAP.
    • positive pressure that is applied by the ventilator at the end of expiration
    • preset pressure which augments the patient's spontaneous inspiration effort and decreases the work of breathing
    • (makes sure the pt reaches a certain pressure before exhaling)
    • delivers a small amount 
of gas at a rapid rate (as much as 60-100breaths per minute)
    • not used very much
  26. TV + RR=
    • Minute ventilation
    • which effects CO2 level
  27. FiO2 and PEEP effect:
  28. imp ventilator setting that you will include in your vent order:
    • Mode
    • TV
    • Rate
    • FiO2
    • PEEP
    • PSV (if appropriate)
    • Sensitivity (effort required for pt to take breath)
    • I Time ( inspir phase in sec's)
    • Pressure limit (top pressure during inspir)
  29. ventilator settings to improve oxygenation (O2):
    • adjust:
    • FiO2
    • PEEP
  30. ventilator settings to improve ventilation (CO2):
    • RR
    • TV
    • Pressures
    • I:E Ratio
Card Set
ventilator management
ventilation management
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