ventilator management

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Author:
merazar15
ID:
258871
Filename:
ventilator management
Updated:
2014-01-28 15:28:37
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vent management
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Description:
ventilation 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:
    higher
 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 
burns
    • 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?
    10/5
  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)
  19. CONTROLVENTILATION (CV)-
    delivers pressure 
regardless of patient's own inspiratory efforts
  20. ASSIST-CONTROLVENTILATION (A/C) OR CONTINUOUS 
MANDATORY VENTILATION (CMV):
    delivers 
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
  22. SYNCHRONOUSINTERMITTENT MANDATORY VENTILATION 
(SIMV):
    • 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
  23. POSITIVE-ENDEXPIRATORY PRESSURE (PEEP)
    • Same as EPAP.
    • positive pressure that is applied by the ventilator at the end of expiration
  24. PRESSURE SUPPORT VENTILATION (PSV):
    • 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)
  25. HIGHFREQUENCY VENTILATION (HFV):
    • 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:
    oxygenation
  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

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