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Name at least 3 clinical indications for NPPV (BiPAP).
- avoid intubation
- decrease length of hospitalization
- decrease vent associated pneumonia (VAP)
- decrease length of ventilation
For a typical adult patient, where would you start with BiPAP settings?
- IPAP/EPAP: 12/5
- RR: 12
- Adjust FiO2 to keep SpO2 above ~90%
To blow off more PaCO2 with NPPV, you would increase the _____________.
IPAP... incr Vt or rate
To improve oxygenation with NPPV, you would increase the ___________.
EPAP... incr O2 or PEEP
If NPPV (BiPAP) is goint to work, it will start to help within ___ to ___ hours. If not, you should consider _________.
Three types of ventilator input power:
What are the 3 independent variables for vent control?
Example of a negative pressure contolled ventilator:
The ventilator controls pressure, but volume and flow will vary with changes in compliance and resistance. This is a ___________ vent.
pressure control vent
PEEP, NEEP, and ZEEP - What are they?
- PEEP - positive end expiratory pressure
- NEEP - negative end expiratory pressure
- ZEEP - zero end expriatory pressure
What do spontaneous and mandatory mean?
- Spontaneous: patient accuated breath
- Mandatory: ventilator triggered breath
What is an open loop control?
Referring to an early/basic ventilator where no feedback is given based on flow, volume, or pressure (like a Byrd Ventilator - NO FEEDBACK)
What is a closed loop control?
Referring to a ventilator where flow, volume or pressure are set and measured with feedback. (Measuring and PROVIDING FEEDBACK for the next breath)
What is CMV? AKA?
aka A/C (assist controlled): continuous mandatory ventilation. All breaths are mandatory; full support.
What is SIMV?
Syncronized Intermittent Mandatory Ventilation. Providing partial support; breaths can be manditory or spontaneous.
SIMV generally keeps _______ lower than CMV?
Mean airway pressure
CPAP is intially set at ________ cmH20?
One example of a clinical setting in which you might use CMV?
ARDS, brain injury, bad chest/rib injury (using PEEP to splint)
One example of a clinical scenario in which you might use SIMV?
to wean a patient off a vent
One example of a clinical scenario in which you might use CPAP?
prevent intubation in a premature baby (surfactant deficient) with RDS
When the SIMV rate has dropped to 4, the next step is?
Spontaneous breathing trial (t-piece trial)
What is HFJV?
High Frequency Jet Ventilation: pulses of gas via special double lumen ET tube, exhalation is passive.
What is HFOV?
High Frequency Oscillatory Ventilation: active insp & exp facilitated by the forward & reverse action of a diaphragm (PISTON ACTION) *Blows off CO2 better because it will extract air!
What is the essential difference between HFJV and HFOV?
HFOV will extract air, efficient in blowing off CO2.
What is PSV?
pressure support ventilation: pressure that takes away resistance of the breathing tube. (easier to wean people off the vent, because you can drop the rate and know they'll be able to breath better on their own!)
What is the primary benefit of PSV?
Patient has control over rate, flow, inspiratory time and tidal volume.
What is adaptive ventilation?
A vent that adjusts the settings based on breath to breath feedback. (ultimate example of closed loop control)