mech vent

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mech vent
2011-05-02 02:59:09
mech vent

mech vent
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  1. PIP should be set to obtain a specified
    exhaled VT
  2. pt receiving PCV and the exhaled VT decreases with no change in ventilator settings= what happens to compliance and airway resistance
    • decreased compliance
    • increased airway resistance
  3. PCV, inspiratory pressure is limited and cannot increase if compliance decreases or resistance increases, delivered vt will
  4. bipap- once inspiration begins, a preset
    IPAP is reached
  5. CPAP setups should always have a what type of pressure alarm on so that leaks in the system is detected
    low pressure alarm
  6. VT should be set between
    8-12 ml/kg IBW
  7. VT for ARDS pt should be btwn
    5-6 ml/kg
  8. use of VT is best to maintain
    alveolar pressure (static pressure) less than 35
  9. alveolar pressures greater than 35 cm results in
    lung damage
  10. most effective way to improve alveolar ventilation and decrease pac02 is by
    increasing VT not by increasing RR
  11. increasing VT increases
    • alveolar ventilation
    • increasing the mv
  12. anatomic dead space is equal to ___ ml/lb of the pt's IBW
    1 ml/lb but it is reduced by 50% in intubated pt
  13. to accurately measure the VT delivered by the ventilator, place a respirometer directly on the
    ventilator outlet
  14. normal RR initial setup is
    8-12 breaths/min
  15. adjusting the rate control alters the
    expiratory time, therefore altering the I:E ratio
  16. what happens to the exp time when you increase RR
    decrease exp time

    vice versa
  17. adjusting the RR alters the
    MV- inc the RR increases mv

    vice versa
  18. adjusting the flow rate alters the
    inspiratory time, altering I:E ratio

    increasing flow, decrease itime

    vice versa
  19. I:E ration is establised by the use of 3 vent controls
    • vt
    • flow
    • rr
  20. inc vt= ___ itime
    increasing itime

    vice versa
  21. inc flow = ___ itime
    decreasing itime

    vice versa
  22. inc RR= ____exp time
    decreases exp time

    vice versa
  23. pt with nomal paco2 with hypoxemia and the peep and fio2 levels are high, increase the=
    ins time to increase pa02

    allows longer time for oxygen to diffuse across the alveolar capilalary membrane, thereby increasing pao2
  24. increasing flow is the most common adjustment to correct for an
    inverse i:e ratio
  25. what should you do with the sensitivity if it takes more than -2.0 cm h2o pressure to cycle the vent into inspiration
    increase the sensitivity
  26. sigh rate should be set btwn
  27. sigh vol should be set __ times the vt
  28. sighs aid in preventing
  29. sigh controls is usually not functional in what mode
  30. expiratory retard/resistance is used to prevent
    premature airway collapse during expiration
  31. indications of peep
    • atelectasis
    • hypoxemia with the use of 60% fio2 or more
    • decreased lung compliance
    • pulm edema
  32. hazards of peep
    • barotrauma
    • dec venous return
    • dec cardiac output
    • dec urine output
  33. level of peep that improves lung compliance without decreasing cardiac output
    optimal peep
  34. nomal pvo2 is
  35. <35 is a decrease in
    cardiac output
  36. PIP level should be maintained at less than ____ to prevent lung tissue damage
    35-20 cm h20
  37. normal PETco2 is btwn ____%
  38. what type of measurements can help determine the pt's lung status
    • MIP
    • VC
  39. common criteria for initation of mech vent
    • vc <10 - 15 (normal is 65-75)
    • p(A-s)o2 of greather than 450 mm hg with the use of 100% o2, normal is 25-65
    • vd/vt ratio of greather than 60%, normal is 25-35%
    • MIP of at least -20 cm h20
    • PEP of less than 40
  40. pneumothorax may be characterized by
    subcu emphysema (air in the subcu tissue)
  41. most cost-effective method of preventing cross contamination of pt's and equipment is
    proper hand washing
  42. never add deadspace if pt is receiving what type of modes
    • simv
    • psv
    • cpap

    bc deadspace would increase airway resistance and wob
  43. if a vent pt has an elevated pac02 and the question indicates the pt has dead space added to the vent circuit, what would you do first?
    remode the dead space first
  44. dynamic comp is not an accurate measurement of
    lung compliance

    static compliance is more accurate bc it is measure with no air flowing through the circuit and airways
  45. increasing pl pressure indicate that the lung comp is decreasing, or the lungs are
    harder to ventilate
  46. an increased RAW is occuring from
    • bronchospasms
    • secretions
    • coughing
    • tubing obstruction
  47. calculation of lung comp is also important in the determination of
    optimal peep
  48. RAW=
    (pip - pl pressure)/flow rate

    divide flow by 60
  49. criteria for weaning
    • vt = 3x's the body weight in kg
    • VC>10 to 15 or twice the VT
    • MIP at least -20 cm h20
    • VD/VT < .60
    • P(A-a)o2 <350 with tthe use of 100%
    • rsbi <105
    • RR < 25
    • peep <10
    • pao2/fio2 >200
    • underlying disease or condition stable or improving
    • alert pt who is able to follow commands
    • pt not taking any meds that may hinder spont vent
    • no life threatning situation, such as shock or hypotension
    • no anemia, fever, electrolyte imbalance
  50. to lower PACO2 using high frequency vent/oscillation, you should
    increase the freq or oscillatory amplitude