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PIP should be set to obtain a specified
exhaled VT
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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
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PCV, inspiratory pressure is limited and cannot increase if compliance decreases or resistance increases, delivered vt will
decrease
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bipap- once inspiration begins, a preset
IPAP is reached
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CPAP setups should always have a what type of pressure alarm on so that leaks in the system is detected
low pressure alarm
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VT should be set between
8-12 ml/kg IBW
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VT for ARDS pt should be btwn
5-6 ml/kg
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use of VT is best to maintain
alveolar pressure (static pressure) less than 35
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alveolar pressures greater than 35 cm results in
lung damage
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most effective way to improve alveolar ventilation and decrease pac02 is by
increasing VT not by increasing RR
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increasing VT increases
- alveolar ventilation
- increasing the mv
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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
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to accurately measure the VT delivered by the ventilator, place a respirometer directly on the
ventilator outlet
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normal RR initial setup is
8-12 breaths/min
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adjusting the rate control alters the
expiratory time, therefore altering the I:E ratio
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what happens to the exp time when you increase RR
decrease exp time
vice versa
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adjusting the RR alters the
MV- inc the RR increases mv
vice versa
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adjusting the flow rate alters the
inspiratory time, altering I:E ratio
increasing flow, decrease itime
vice versa
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I:E ration is establised by the use of 3 vent controls
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inc vt= ___ itime
increasing itime
vice versa
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inc flow = ___ itime
decreasing itime
vice versa
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inc RR= ____exp time
decreases exp time
vice versa
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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
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increasing flow is the most common adjustment to correct for an
inverse i:e ratio
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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
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sigh rate should be set btwn
6-12
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sigh vol should be set __ times the vt
1.5-2.0
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sighs aid in preventing
atelectasis
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sigh controls is usually not functional in what mode
SIMV
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expiratory retard/resistance is used to prevent
premature airway collapse during expiration
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indications of peep
- atelectasis
- hypoxemia with the use of 60% fio2 or more
- decreased lung compliance
- pulm edema
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hazards of peep
- barotrauma
- dec venous return
- dec cardiac output
- dec urine output
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level of peep that improves lung compliance without decreasing cardiac output
optimal peep
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<35 is a decrease in
cardiac output
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PIP level should be maintained at less than ____ to prevent lung tissue damage
35-20 cm h20
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normal PETco2 is btwn ____%
4.5-5.5%
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what type of measurements can help determine the pt's lung status
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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
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pneumothorax may be characterized by
subcu emphysema (air in the subcu tissue)
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most cost-effective method of preventing cross contamination of pt's and equipment is
proper hand washing
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never add deadspace if pt is receiving what type of modes
bc deadspace would increase airway resistance and wob
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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
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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
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increasing pl pressure indicate that the lung comp is decreasing, or the lungs are
harder to ventilate
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an increased RAW is occuring from
- bronchospasms
- secretions
- coughing
- tubing obstruction
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calculation of lung comp is also important in the determination of
optimal peep
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RAW=
(pip - pl pressure)/flow rate
divide flow by 60
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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
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to lower PACO2 using high frequency vent/oscillation, you should
increase the freq or oscillatory amplitude
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