Flashcards
mechanical ventilation
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- 1Cufftwo functions:
prevent aspiration, seal for IPPV
- Does no hold tube in place
Volume sufficient to hold a seal (less than 30 mmhg)
- cuff isolates lungs from outside of atmosphere forming a closed circuit between pt and ventilator
- closed circuit = control - 2Negative pressure ventilatorsIron lungs
- intrathoracic pressure - 3What is a ventilator?a positive pressure ventilator is a device that forces gas into patient lungs
creates a pressure gradient higher than normal atmosphere or spontaneous breathing - lungs fill with gas and then respire (take away positive pressure ) gas flows out - 4Indications for ventilationmaintain gas exchange in resp failure
control over CO2 elimination
reduction of cardiac work in cf
prophylaxis prior to resp failure (sepsis) - 5Ventilation functionwork of switching between inspiratory and inspiratory modes, their cyling
- volume cyling - breath is terminated once a set volume is delivered
- pressure cycling - cycles off once a preset pressure has been reached therefore volumes will not be constant
- time cycling - delivered breath is terminated once a preset time has been reached - 6Modes- mouth to mouth/mask
- IPPV - mechanical ventilation
- IMV intermittent mandatory (volume) ventilation
- MMV mandatory minute ventilation
- SIMV synchronised IMV (assisted)
- SIMV + ps + SIMV + pressure support - 7modes contBIPAP
HFV - high freq vent
HFO - ossicilation
hfjv - Jet ventilation
PEEP
CPAP
NPV
Apnoeic on - 8Volume controlnot used as a standard mode
delivers a set volume of gas
may require pressure that are not too high
pressure to deliver the breath is dependent on compliance and resistance encountered - 9Pressure controlPCV - delivered by a pressure limited time cycled ventilator
- Gas is delivered until a set pressure is reached
- Reserved for pt with poor resp function
- For pts with increased risk of barotrauma - 10Pressure support- assist mode
- Patient initiates breath from ventilator
- Ventilator assists with supporting pressure
- Pt factors decide the VT
- indicated for synchrony, weaning, assistance to overcome tube resistance - 11MMV -mandatory minute ventilation
- Allows spontaneous breathing with automatic adjustments of mandatory ventilation to meet the pts present minimum minute volume requirement.
- If pt maintains minute volume settings for VT, no mandatory breaths are delivered - 12MMV cont- if pt minute volume is insufficient, mandatory delivery of preset tidal volume will occur until minute volume is achieved
- 13Modesat time of connection a mode of ventilation will be chosen
- 14MODES CONTSIMV 600 X 12 PS 20 P5 FIO2 100%
SIMV = synchronised intermittent mandatory ventilation
ventilator modes are either
mandatory - pt will receive a vent, breath
spontaneous - pt is initiating the breath and receiving assistance from the ventilator - 15Tidal volumeamount of gas moved in a respiratory cycle, measure in mls
normal VT - 5-8ml/kg less than 5 may need for ventilation - 16PSpressure support, is the level of support ventilator will provide if the patient initiates their own breath
normal ranges are 10-20h20 - 17PEEP contimproves potential for gas exchange
improves FRC through alveolar recruitment and reducing alveolar collapse
improves pa02 by improving V/Q mismatch - 18PEEPPositive end expiratory pressure, how much pressure remains in the alveoli at the end of expiration, maximises the potential for diffusion
normal range: 5-10 - 19FRCfunctional residual capacity
amount of air remaining in the lungs following a normal expiration
FRC = 2300mls in normal lung - 20PEEP contis atmosphere pressure higher than zero at the end of expiration
- 21Intrinsic PEEPalso called autoPEEP, PEEPi
- consequence of disease process, eg asthma, gas trapping - 22Auto - PEEPincomplete expiration has occured, gas has trapped, prior to delivery of next breath
- 23I:E ratioincorrect application of I:E ratio will predispose patient to gas trapping
normal I:E 1:2
may be changed in conditions such as asthma to extend expiratory time eg 1:4 - 24Inverse ratio ventilationexpiratory time is greater than inspiratory time
-induces PEEP
- deliberate gas trapping to recruit alveoli
- may only be used when other respiratory measures have failed
- Barotrauma - significant risk - 25Extrinsic PEEP- external applied PEEP through a ventilator
- closed circuit suction - maintain PEEP throughout suction - 26FI02fraction of inspired oxygen
the percentage amount of oxygen being delivered to the patient
range 21-100% - 27Determination of FI02aiming for PAO2 of 60-100mmHG
ABG guides FI02 after 15 - 30 mins of higher level eg. 100%
IF FI02 cannot maintain oxygenation PEEP is indicated
The best FIO2 is the minimum required to provide an adequate PA02 - 28Work of breathingthe energy required to take a breath
WOB = p x v
measure of amount of pressure that must be generated to move a certain volume of gas - 29Nursing care of ventilated ptcorrect circuit disconnections
provide suction
monitor ventilator effects
observe complications of ventilation
check order against ventilator
check ETT length
check pilot balloon
maintain ABGs, Sao2
maintain adequate nutrition
care as for unconscious pt, mouth, eye care, oral suction
manage pain
neurological obs - 30Nursing care chartingVT - vent and pt
RR - vt and pt
level of PEEP
airway pressure
compliance - 31Airway pressuremeasure of pressure withint the patients airwar
- 32Complications of mechanical ventilation barotrauma (volutraume)injury to lung as a result of over distenstion of lung tissue, either too much volume or too much pressure
ie. alveolar injury
- pts at risk
- high airway pressure
- emphysema, asthma
- ARDS
- high levels of PEEP - 33To avoid alveolar injury- use small VTs
- monitor alveolar pressure below 35cm H20
- avoid RMB intubation
- avoid high functions that have large volumes
- monitor for PEEP - 34Manifestations of barotrauma- pneumothorax
- simple pneumothrorax
- avoid further large volumes/pressure - 35Surgical emphysemasubcutaneous (surgical) emphysema
pnumomediastinum - collection of air in the mediastinum (ie between the lungs) secondary to alveoli rupture
- can occur in isolation or together with pneumothorax - 36Complicationsalteration in CO - monitor urine output
- aspiration, pneumonia, ARDS
endotracheal tube - physical pressure, tracheal stenosis - 37Weaningshould begin after intubation
requires correction of underlying pathology
maintaining muscle strength and nutrition - 38Assessment for weaningconsider
- resp function, vent support
secretions, drugs, abgs - ph normal
FIO2 - less than 5
PEEP - less then 5cm H20
VT - guided by pt - 39VCvital capacity
- is a reflection on the muscle/lung strength normal VC 65-75ml/kg
the total amount of air that can be exhaled after maximum inspiration - 40Non- invasive ventilationCPAP, BIPAP - used to avoid intubation
- also has risks of barotrauma - 41CPAPContinous positive airway pressure
- relies on spontaneous effort of the patient
- the application of constant pressure, above surrounding atmosphere throughout the respiratory tubing and resp cycle
- increased FRC, reduce WOB, reduce atelactesis - 42Contraindications to CPAP- untreated pneumothorax
- hypovolamia
- patients with elevated ICP
- lung condications such as emphysema, as significnat changes to lung structures may have already occured - 43BIPAPBilevel positive airway pressure
- delivers CPAP but also ensures senses when an inspiratory effort is being made and delivers a higher pressure during inspiration
- has an inspiratory (IPAP) and expiratory pressure (EPAP) - 44NURSING CARE CPAP/BIPAPensure you know correct settings
set CPAP levels prior to patient connection
ensure tight seal obtained with mask
- observe for pressure areas
- check gastric distenstion, pt swallowing air - 45other modes- high frequency delivery of high rate, small volume neonatal care
- ECMO - extracorporeal membrane oxygenation - blood is circulated outside of body and perfused with oxygen
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- User has deleted their subject information Flashcards on mechanical ventilation, created by Deleted user on 29/08/2018.
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- Created by Elizabeth Then · Aug 28, 2018
- Copied by Elizabeth Then · Aug 29, 2018
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