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18 Cards in this Set
- Front
- Back
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INDICATIONS FOR MECHANICAL VENTILATION |
-Clinical signs that pt. is unable to maintain: airway adequate oxygenation or ventilation -RR >30/min -Arterial O2Sat < 90 % with FiO2 > 0.60 PaCO2 > 50 mmHg with pH < 7.25
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Normal inspiration generates (-) intrapleural pressure |
In mechanical ventilation, the pressure gradient results from (+) pressure |
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END EXPIRATORY IN THE ALVEOLI |
is normally the same as atmospheric pressure |
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INTRINSIC PEEP |
Failure of the alveoli to empty d/t airway obstruction, airflow limitation, or softened expiration time may --> (+) end expiratory pressure |
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VOLUME-CYCLED VENTILATION |
Includes both volume control (V/C) and synchronized intermittent mandatory ventilation (SIMV) Ventilator delivers a set tidal volume |
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V/C |
Each inspiratory effort triggers delivery of a foxed tidal volume. If the pt. doesn't trigger the vent often enough, the vent initiates one |
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SIMV |
Unlike V/C, pts. efforts above the set RR are unassisted. |
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PRESSURE CYCLED VENTILATION |
Includes pressure control ventilation (PCV) and pressure support ventilation (PSV) & includes several noninvasive modalities via face mask, all of which deliver a set inspiratory pressure. AHRF, ARDS |
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PCV is a pressure cycled form of A/C |
Each inspiratory effort beyond the set theshold delivers full pressure support for a fixed interval & a minimum RR is maintained |
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PSV |
All breaths are triggered by the pt. Commonly use to liberate pt. from the vent by allowing them to assume more of the WOB |
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NONINVASIVE POSITIVE PRESSURE VENTILATION |
CPAP or BIPAP BIPAP both the ex. positive airway pressure & the inspiratory positive airway pressure is set by the MD but the respiration are triggered by the pt. Avoid in hemodynamically unstable & those with impaired gastric emptying eg ileus, bowel obstruction, pregnancy & obtunded pts |
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MINUTE VENTILATION |
The amount of air a person breathes in a minute 8 to 10 ml/kg Tidal volume and RR Too high a rate-> hyperventilation & alkalis Too low a rate -> hypo ventilation & acidosis |
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THERAPEUTIC PEEP |
May limit the atelectasis that frequently accompanies ET intubation, sedation, paralysis, & supine positioning Peep may improve oxygenation and may permit lower FiO2 PEEP increases intrathoracic pressure and so may impede venous return |
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PATIENT POSITIONING |
Typically with the pt. In the semi upright position ARDS pts. may be better oxygenated in the prone position by creating more uniform ventilation thereby reducing the amount of shunt |
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SEDATION & COMFORT |
Sedation may be needed to minimize stress & anxiety and may reduce energy expenditure -> less CO2 production & O2 consumption |
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COMPLICATIONS OF MECHANICAL VENTILATION |
VAP Tracheal stenosis Vocal cord injury Tracheal esophageal fistula Tracheal vascular fistula |
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VAP: PATHOGEN ENTRY TO THE LOWER RESPIRATORY TRACT |
Inhalation of aerosols Handling of airways & vent circuits Micro aspiration of oropharyngeal secretions Hematogenous spread Translocation from GI tract |
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VAP |
Infection rate of 22.8% GOOD HAND WASHING is the 1° way to prevent contamination of resp. equipment Keep manipulation of the airway & vent system to a minimum |
