Mechanical Ventilation

what is a benefit of using heating high flow nasal cannula (HHFNC)?

no mask; therefore, the patient is more comfortable & able to speak & eat

when is HHFNC indicated?

- pneumonia

- hypoxemia

- NC > 10 lpm

- peds (bronchectasis)

what is the flow rate w/ HHFNC?

up to 40 lpm

- allowing for flush of deadspace gas = decreased WOB & RR

w/ HHFNC, O2 can be titrated between _______.

21-100%

w/ HHFNC, gas can be heat to 37*, what does this allow for?

improved secretion clearance

when is BiPAP indicated?

for hypercapnic & hypoxic respiratory failure

BiPAP ___________ the patient's spontaneous breathing

augments

what are the initial settings for BiPAP?

- IPAP: 15 cm H2O

- EPAP: 5 cm H20

- Rate: 12 bpm

- O2: 100% & titrate

does BiPAP control the patient's breathing like mechanical ventilation does?

NO, it is AUGMENTING what the patient is doing on their own

what is ▵P?

breath size/volume

increasing rate on BiPAP over ___ can cause asynchrony

20

should you use restraints on someone who is on BiPAP?

NO; CONTRAINDICATED!

CPAP alone may __________ WOB, but changing to BiPAP will give an inspiratory boost & may decrease WOB

increase

when is CPAP indicated?

- OSA

- pulmonary edema

- lung recruitment w/o hypercapnia

- if pt forgot theirs at home

oxygenation & ventilation issues usually go hand in hand when on BiPAP - due to what?

interface leaks & medication limitations

troubleshooting the patient on BiPAP:

- increase O2%

- change ▵P

- adjust rate

- titrate settings

- change mask

- assess for leaks

- assess pt triggers

- pain/sedation titration

- improve pt comfort

- change in medical or mental status

- time for mechanical ventilation?

should NIV (CPAP or BiPAP) be used in extreme hypoxemia?

NO

1 multiple choice option

should HHFNC be used for post-op patients?

NO

1 multiple choice option

consider these things in your decision to choose NIV or HHFNC:

- level of consciousness (GCS score)

- able to protect airway?

- acidotic?

- extreme hypoxia or hypercapnia?

- intubation may be the best option!

what should be monitored in a patient on mechanical ventilation?

- O2

- are they breathing? (assisted or controlled breath?)

- secretions (amount, color, consistency)

- PIP (trend this value, peak vs plateau)

what is the 1st parameter that you should increase when a patient is sick/respiratory status declines or decrease when they improve?

O2

what is positive end-expiratory pressure (PEEP)?

applied at end of expiration (air trapping on purpose)

- improves oxygenation & ventilation

how does PEEP improve oxygenation (PaO2) & ventilation (PaCO2)?

by opening & recruiting collapsed alveoli

PEEP also improves PaO2 by ___________ O2 into the blood

"pushing"

side effects of PEEP:

- decreased systemic blood pressure, CO, or venous return to the heart

- barotrauma (injury due to excessive pressure)

- increased ICP

ventilator parameters & settings

A/C VC+ =

assist control & volume control + flow

ventilator settings:

A/C VC+

A/C PC

spont/PS

what does assist control (A/C) mean?

- every breath given to the patient is the "right" breath

- there is a set target inspiratory volume which supports spontaneous breaths by the patient

- set vent rate is a minimum RR for patient

- each breath guaranteed at a set target volume

improved synchrony between ventilator & patient =

decreased sedation = less time on vent = less time in ICU

what does volume control (VC+) mean?

preset tidal volume is delivered at a set rate

- guaranteed volume in the presence of changing lung compliance

- variable flow to meet pt's inspiratory flow demands

A/C PC =

assist control & pressure control

what does pressure control (PC) mean?

ventilator delivers a breath to a set pressure & rate

- variable volumes & flow to meet pt's inspiratory demands

- inspiratory time is set/constant

spont/PS =

spontaneous mode w/ pressure support

what does spontaneous mode (spont) mean?

- ventilator set to rate of 0

- pressure support used to augment tidal volume (Vt/volume w/ each breath)

- PATIENT MUST HAVE A STABLE RESPIRATORY DRIVE

- ventilation will kick in during periods of apnea as a safety net

what does pressure support (PS) mean?

supports & augments patient's inspiratory effort

- pt controls RR, flow, volume & inspiratory time (IT)