Mechanical Ventilation Initiation and Management

oxygenation

inverse ratio ventilation can be used to improve...

impending ventilatory failure

patient is tachypneic, tachycardic, flushed, diaphoretic, and using ventilatory muscles. CO2 is low and breaths are rapid and shallow. This is indicative of...

5 cc/kg IBW

normal tidal volume should be...

5 cc/kg IBW

tidal volume less than ______ cc/kg IBW indicated mechanical ventilation

12-20

normal respiratory rate

exhaustion, hypoventilation (ventilatory failure)

respiratory rate greater than 30 can lead to...

5-8 liters/min

normal minute ventilation

10 L/min

minute ventilation greater than ______ can indicate a high respiratory rate

10-15 cc/kg IBW

normal vital capacity should be between...

15 cc/kg IBW

vital capacity less than _______ may indicate mechanical ventilation

-20 cmH2O

maximum inspiratory pressure should be no more than...

-20 cmH2O

maximum inspiratory pressure greater than _____ indicates mechanical ventilation

35-45 mmHg

normal PaCO2

50 mmHg

PaCO2 greater than _______ mmHg indicates mechanical ventilation

300mmHg

what is the P/F ratio threshold for ALI?

200 mmHg

what is the P/F ratio threshold for ARDS?

-CMV

-A/C or SIMV *in absence of spontaneous breaths*

name 3 modes that can offer full ventilatory support

SIMV

name a mode that can offer partial ventilatory support

Pressure Support Ventilation (PSV)

SIMV must always be used in tandem with....

10-16 breaths per minute

the initial frequency setting should always be between...

near 40 mmHg0

for normal patients, what PaCO2 should we target?

near 50 mmHg

for CO2 retainers (COPD), what PaCO2 should we target?

increase frequency

how would we manipulate frequency to lower PaCO2?

decrease frequency

how would we manipulate frequency to raise PaCO2?

tidal volume X respiratory rate

minute ventilation formula

shortens E-time, which can lead to air trapping

how does excessive frequency affect E-time? what is a potential complication of this?

Increased Intracranial Pressure (ICP) (Traumatic brain injury)

when would we allow permissive HYPOcapnia?

acute respiratory distress syndrome (ARDS)

why would we allow for permissive HYPERcapina?

6-8 cc/kg IBW

what is the tidal volume range for mechanical ventilation?

4-6 cc/kg IBW

what is the tidal volume range for ARDS patients?

100%

what is the initial FiO2 setting?

P/F ratio:

PaO2/FiO2 = Desired PaO2/Desired FiO2

how do we determine the desired FiO2? Give the formula

-Increasing FRC

-Alveolar Recruitment

what are the 2 primary functions of PEEP?

0

what is the initial PEEP setting (in NBRC world)

any signs of cardiac embarrassment

what should we be cautious of when adding PEEP

-decreased cardiac output

-decreased urinary output

-decreased blood pressure

-increased heart rate

name 4 signs of cardiac embarrassment

60%

at what FiO2 is it acceptable to add PEEP?

-free radicals

-nitrogen washout

-decreased surfactant production

-termination of hypoxic drive in CO2 retainers

name 4 results of oxygen toxicity

1 : 1.5 to 1 : 4

what is the typical range for I:E ratio?

increase E-time

how can we fix air trapping on a ventilator?

increase flow rate

adjust flow rate to increase E-time

decrease frequency

adjust frequency to increase E-time

decrease tidal volume

adjust tidal volume to increase E-time

total frequency

should the frequency alarm be set based on the total frequency or set frequency?

40 ml/hour

what is normal urinary output?

(RR)(PaCO2) = (RR)(Desired PaCO2)

formula for desired PaCO2

extracorporeal membrane oxygenation

what does ECMO stand for

True

True or False: auto-PEEP increased work of breathing

LOW; Low circuit compliance maintains delivered tidal volume

should ventilator circuits have high or low compliance

Heat and Moisture Exchanger (HME)

temporary humidification device for the artificial airway

37 Celsius

what is the targeted temperature of the vent heater?