E

normal VC

65-75

acceptable VC

>10

unacceptable VC

<10

normal MIP/NIF

80

acceptable MIP/NIF

20

unacceptable MIP/NIF

<20

normal VD/VT

20-40%

acceptable VD/VT

<60%

unacceptable VD/VT

>60

normal cst (static compliace)

60-100

acceptable cst

>25

unacceptable cst

<25

normal A-a DO2 100%

25-65

acceptable A-a DO2 100%

66-300

unacceptable A-a DO2 100%

>300

normal Qs/Qt

<5%

acceptable Qs/Qt

<20%

unacceptable Qs/Qt

>20

treatmeant for unacceptable A-a or shunting

increase FiO2 or PEEP

inital setting for VT

5-10 of ideal body weight

inital setting for PC

Pplat from VC

achieve VT

or <35

IBW formula

50 + (2 x in over 5ft)

infant MV setting VT

4-6

infant MV setting PIP

20-30

infant MV setting RR

20-30 breaths

infant MV setting FiO2 pt on room air

40-60

infant MV setting PEEP no info

2-4

infant MV setting peep on cpap

set at same level prior to ventilation

dynamic compliance formula

VT/ PIP-PEEP

static compliance formula

VT/ Pplat-PEEP

mean airway pressure with patients with normal compliance and resistance

5-10

mean airway pressure with patients with obstructive disease

10-20

mean airway pressure with patients with ARDS

15-30

mean airway pressure primarily effects

oxygenation

patients with IRV should be

paralyzed and sedated to allow the ventilator to control the breathing pattern

IRV I:E ratio starts with

2:1 or greater

HFOV

improves oxygenation in patients with severe lung injury, such as ARDS

when you wish to normalize a high PaCO2 you should

• remove deadspace

• increase VT or PIP

• increase RR

normalize a low PaCO2

• evaluate the cause (hypoxemia, pain, fever)

• decrease RR

• decrease VT or PIP

increase a low PaO2

• FIRST increase FiO2 by 5-10%

• THEN increase PEEP by 2-5

decrease a high PaO2

• FIRST decrease FiO2 to less than 0.60

• THEN decrease PEEP

ARDS VT

inital 6 then reduce to 4

ARDS pplat

<30

with ARDS consider what

permissive hypercapnia and subsequent respiratory acidosis

if the patient has ARDS swith from VC to what

PC

• low compliace and high ventilating pressure

what is a recruitment maneuver

sustained increase in pressure in the lungs with the goal of opening as many collapsed lung uits as possible

most common RM

increase to a high level of PEEP for a short period of time

RM PEEP

PEEP to 40 for 40 seconds

RM CPAP

CPAP 20 for 20 seconds

what should be consider for patients with ARDS/ALI

prone

FiO2 and PEEP when proning

• FiO2 >60

• PEEP >12

P/F ratio <200

consider proning

when does auto-peep occur

there is incomplete exhalation and air is trapped in the lungs caused by insufficient expiratory time

how to fix bird beak

reducing VT or PIP

advere effects of AUTO-PEEP

• decreased venous return

• increased ICP

• overdistenion of alveoli

auto-peep can be fixed by

• decrease inspiratory time

• increase flow rate

• increase expiratory time

• consider changing modes

• consider sedation

asynchrony

occurs when the patients inspiratory requirements for flow and voulme are nto emt by the ventilator, resulting in an increased work of breathing

types of asynchrony

trigger caused

auto trigger

causes of trigger caused asynchrony

• auto peep

• inappropriate trigger setting

• weak patient effort

correct for trigger caused asynchrony

adjust trigger setting

causes of auto trigger

• leak in circuit or airway

• inappropirate trigger setting which is too sensitive

• condensation in vent circuit

• boudning pulse or cardiac movement

correct for auto trigger

recongize and adjust trigger sensitivity

sedatives

decrease anxiety and promote relaxation

anesthetics

reduces patients ability to perceive sensation

analgesics

reduce sensation of pain

neuromuscular blocking agents

cause paralysis of skeletal muscle

RSBI

<100

weaning RR

8-20

weaning VC

>10

weaning min vent

<10

weaning spon VT

>5

weaning MIP/NIF

-20

weaning MEP

40

clinical measurements for weaning A-a DO2

<300

clinical measurements for weaning Qs/Qt

<20%

clinical measurements for weaning VD/VT

<60%

SBT/SAT

• best method to evaulate weaning

• administer CPAP with or without PSV

min SBT

30 mins

max SBT

2 hours

when are patients considered vent dependent

3 months of failed weaning attemps

indications for NPPV

• COPD

• CHF

• DNI

contraindications for NPPV

• CPR

• upper airway obstruction

• unable to protect airway (aspiration, dysphagia)

• unable to clear secretions

• facial/head trauma

• uncooperative patient

advantages of NPPV

• avoids VAP

• avoids complications of artfical airway

• avoids complications of MV

IPAP inital setting

8-12

EPAP inital setting

4-6

restrictive

lungs are too stiff and cannot expand

can get air in but not out

compliance

how easily the lungs stretch/expand

anatomical deadspace

voulme of air that you breath in that stays in the airways and never reaches the alveoli

airway resistance

how much the airways resist /block airflow as air moves in and out

• wide airway, low resistance, air moves easy

• narrow airway, high resistnace, air has trouble moving

high mean airway presure impairs

cerebral venous return