Mechanical Ventilation Flashcards

Flashcards about mechanical ventilation

What does a ventilator do?

FiO2 in & out of the lungs with mechanical ventilation. Controls the volume & duration of breaths throughout the respiration cycle. Can take over breathing function completely. Settings can allow the right volume of gas/air exchange (CO2/O2). Not curative, supportive therapy & sometimes a bridge until patient can breathe on their own.

What are the indications for ventilator use?

Apnea, impending inability to breathe, or protect the airway, Trauma patients, Acute respiratory failure, Pneumothorax, COPD, PNA, ARDS, Severe hypoxia, Respiratory muscle failure, Surgery

What are the goals of mechanical ventilation?

Prevent lung injury, Ventilation, Oxygenation

What is intubation?

Insertion of endotracheal tube (ETT). Performed to place patient on ventilator. Anesthesia, sedation, severe illness

What is positive pressure ventilation?

Acutely ill patients. Inspiration = air pushed into lungs with + pressure (increases intrathoracic pressure). Passive expiration. Volume or pressure ventilator. Volume: predetermined tidal volume (VT) with inspiration, Pressure varies based on compliance & resistance. Pressure: peak inspiratory pressure is pre-determined, VT varies & need to monitor

What is negative pressure ventilation?

Encase chest or body & surround with sub-atmospheric negative pressure. “iron lung” developed during polio epidemic. Pulls chest outward to decrease intrathoracic pressure. Passive expiration. Non-invasive, similar to normal respirations. Not for acutely ill patients. Could be used for ventilatory support at home

What are the ventilator settings?

Rate, VT, FiO2, PEEP, pressure support, I:E ratio, inspiratory flow, sensitivity, high pressure limit

What is control ventilation?

Vent delivers preset volume or pressure regardless of patient inspiratory effort. Indicated for severe neurological conditions, deep sedation, shock, severe respiratory failure

What is Assist Control Ventilation (ACV)?

Vent delivers preset VT at preset frequency. Set VT, RR, FiO2, PEEP. Patient can initiate breaths but full VT delivered. Patient can breath faster but not slower. Some controlled & some assistance with breathing. Used for neuromuscular disorders, pulmonary edema, acute respiratory failure. Potential for hyperventilation (respiratory alkalosis). Too many set and/or initiated breaths by the patient

What is Synchronized Intermittent Mandatory Ventilation (SIMV)?

Vent works in synchrony with patients spontaneous breathing. Looks like ACV if patient not taking spontaneous breaths. Set VT, RR, FiO2, PEEP, & pressure support. Preset FiO2 with spontaneous breaths but patient self-regulates rate & VT. Different from ACV. Used for continuous ventilation or weaning, partial ventilatory support. Improved patient-vent synchrony. Prevents muscle atrophy – patient can take over breathing

What is Pressure Support Ventilation (PSV)?

Patient with spontaneous respirations & must be able to initiate a breath. Pressure preset (10/5 or 5/5). Set FiO2, PEEP, pressure support. Patient determines inspiratory length, VT, and respiratory rate. “trial” before extubation. Risk for hypoventilation & apnea so NOT used with acute respiratory failure

What is Continuous Positive Airway Pressure (CPAP)?

Spontaneous breathing anytime with preset continuous + airway pressure. Similar to PEEP. Expressed as cm H2O. 5-35 but not more than 20 in acutely ill patients. Used to treat OSA = nocturnal hypoxia from collapse. Delivered via mask for ETT. Increased WOB, patient must forcefully exhale

What is Bilevel Positive Airway Pressure (BiPAP)?

Patient needs to spontaneously breath. Use with COPD patients with HF, acute respiratory failure, or sleep apnea. Two Pressure settings: ipap and epap. ipap 5-25/30 (help with ventilation). epap 0 to something less than ipap (like CPAP/PEEP). Use prior to intubation & ventilation

What is Positive End-Expiratory Pressure (PEEP)?

• pressure applied with exhalation at present level 3-20 cm H2O. Causes > lung volume with expiration & between breaths to increase functional reserve and oxygenation. Titrate to increase oxygen without hemodynamic compromise. 5 cm H2O PEEP is physiologic PEEP. Increases gas exchange, vital capacity, & inspiratory force with weaning. Purpose is to maintain or improve oxygenation while limiting oxygen toxicity. Used for all vented patients. Caution use in patients with increased ICP, decreased CO, & hypovolemia

What are the initial ventilator settings?

Mode: Reason, Sedation, and workload of breathing. FiO2: 30-100%. Rate: 10-18 Breaths per minute. Tidal Volume: 4-10 mL/kg (predicted body weight). PEEP: 5cm H2O or higher

What are the complications of positive pressure ventilation?

↑ intrathoracic pressure = compression of thoracic vessels. See ↓ venous return, preload, & CO = hypotension. Barotrauma, Ventilator Associated Pneumonia (VAP). Fluid retention 48-72 hours with PPV (esp PEEP), ↓ UO with ↑ sodium retention, ↓ CO = ↓ renal perfusion, stress response. Stress ulcer & GI bleed risk; ↓ CO with PPV may cause GI ischemia

What are the phases of weaning a patient off a ventilator?

3 Phases: 1. Pre-weaning & Assessment: Determine patient’s ability to breath spontaneously. Is primary problem resolved? CXR should be clear. Assess muscle strength, endurance, neuro status, hemodynamics, fluid balance, electrolytes, acid-base balance, nutrition, Hgb. Spontaneous Awakening Trial (SAT) — will not do it for more than 1 or 2 hours. Spontaneous Breathing Trial (SBT). 2. Weaning – per facility protocol. 3. Outcome – extubate or no progress: Hyperoxygenation & suction prior to extubation

What information should be included in a RN to RN shift report for a vented patient?

Size of ETT: 2-5 infants and children, 6-8.5 adults. Lip Marker: Example: 23 at the lip. Mode of ventilation. FiO2. Rate. Tidal volume (VT). PEEP

What nursing care is required for an intubated patient?

Check vent settings & alarms every shift. Empty vent tubing of collected moisture. Respiratory assessments Q4/PRN and/or per hospital policy. VS Q1 or per hospital policy. Mouth Care Q4 or per hospital policy. Check inflation of trach/ETT cuff. Suction Q shift/PRN or per hospital policy. Move ET T to opposite corner of mouth Q shift or per hospital policy. I/O - monitor fluid balance. Turn q2/PRN. Skin integrity, with restraints also