Term
|
Definition
| A condition where the resp syst fails to maintain its principle function : adequate oxygenation of arterial blood and removal or elimination of CO2 |
|
|
Term
| normal blood gas at Sea Level |
|
Definition
Ph- 7.35 to 7.45
PACO2 35-45 mmhg
HCO3 22-25 meq/l
PaO2 80-100 mmhg
the higher the altitude..the lower the PO2 |
|
|
Term
|
Definition
PaO2< 60 mmhg
PaCO2> 50 mmhg
ph 7.35-7.45
HCO3 22-26 mmhg |
|
|
Term
| Compensation in Chronic RF |
|
Definition
1.changes in Resp pattern(v/q)
2.use of accessory muscle
3.hyperventilation-ventilate greater than needed for metabolism
4.circulatory adjustment(to increase O2 transport
5.alteration in blood (collateral circulation) incr HGB
6.Renal compensation (incr HCO3 to correct acid base balance)
7. decr physical activity |
|
|
Term
|
Definition
1.Rapid onset
2.No Compensation
3.Inadequate tissue/organ perfusion
4.severe acid base disturbance (PH) |
|
|
Term
|
Definition
PaO2<60mmhg (low)
PaCO2> 50mmhg (high)
PH decr 7.35-7.45 decr acidosis
HCO3 normal |
|
|
Term
| 3 types of Respiratory Failure |
|
Definition
1.Ventilatory Failure
2.hypoxemic-hypercarbic RF
3.Hypoxemic RF |
|
|
Term
|
Definition
1 ventilatory fails in the presence of normal lungs.
2.Pure Alveolar hypoventilation ( lungs are normal but simply not breathing
3.Normal AaDO2, less than 10mmhg |
|
|
Term
|
Definition
depressed resp center
1. CNS depressant Drugs
2.Cerebral Tumors
3. Cerebral trauma(resp center in brain not sending signal to diaphragm to work.
Insufficient Chest Wall function
1. Neuromuscular Disease
2. Trauma
3. Kyphoscoliosis
4. obesity/pregnancy
5. Neuromuscular blocking agents
Sleep Apnea
1. central- brain doesnt send out signal to breath
2. obstructive
3. mixed |
|
|
Term
|
Definition
1. inability to excrete CO2
2. marked V/Q imbalance with airtrapping
3. hypoxemia
4. hypocarbia |
|
|
Term
| hypoxemic-hypercarbic RF causes |
|
Definition
Copd
1. cystic fibrosis- disease of sweat glands and mucous glands
2. Bronchitis(chronic)
3. Asthma
4. Bronchiectasis
5. Emphysema(cant exhale, CO2 buildup) |
|
|
Term
|
Definition
1. inability to oxygenate arterial blood
2. ventilate ok(PaCO2 normal or Incr
3. PaO2 decr, AaDO2 incr |
|
|
Term
|
Definition
1. Pulmonary Edema
2. Atelectasis
3. Lung injury
4. ARDS
5. Pulmonary Fibrosis |
|
|
Term
| precipitating or exacerbating factors |
|
Definition
1. changes in the TB secretions
2. infections
3. disturbance of TB clearance
4. Drugs
5. inhalation or aspiration of irritants, vomitus or foreign bodies
6. cardiovascular disorders
a. pulm embolism
b. shock
7. mechanical factors
a. pneumothorax
b. pleural effusion
c. abdominal distension/obesity/pregna
8. trauma surgery
9. allergic disorders
a. bronchospasm
10. incr O2 demand
a. fever
b. infection
c. seizure
11. inspiratory muscle fatigue |
|
|
Term
|
Definition
| A collection of air or gas beneath the layers of the skin |
|
|
Term
|
Definition
| Distensibility (stretchiness) of the lungs, calculated by the formula vol divided by pressure and expressed as ml/cmh2o |
|
|
Term
|
Definition
| opposition to airflow determined by airway diameter and high flow rates, expressed as cmh2o/L/sec |
|
|
Term
|
Definition
| an instrument for measuring lung volumes. |
|
|
Term
|
Definition
| the tendency of the lungs to return to a resting state after being inflated |
|
|
Term
|
Definition
| amt of air passing into and out of the lungs in 60 seconds, usually expressed in liters |
|
|
Term
|
Definition
| accumulation of air in the pleural space, resulting in collapse of the lung on the affected side. |
|
|
Term
|
Definition
| an instrument for measuring the pressure of the liquids or gases |
|
|
Term
|
Definition
| amt of gas passing into and out of the lungs in each resp cycle, usually expressed in milliliters |
|
|
Term
|
Definition
| the portions if the resp tract that are ventilated but not perfused by the pulmonary circulation;includes anatomical and alveolar |
|
|
Term
|
Definition
| presence of gas or air in the sac surrounding the heart which may interfere with the cardiac pumping ability. |
|
|
Term
|
Definition
| An I:E ratio where the inspiratory time is longer that the expiratory time. |
|
|
Term
|
Definition
| a mechanism in a MV through which the patient exhales; this mechanism must close to allow inspiration |
|
|
Term
|
Definition
| the portion of the cardiac output that returns to the left side of the heart without being oxygenated, I:E blood that perfused the lungs but did not participate in gas exchange; includes anatomic capillary |
|
|
Term
|
Definition
| MV maneuver where a vol of gas in delivered to the pt and kept in the lungs for a preset amt of time before expiration is allowed to occur. |
|
|
Term
|
Definition
| Presence of air or gas in the thoracic space containing the heart, trachea, and esophagus; it may interfere with respiration and circulation |
|
|
Term
|
Definition
| Signal from the brain to the Diaphragm via phrenic nerve(C3,4,5) |
|
|
Term
|
Definition
1. Acute resp failure, acute ventilatory failure, acute respiratory acidosis
2. impending resp failure- can see it coming
3. Apnea ( or absence of adequate ventilation)
4. inadequate oxygenation, not as common |
|
|
Term
T or F
MV does not cure the disease process |
|
Definition
|
|
Term
|
Definition
maintain adequate cardiopulmonary function with minimal side effects on other body systems
1. to allow pulm syst to recover
2. maintain bronchial hygiene
3. decr myocardial work
4. decr WOB
5. improve gas distribution
6. restore acid/base balance |
|
|
Term
|
Definition
HX
DX- diagnosis
physical assessment
ABG's
lung mechanics(nip,vc,vt etc.)
prognosis |
|
|
Term
| name 2 types of mechanical ventilation |
|
Definition
1. Negative pressure
2. Positive pressure (use this the most) |
|
|
Term
| Negative Pressure was first used in the 1940's for ______ patients. |
|
Definition
|
|
Term
| name 3 approaches that apply extrathoracic negative pressure which is trnasmitted through the chest wall to alveolar spaces causing airflow to lungs |
|
Definition
1. iron lung
2. chest cuirass
3. pneumosuit |
|
|
Term
| name some neg pressure cons |
|
Definition
1. large size
2. noisy
3. pt is inaccessible
4. hard to seal
5. not much adjusting possible
6. pooling of blood in the abs(tank shock) |
|
|
Term
| Neg pressure ventilation advantages |
|
Definition
1. easy to use
2. dependable
3. No ETT needed
4. pt can talk, eat, drink
5. fewer physiologic side effects than PPV |
|
|
Term
|
Definition
It inflates the bladder pushing the abdominal contents up moving the diaphragm...helping expiration.
can acheive Vt up to 300 ml
its a pt ventilatory assist device
advantage: noninvasive |
|
|
Term
| whats the rocking bed do? |
|
Definition
supports ventilation by rhythmically moving the diaphragm and abdominal contents by rocking bed
Vt up to 500 ml
rates up to 30/min
can cause motion sickness |
|
|
Term
| explain positive pressure ventilation |
|
Definition
important that you must create a pressure gradient for air to flow.
Neg pressure vents create positive pressure by lowering alveolar pressure relative to ambient pressure
Positive Pressure vents create positive pressure by raising pressure outside the mouth higher the alveolar pressure
measuring ventilating pressure in CMH2O |
|
|
Term
| explain positive pressure |
|
Definition
| PPV occurs when a system literally blows air into patients lungs...the pressure must be high enough to overcome elastic forces of lung, chest wall and resistance. |
|
|
Term
T or F
PPV is not natural. |
|
Definition
|
|
Term
| PPV can be invasive and non invasive...give example of both |
|
Definition
invasive- (ETT)
noninvasive- (face mask, nasal mask, mouthpiece and face shield) |
|
|
Term
| PPV pressures are measured at the.....(3) |
|
Definition
1. mouth
2. circuit
3. ventilator |
|
|
Term
| The best place to measure positive pressures is...... |
|
Definition
|
|
Term
|
Definition
Pressure at end- expiration.
normally 0 cmh20(atmospheric.
can be > 0 cmh2o is PEEP(positive end expiratory pressure) set by operator= intentional=extrinsic
unintentional is intrinsic which is auto peep. ( our fault)if set wrong then can cause barotrauma and airtrapping |
|
|
Term
|
Definition
| the highest pressure attained during inspiration(doesnt have to be end pressure) |
|
|
Term
|
Definition
|
|
Term
|
Definition
No GAS flow during plateau
pressure during inspiratory hold
1.IS part of T1 because no gas flow during
2. good impression on alveolar pressure, the hold takes away the praw and allow you to measure PA.
PIP= Pplat + Praw
Praw= 5 cmh2o = pressure lost in airways
Pplat= pressure for gas exchange |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| ave pressure throughout the respiratory cycle. its a funtion of the amount of pressure and duration of pressure. Important in infants and children. |
|
|
Term
| Mean airway pressure is determined by |
|
Definition
| pip, eep, RR, I:E ratio(Ti and Te), ventilation mode, inspiratory waveform, flow |
|
|
Term
T or F
FIO2 effects mean airway pressure |
|
Definition
|
|
Term
| what are the volumes measured for MV |
|
Definition
1. inspired Vt
2. expired Vt
3. minute volume
note: the gas that comes in and the gas that goes out have to be close to equal |
|
|
Term
| T or F according the Mean Airway pressure...if PaO2 goes up then MAP goes up and if MAP goes up then side effects go up |
|
Definition
|
|
Term
| T or F all the airway under the curve is mean airway pressure. |
|
Definition
|
|
Term
| describe Pneumatic power source |
|
Definition
Use only "compressed gas for power
50 psi pressure reduced to safe level
Compressed gas source lost"no ventil"
2 types
"pneumatic"
▪ Needle valves, injectors, diaphragms, spring-loaded valves
to control gas flow, timing & volume delivery
"fluidic"
▪ Uses fluidic principle (Coanda Effect) to control functions |
|
|
Term
| Describe electric power source |
|
Definition
Operate by "electricity" alone
Use compressed O2 only to ↑ FIO2 > 0.21
Gas source lost vent will ventilate but
_____________________
Compressors, fans, bellows, solenoids to provide
gas flow |
|
|
Term
| describe combined power source |
|
Definition
Uses both "electricity and gas" to
operate
Electricity to control functions
Compressed gas to provide energy for gas flow
Lose either "no ventilation" |
|
|
Term
| List 7 types of drive mechanisms used to generate inspiratory force. |
|
Definition
. Compressor
. Volume displacement or Bellows
. Linear Driven piston
. Rotary Driven Piston
. proportional solenoid valve
. Control panel
. volume controller
. flow controller |
|
|
Term
| whats the difference between single vs double internal circuits |
|
Definition
| on single circuit, gas from the source goes directly in one flow to the patient. On Double circuit gas goes from the source causes a secondary mechanism to compress causing a secondary flow that goes to the patient. |
|
|
Term
| describe a mandatory breath |
|
Definition
• = machine (time)-cycled breath
• Initiated by ventilator
• Ended by ventilator
• Vent performs all of the WOB
• = full ventilator supported breath |
|
|
Term
|
Definition
• Initiated by Patient
• Ended by ventilator
• The only WOB patient does is triggering inspiration,
vent does the rest
• = partial ventilatory supported breath |
|
|
Term
| describe spontaneous breath |
|
Definition
• = patient breath
• Initiated by patient
• Ended by patient
• Patient does all the WOB
• Much like nebulizer blow-by, i.e vent is only providing
humidity, heat, FIO2, EEP
• = no ventilator support |
|
|
Term
| List mechanical ventilator control variables. |
|
Definition
1. volume
2. inspiratory time
3. flow
4. pressure |
|
|
Term
| Discuss the Flow vs insp time relationship |
|
Definition
• flow delivered for a period of time will result in a
volume
VT(L) = flow (L/s) x IT (s)
VT = flow divided by 60 x IT |
|
|
Term
| discuss the flow vs pressure gradient relationship |
|
Definition
• Depends on the difference in pressure between the
power source, ventilator & the pressure in the lungs
• i.e the greater the pressure gradient the greater the
flow rate that can be achieved
• Clinically important because different vents are capable
of different high-end flow rates |
|
|
Term
| describe the pressure vs lung compliance relationship |
|
Definition
| stiff lungs inflated with Vt of 500 would have more pressure in them then stretchy lungs with a vt of 500. |
|
|
Term
| describe the pressure vs volume delivered relationship in lungs |
|
Definition
| normal lungs with a vt of 1000 would have more pressure in them then normal lungs with vt of 500 |
|
|
Term
| describe the pressure vs airway resistance relationship in lungs |
|
Definition
| lungs inflated with vt of 500 that has an airway with lots of secretions would have more pressure in them then lungs with a vt of 500 that has no secretions on the airway |
|
|
Term
| what are 4 things that would cause resistance to gas flow |
|
Definition
1. diameter to the airway
2. bronchospasm
3. secretions
4. edema and swelling |
|
|
Term
| What do phase variables do? |
|
Definition
| they are used to change phases of ventilatory cycle |
|
|
Term
| Any breath can be described in detail by answering 4 simple questions |
|
Definition
1. What causes the breath to begin?
2. What happens during inspiration?
3. What causes the breath to end?
4. What occurs during exhalation |
|
|
Term
| Describe Trigger Phase variable |
|
Definition
• Causes vent to begin inspiratory phase
• 3 types:
• Time
• Patient effort
• Negative pressure
• Flow
• Manual |
|
|
Term
|
Definition
• Vent initiates inspiration at an operator-selected time
(w/o regard to Patient effort)
• “Cycle rate”, “BPM”, “Respiratory Rate” controls all set
Total Cycle Time (TCT, TC)
TC = IT + ET
TC=60sec divided by RR |
|
|
Term
| Describe "patient/Neg pressure" triggering |
|
Definition
• Patient effort causes _____________ pressure
• At the negative pressure (Sensitivity) set by the
operator, vent begins inspiration
• Normally set at -1 or -2 cmH2O |
|
|
Term
Is ventilator more “sensitive” at -5
cmH2O or -1 cmH2O? |
|
Definition
|
|
Term
re: patient/neg pressure trigger
time between patient effort and response of ventilator is ?
this is measured in ? |
|
Definition
|
|
Term
| incr response time is incr on patient |
|
Definition
|
|
Term
| reasons why is "flow" triggering is better |
|
Definition
• Base flow & flow sensitivity is preset on most vents
• Flow-triggering greatly reduces the WOB because as
the patient begins the insp effort, gas is available,
instead of having to create neg. pressure & maintain
that pressure until a demand valve opens
(it doesnt have to wait) |
|
|
Term
| describe the settings on "flow" trigger" |
|
Definition
• Newest method
• Set “base flow”
• Continuous flow through circuit
• ~ 10 LPM
• Set “flow sensitivity”
• = how much flow patient must pull from circuit for vent to
begin inspiration
• 1 - 3 LPM |
|
|
Term
| describe " Manual" trigger |
|
Definition
• Some vent have a “Manual Inspiration” button/dial/pad
to initiate an inspiration at the volume/pressure
parameters set |
|
|
Term
| when would you use "manual" trigger? |
|
Definition
1. hyperventilation
2. hyperventilation to decr ICP |
|
|
Term
| name 4 things that cause the ventilator to end inspiration |
|
Definition
1. volume cycling (ML or L)
2. pressure cycling (cmh2o)
3. time cycling (sec)
4. flow cycling (L/M) |
|
|
Term
| describe "volume" cycling |
|
Definition
• Inspiration ends when a preset "volume"
has been delivered to the patient circuit
• If no leaks are present - every breath is the same
volume
• Pressure generated is variable from breath-to-breath
depending on lung characteristics (CL, RAW) |
|
|
Term
| How is ventilator set for this? |
|
Definition
• Set VT (ml) (can set 2 of the 3)
Set flow rate of gas (lpm)
• Setting these parameters sets the TI(inspiratory time)
• = volume-cycled(set), flow-limited ventilation(limited because its set)
. formula used is Vt(L)=flow(l/m)/60 x Ti (know that every breath is the same) |
|
|
Term
|
Definition
• Inspiration ends when a preset Ti
has elapsed
• Every breath is the same TI
• Can be volume-targeted or pressure-targeted (vent. will deliver vol and flow to reach that Pressure) |
|
|
Term
| describe "volume ventilating" using time cycling |
|
Definition
• Set TI (% TC)
Set VT (ml)
• Setting these parameters sets the gas flow rate (lpm)
• = time-cycled, flow-limited ventilation
. important: if vol is set then pressure happens and could vary meaning it can change from breath to breath.
. if you set 2 parameters then the third is automatically set...ex: if you set Ti and vol then flow is automatically set |
|
|
Term
| describe " pressure ventilating" using time cycled |
|
Definition
• Set TI (% TC)
Set Insp Pressure (cmH2O)
• = time-cycled, pressure-limited ventilation
**when you set pressure volume happens and can vary because of lung compliance and airway resistance. you set the ventilator but vol varies with each breath.
. know that time-cycled means that time ends the inspiration |
|
|
Term
|
Definition
• Inspiration ends when " inspiratory flow" drops to a
preset level (lpm)
• Pressure Support mode (PS)
***pressure supported breath is flow cycling***
=flow cycled, pressure- ventilated flow
***pressure set stays the same***
know for example that if inspiratory flow is set like to 25% then terminal flow is set to 25% of peep flow..in other words its set to end 25% of what peep flow was and inspiration varies from breath to breath.
on notes:
• In Pressure Support mode (PS), terminal flow is preset
• Inspiratory pressure level is also set
• Volume delivered is variable from breath-to-breath
depending on lung characteristics (CL, RAW)
• = flow-cycled, pressure-limited ventilation |
|
|
Term
| explain "pressure" cycling |
|
Definition
• Inspiration ends when a preset Presure
has been reached in the patient circuit
• Volume delivered, flow rate of gas & TI are variable
from breath-to-breath depending on lung
characteristics (CL, RAW)
• Bird IPPB machines
• = pressure-cycled ventilation |
|
|
Term
| patient circuit tubing is stretchy/compliant and stretches under pressure trapping volume..how much pressure gets trapped in tubing? |
|
Definition
|
|
Term
| whats the tubing compliance formula |
|
Definition
| VT= set Vt - (PIP-PEEP x tubing compliance) |
|
|
Term
T or F
leaks in system are impossible to avoid |
|
Definition
|
|
Term
| what is the "limit" during the inspiratory phase? |
|
Definition
| it means that phase is set. |
|
|
Term
| Give 3 reasons a patient does not receive the set volume when volume targeting ventilation. |
|
Definition
1. tubing compressed vol
2. leaks
3. spontaneous breathing |
|
|
Term
|
Definition
1. an instrument for measuring the pressure of liquids or
gases |
|
|
Term
|
Definition
accumulation of air or gas in the pleural space, resulting
in collapse of the lung on the affected side |
|
|
Term
|
Definition
| amount of gas passing into and out of the lungs in 60 seconds, usually expressed in liters |
|
|
Term
|
Definition
| the tendency of the lungs to return to a resting state after being inflated |
|
|
Term
|
Definition
| an instrument for measuring lung volumes and capacities |
|
|
Term
|
Definition
| opposition to airflow determined by airway diameter and high flow rates, expressed as cmH2O/L/sec |
|
|
Term
|
Definition
| distensibility ("stretchiness") of the lungs, calculated by the formula vol ÷ pressure and expressed as ml/cmH2O |
|
|
Term
|
Definition
| a collection of air or gas beneath the layers of the skin |
|
|
Term
|
Definition
| amount of gas passing into and out of the lungs in each respiratory cycle, usually expressed in milliliters |
|
|
Term
|
Definition
presence of air or gas in the thoracic space containing
the heart, trachea, and esophagus; it may interfere with respiration and circulation |
|
|
Term
|
Definition
| mechanical ventilation maneuver where a volume of gas is delivered to the patient and kept in the lungs for a preset amount of time before expiration is allowed to occur |
|
|
Term
|
Definition
| the portion of the cardiac output that returns to the left side of the heart without being oxygenated, i.e. blood that perfused the lungs but did not participate in gas exchange;includes anatomic and capillary |
|
|
Term
|
Definition
| a mechanism in a mechanical ventilator through which the patient exhales; this mechanism must close to allow inspiration |
|
|
Term
|
Definition
| an I:E ratio where inspiratory time is longer than expiratoy time |
|
|
Term
|
Definition
| presence of gas or air in the sac surrounding the heart which may interfere with cardiac pumping ability |
|
|
Term
|
Definition
| the portions of the respiratory tract that are ventilated but not perfused by pulmonary circulation; includes anatomical and alveolar |
|
|
