Mechanical Ventilation: Questions and Answers for Medical Students, Exams of Nursing

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VENTILATORS (BCEN course) Questions and answers 2024 two categories indicating mechanical ventilation \correct answer✅pulmonary and nonpulmonary pulmonary indications: chronic \correct answer✅COPD (bronchitis and emphysema) asthma cystic fibrosis restrictive lung diseases pulmonary indications: acute \correct answer✅any condition that affects lung tissue has potential to precipitate respiratory failure: chest trauma pneumonia pleural effusion transfusion related acute lung injury ARDS aspiration SARS non-pulmonary conditions \correct answer✅any condition that threatens the patency of the airway or the CNS's ability to control ventilation vent can be used for a few hours or days when there is no problem with the lungs general anesthesia facial or airway procedures to protect against post-procedural swelling patients who cannot cooperate to facilitate proper exams: intoxication overdose anaphylaxis oral/pharyngeal abscesses or lesions epiglottitis foreign bodies angioedema long term conditions requiring ventilation \correct answer✅LT conditions with airway compromise, alterations in CNS's control of respiration, or respiratory muscle compromise: cervical spine injuries severe head injuries anoxic brain injuries coma amyotrophic lateral sclerosis guillain barre syndrome volume control \correct answer✅oldest mode ventilator delivers set volume of air regardless of how a breath is initiated or how high the pressure exerted within the lung becomes disadvantage: potential to overinflate the lung Assist Control (AC) \correct answer✅delivers a specific number of breaths a minute at a set volume if the patient initiates a breath, the ventilator will take over the breath and deliver the volume set pt receives guaranteed volume of air diadvantage: may receive too much air causing drop in ETCO2; pt's respiratory muscles become weak from lack of use use for patients not expected to breath on their own Intermittent Mandatory Ventilation (IMV) \correct answer✅mode of mechanical ventilation that provides a combination of mechanically assisted breaths and spontaneous breaths pressure control \correct answer✅delivers air until a set pressure is reached in the lungs volume varies with each breath why use pressure control? \correct answer✅healthy lungs are compliant and stretch easily; disease lungs become stiff and less compliant this setting will deliver a set pressure and will not overfill the lungs preferred in pedi patients and patients with poor lung compliance Peak Inspiratory Pressure (PIP) \correct answer✅max pressure reached within the lungs during inspiration sum of positive end-expiratory pressure (PEEP) and pressure control to reduce risk of barotrauma- PIP should be below 35 cm H2O common initial setting of PC 15 and PEEP of 5 achieve a PIP of 20 advanced modes of ventilation \correct answer✅APRV HFOV airway pressure release ventilation (APRV) \correct answer✅pressurizes the airway at a very high level of PEEP, much higher than can be tolerated in volume or pressure control vent holds this high pressure for a specific period of time f/b short drop in pressure to zero which is expiration -needs airway protection but has no identifiable pulmonary problems -needs it to stimulate breathing 2. what mode is best? -needs support while the drugs wear off -IMV would be best- assures she gets adequate number of breaths/minute while allowing her to breath on her own as she awakens -rate of 12 3. TV calculation -107 kg, ideal weight is 60 kg -x4 =240; x6 = 360; x8=480 -set between 240-480 4. PEEP and pressure support to keep airway open -100% oxygen initially Jenny's initial settings for IMV: \correct answer✅rate: 12 TV: 360 FiO2: 100% PEEP: 5 pressure support: 10 Larry arrives with a through-and-through gunshot wound to the left side of the neck. He is alert and oriented X4. Speaking full sentences. Bleeding has been controlled. The decision is made to intubate Larry to protect his airway due to rapidly expanding neck swelling. His vital signs are stable. There are no other injuries. He is six-feet tall and weighs 180 pounds/81 kg (ideal body weight 78kg). Question 1: Will Larry need a mechanical ventilator due to pulmonary or non-pulmonary reasons? \correct answer✅Non-pulmonary There is nothing indicating a pulmonary problem. Intubation and ventilation are for airway protection. What would be the proper mode of ventilation for Larry? \correct answer✅IMV allows larry to spontaneously breath while assuring he gets adequate ventilation What respiratory rate does Larry need? \correct answer✅12-14 What would the setting be for tidal volume for Larry? \correct answer✅x4= 312 mL x6= 470 mL x8= 625 mL How much FiO2 does Larry need? \correct answer✅100% but will probably be dropped down to 40% very quickly What PEEP setting is appropriate for Larry? \correct answer✅5 Does Larry require pressure support? \correct answer✅Yes Pressure support is added if the patient will be able to breathe spontaneously. 10 cmH2O pressure support should be added. Mary arrives obtunded with a GCS of nine after a ground-level fall. Rapid CT reveals a large subdural hematoma. No other injuries are noted. Vital signs are stable. Mary will be intubated in preparation for transfer to the OR. Mary is five-foot-seven-inches tall and weighs 120 pounds/54 kg. (ideal body weight 61 kg). What would you recommend for Mary's initial ventilator settings? Mode? Rate? FiO2? Tidal volume? PEEP? Pressure Support? \correct answer✅mode: IMV rate:12-14 FiO2: 100% TV: 370 mL PEEP: 5 pressure support: 10 Mary has increased intracranial pressure. Watch her ETCO2 closely and adjust, as necessary. Low ETCO2 is detrimental to patients with increased intracranial pressure. ALARMS \correct answer✅high pressure limit high pressure limit alarm \correct answer✅when the ventilator senses pressure within the circuit that is higher than the alarm has been set coughing and patient-ventilatory dyssynchrony (patient fighting the vent or needs to be suctioned) equipment: kink in the tubing or water in the line vents should be humidified, filtered, and warmed and condensation can cause resistance to airflow low exhaled TV \correct answer✅means air is going in that is not coming out alarms when there is air loss between the breath delivered by the ventilator means air is escaping into the patient's body (pneumothorax or a bronchiole disruption) break in the tubing will cause this to alarm- assess from the patient end and follow the tubing back to the insertion at the vent can alarm if disconnected or loose underinflated cuff on the airway tube- air leaks around the cuff during positive pressure ventilation (can be heard by listening near the patient's head) -remedy by reflating cuff to 20-30 cm H2O high respiratory rate \correct answer✅frequency of respirations is too high patient is breathing too fast (pain, anxious, cough, laughing, gagging) vibration/chest physiotherapy or tidaling of fluid from condensation can also be sensed by the vent Linda was intubated upon arrival for respiratory failure due to suspected COVID-19 pneumonia. After moving Linda onto the table for a CT of the chest the ventilator begins alarming. You see a "low exhaled tidal volume" alarm light on the ventilator. What is your first action? A. Do nothing. This is to be expected when jostling the equipment. B. Begin bagging Linda and stat page a respiratory therapist. C. Auscultate Linda's breath sounds and palpate for crepitus. D. Check the ventilator connections starting at Linda's airway. \correct answer✅D. Check the ventilator connections starting at Linda's airway. Positive pressure can open up alveoli to increase the surface area for gas exchange. On the other hand, ___________________ can compress capillary flow to the alveoli reducing the blood flow coming through to pick up oxygen. \correct answer✅overdistention Overdistension can rupture weakened alveoli leading to a _______________. And overdistension can cause inflammatory changes to the lung tissue. These inflammatory changes can lead to _____________________________ and ultimately _____________. \correct answer✅pneumothorax non-cardiogenic pulmonary edema and ARDS Positive pressure ventilation increases the intrathoracic pressure which can reduce ___________. Reduced preload equals decreased __________output. Decreased cardiac output equates to less oxygen-rich blood circulating per minute. \correct answer✅preload cardiac best practices for vented patients \correct answer✅HOB elevated 30 degrees hand hygiene avoid breaking closed ventilator circuit verify cuff is inflated to 20-30 cm H2O to reduce leakage of oral secretions into the airway oral care inline suction ongoing care tips \correct answer✅avoid gastric distention with the use of NG/OG tube initiate gastric feeding so flora stays active reposition pt frequently