Pilbeam's Mechanical Ventilation Workbook Chapter 5.docx

List 7 questions that the clinician should ask when determining the appropriate ventilator and mode of ventilation - correct answer 1- why does the patient need ventilatory support? 2- Does the ventilator problem require a special mechanical ventilation mode? 3- What therapeutic goals can be achieved by using a specific ventilation? 4- Does the patient need to be intubated, or can a mask be used? 5- Will the ventilatory support be provided in the intensive care unit, patient's home, or an extended care facility? 6- Will the ventilatory support be required for a brief period or long term? 7- How familiar are the staff with the ventilator under consideration? What support types matches with the appropriate ventilator connection or interface? - correct answer Negative pressure ventilation - Chest cuirass CPAP - oral endotracheal tube, nasal mask, face mask, tracheostomy tube Positive pressure ventilation - oral endotracheal tube, & tracheostomy tube Noninvasive positive pressure ventilation - nasal mask & face mask CPAP is commonly used in the hospital setting as a method to _________ while in the home-care setting it is typically used when treating _________. - correct answer improve oxygenation; obstructive sleep apnea Acute-on-chronic respiratory failure is most often treated with which type of noninvasive positive pressure ventilation? (NIV) - correct answer Bilevel PAP Name a type of ventilation that reduces the requirements for heavy patient sedation. - correct answer NIV List 5 disorders that are sometimes managed with NIV. - correct answer 1- neuromuscular disorders 2- chest wall deformities 3- COPD 4- central ventilatory control abnormalities 5- acute cardiogenic pulmonary edema Advantages of NIV: - correct answer - avoids complications associated with artificial airways - provides flexibility in initiating and removing mechanical ventilation - reduces requirements for heavy sedation - preserves airway defense, speech, and swallowing mechanisms - reduces need for invasive monitoring Disadvantages of NIV: - correct answer - can cause gastric distention, skin pressure lesions, facial pain, dry nose, eye irritation, discomfort, claustrophobia, and poor sleep and mask leaks can occur. Define full ventilatory support - correct answer - the ventilator provides all the energy necessary to maintain effective alveolar ventilation Define partial ventilatory support - correct answer - any degree of mechanical ventilation in which set machine rates are than 6 breaths/min and the patient participates in the work of breathing to help maintain effective alveolar ventilation The typical minimum ventilatory rate setting for a patient receiving full ventilatory support is considered _______ breaths/min. - correct answer 8 breaths Partial ventilatory support uses set machine rates lower than _____ breaths/min. - correct answer 6 breaths What type of ventilatory support would you consider using when your patient has acute ventilatory failure from ventilatory muscle fatigue or high WOB? - correct answer - When treating patients with acute ventilatory failure, the initial goal of mechanical ventilation is to supply all the necessary ventilation (full ventilatory support) while the ventilatory muscles are given time to rest. List and explain 3 types of breath delivery. - correct answer 1- Mandatory breaths - are breaths for which the ventilator controls the timing, the Vt, or the inspiratory pressure 2- Spontaneous breaths - the patient controls the timing and the Vt. 3- Assisted breaths - all or part of the breath is generated by the ventilator, which does part of the WOB for the patient. What is the primary advantage of volume-controlled ventilation? - correct answer - it guarantees a specific volume delivery and volume expired gas, regardless of changes in lung compliance and resistance or patient effort. It's to maintain a certain level of PaC02. What is the main disadvantage of volume-controlled ventilation? - correct answer - it becomes evident when the lung condition worsens, which can cause the peak and alveolar pressures to rise, leading to alveolar overdistention. During volume-controlled ventilation, a patient develops acute bronchospasm. What will happen to the peak inspiratory pressure? What will happen to the amount of volume delivered to the patient? - correct answer - PIP rises anytime airway resistance increases - volume will remain constant because it is a set variable A patient experiencing acute bronchospasm receives an adrenergic bronchodilator. If the bronchodilator is effective, the peak inspiratory pressure is expected to ______________. - correct answer - decrease When targeting pressure as the control variable, what will vary with changing lung characteristics? - correct answer - the pressure remains constant, but volume delivery changes as lung characteristics change. What are 3 advantages of pressure-controlled ventilation (PCV)? - correct answer 1- it allows the clinician to set a maximum pressure, which reduces the risk for overdistention of the lungs by limiting the amount of positive pressure applied. 2- the ventilator delivers a decelerating flow pattern 3- it may also be more comfortable for patients who can breathe spontaneously What are 3 disadvantages for PCV? - correct answer 1- the volume delivery varies as the patient's lung characteristics change 2- Vt decrease when lung characteristics deteriorate 3- Ve decrease when lung characteristics deteriorate When a patient's lung compliance worsens during PCV, what will happen to tidal volume being delivered? - correct answer it will decrease What are 3 types of breath delivery timing or sequence available on current ICU ventilators? - correct answer 1- continuous mandatory ventilation (CMV) 2- Intermittent mandatory ventilation (IMV) 3- Continuous spontaneous ventilation (CSV) How should clinicians differentiate between controlled and assisted ventilation? - correct answer By the trigger that is used to initiate the breath