NeaPeds II Exam 2: Questions With Expert Solutions
Safety: ensure gas exchange (BS, Chest rise, Charting, Vent check), Provide
lung protection (watch pressures)
Comfort: Synchrony (try to sedate less), optimal WOB
Liberation: min. vent duration, min. risk Right Ans - MV goals objective
Apnea (hypopnea), Hypoxemia, Acute ventilator failure (hypercapnia, pH
<7.25, PaCO2 >60), cardiovascular instability, cant do NIV (pneumo,
diaphragmatic hernia) Right Ans - MV Indications
Overdistention (volutrauma/barotrauma) ,, atelectrauma, cardiovascular
compilations (low CO/venous return), O2 toxicity, hypoventilation,
Hyperventilation (*auto-triggering* neuro, cerebral, vasoconstriction)
Right Ans - Hazards of MV
Phase 1: Choose the vent, infant circuit and accessory
Phase 2: Monitoring and making adjustments
Phase 3: weaning Right Ans - 3 phases of MV
greater than 15 kilos then adult circuit (less neonatal circuit)
water bag, sx catheter, flux tubing, end tidal CO2, HME
Choose mode of ventilation
inital settings (control mode) Right Ans - Phase 1: Choose the vent, infant
circuit and accessory
based on blood gases, CXR, waveforms and physical assessment Right Ans -
Phase 2: Monitoring and making adjustments
Time cycle pressure limited
set flow 6-10 L
A: control pressure
D: less comfortable less vol Right Ans - Mode: Set Pressure
A: more stable
D: not comfortable Right Ans - Mode: Set volume
Insert IBW for target min vol% Right Ans - Mode: Adaptive (APV)
, Target insp effort Right Ans - Servo (NAVA)
1. Pneumotachometer: measure a pressure differential that is proportional to
flow (flow = change P/R)
2. Hot wire anemometer: nitric, cooling off is proportional to flow
3. Pressure triggering: not good due to delay
4. Electrical Activity of Diaphragm: Esophageal tube lowered to the level of the
diaphragm Right Ans - Trigger and Cycle: Flow sensors
Circuit stretch resulting in loss of effective tidal volume
Volume loss = (PIP-PEEP ) x tubing compliance factor
Only on vents that do not have flow sensor Right Ans - Tidal volume
Accuracy: compressible volume
tube leak compensation
Drager would keep increase lung - V1 compensated better for leaks Right
Ans - Tidal Volume Accuracy: Air leaks
smallest is 3.0 Right Ans - Tidal Volume accuracy: ETT
age, weight, disease state present, type of ventilator being used Right Ans -
Initial ventilator settings dependent upon:
shorter TC, Faster RR, smaller Vt
surfactant deficiency, distended abdomen, ARDS<fibrosis, pneumo Right
Ans - Restrictive pulmonary disease
Long TC, slower RR, bigger Vt
BPD (COPD for babies), meconium, asthma, bronchiolitis, CF < hyperinflation,
air trapping Right Ans - Obstructive pulmonary disease
Neonate: 25-50
Peds: 12-25
Restrictive: higher
Obstructive: lower Right Ans - Variable: RR (frequency)
Neonate:
Peds:
Restrictive:
Obstructive:
Safety: ensure gas exchange (BS, Chest rise, Charting, Vent check), Provide
lung protection (watch pressures)
Comfort: Synchrony (try to sedate less), optimal WOB
Liberation: min. vent duration, min. risk Right Ans - MV goals objective
Apnea (hypopnea), Hypoxemia, Acute ventilator failure (hypercapnia, pH
<7.25, PaCO2 >60), cardiovascular instability, cant do NIV (pneumo,
diaphragmatic hernia) Right Ans - MV Indications
Overdistention (volutrauma/barotrauma) ,, atelectrauma, cardiovascular
compilations (low CO/venous return), O2 toxicity, hypoventilation,
Hyperventilation (*auto-triggering* neuro, cerebral, vasoconstriction)
Right Ans - Hazards of MV
Phase 1: Choose the vent, infant circuit and accessory
Phase 2: Monitoring and making adjustments
Phase 3: weaning Right Ans - 3 phases of MV
greater than 15 kilos then adult circuit (less neonatal circuit)
water bag, sx catheter, flux tubing, end tidal CO2, HME
Choose mode of ventilation
inital settings (control mode) Right Ans - Phase 1: Choose the vent, infant
circuit and accessory
based on blood gases, CXR, waveforms and physical assessment Right Ans -
Phase 2: Monitoring and making adjustments
Time cycle pressure limited
set flow 6-10 L
A: control pressure
D: less comfortable less vol Right Ans - Mode: Set Pressure
A: more stable
D: not comfortable Right Ans - Mode: Set volume
Insert IBW for target min vol% Right Ans - Mode: Adaptive (APV)
, Target insp effort Right Ans - Servo (NAVA)
1. Pneumotachometer: measure a pressure differential that is proportional to
flow (flow = change P/R)
2. Hot wire anemometer: nitric, cooling off is proportional to flow
3. Pressure triggering: not good due to delay
4. Electrical Activity of Diaphragm: Esophageal tube lowered to the level of the
diaphragm Right Ans - Trigger and Cycle: Flow sensors
Circuit stretch resulting in loss of effective tidal volume
Volume loss = (PIP-PEEP ) x tubing compliance factor
Only on vents that do not have flow sensor Right Ans - Tidal volume
Accuracy: compressible volume
tube leak compensation
Drager would keep increase lung - V1 compensated better for leaks Right
Ans - Tidal Volume Accuracy: Air leaks
smallest is 3.0 Right Ans - Tidal Volume accuracy: ETT
age, weight, disease state present, type of ventilator being used Right Ans -
Initial ventilator settings dependent upon:
shorter TC, Faster RR, smaller Vt
surfactant deficiency, distended abdomen, ARDS<fibrosis, pneumo Right
Ans - Restrictive pulmonary disease
Long TC, slower RR, bigger Vt
BPD (COPD for babies), meconium, asthma, bronchiolitis, CF < hyperinflation,
air trapping Right Ans - Obstructive pulmonary disease
Neonate: 25-50
Peds: 12-25
Restrictive: higher
Obstructive: lower Right Ans - Variable: RR (frequency)
Neonate:
Peds:
Restrictive:
Obstructive:
