Mechanical Ventilation - Final Exam.docx

The primary variable that the ventilator manipulates to cause inspiration - correct answer Control variable Control variables - correct answer Volume Pressure Flow Time In what mode is controlling minute ventilation less stable? - correct answer pressure controlled modes In what mode will you see higher mean airway pressures? - correct answer pressure controlled modes Flow triggered, pressure- targeted, time-cycled - correct answer Assisted breath—because flow initiates (patient), set pressure is reached and held until a set time is reached (ventilator). Time- triggered, volume-targeted, volume cycled - correct answer Mandatory breath—because time initiates (ventilator), when set volume is reached inspiration ends (ventilator). Pressure- triggered, pressure targeted, time cycled - correct answer Assisted breath—because pressure initiates (patient), set pressure is reached and held until a set time is reached (ventilator). Flow- triggered, pressure- triggered, flow cycled - correct answer Assisted breath—this is a pressure-supported breath, which is a special form of assisted ventilation. The main advantage of _________ ventilation is that it guarantees a specific volume delivery and minute ventilation, regardless of changes in lung compliance and resistance or patient effort. - correct answer volume During volume ventilation, your patient bronchospasms. What happens to PIP and the volume given to the pt? - correct answer The peak inspiratory pressure rises anytime airway resistance increases, such as with bronchospasm. The amount of volume will remain constant, because it is the set variable. Your patients lung compliance worsens during volume ventilation, what will happen to peak inspiratory pressure and alveolar pressure? - correct answer PIP will increase. Alveolar pressure will increase. When pressure is targeted as the control variable, _______ will vary with changing lung characteristics. - correct answer volume When a patient's lung compliance worsens, during pressure targeted ventilation, volume delivery will ___________ (Increase or decrease?) - correct answer decrease If your patients volume decreases during pressure targeted ventilation because of worsening lung compliance, you could expect alveolar _____________ (Hyperventilation or hypoventilation?) - correct answer hypoventilation What 3 triggers may begin inspiration in the assist-control mode? - correct answer Time Pressure Flow In the PC-CMV mode, the control variables are? - correct answer time or patient trigger, pressure limit, time cycle. Controlled ventilation is appropriate for patients who are: - correct answer obtunded because of drugs; sedated and paralyzed; or who have cerebral malfunction, a spinal cord or phrenic nerve injury, or motor nerve paralysis with no voluntary efforts. What happens when the ventilator is made totally insensitive to patient effort? - correct answer The patient will be "locked out" and will be unable to trigger a breath. (CMV, IMV) _______ allows the patient to breathe spontaneously between mandatory breaths and __________ all are machine breaths. - correct answer IMV,CMV What ventilator parameters do you set in PSV mode? - correct answer Inspiratory pressure, expiratory pressure (PEEP), sensitivity, and flow cycle In PSV, what determines the patients tidal volume - correct answer The tidal volume is determined by the pressure gradient, lung compliance, airway resistance, and patient effort. What situation will cause a mechanical ventilator in the PSV mode to time cycle? - correct answer A leak in the circuit because the inspiratory time would reach the maximum inspiratory time setting. What situation will cause a mechanical ventilator in the PSV mode to pressure cycle? - correct answer Patient coughing or forcible exhalation Rise time - correct answer The time required for the ventilator to rise to the set pressure at the beginning of inspiration PSV ends inspiration by ________ cycling - correct answer flow PSV with your intubated patient who has consistent spontaneous respiratory pattern is likely to benefit because: - correct answer This will help the patient to overcome the resistance due to the endotracheal tube, ventilator circuit, and demand valve system while allowing the patient to be monitored. Top 3 settings for VC-CMV - correct answer Ti V̇e Rate This mode delivers volume-controlled, time-cycled, breaths with each time- and patient-triggered breath. Which mode is this? - correct answer VC-CMV If a patient is acidotic, what 3 things can we do to correct it? - correct answer -Increase Delta P -Increase Ti -Increase frequency An intubated patient is receiving a volume of 350 ml every 3 seconds. This volume of 350 ml is delivered over a period of 1.1 seconds. The patient is triggering a breath 8 times per minute. When the patient triggers a breath, they receive a volume of 350 ml over a period of 1.1 seconds. at the end of each expiratory phase, the pressure returns to 6 cmH2O. Which mode is this? - correct answer PC-CMV In detail, describe what happens during a patient-triggered, time-cycled breath in VC-CMV. - correct answer Set VT is going to be delivered in the set Ti, even if pt. triggers, set VT will still be delievered. A patient is on VC-CMV with a set inspiratory flow. The patient is not "breathing" above/more than the set rate. Based solely on this information and excluding sensitivity and FiO2, which three parameters should remain constant throughout each inspiratory phase? - correct answer -VT -Ti -flow In reference to VC-CMV, which *specific parameter* will vary according to lung characteristics? - correct answer PIP A patient has a Raw of 4 cmH2O/L/sec and a Cs of 50 ml/cmH2O. The patient's respiratory drive is not intact, and we need to provide a guaranteed MV̇. Which mode of ventilation is most appropriate for this patient? - correct answer VC-CMV Which ventilator setting is most similar to the change in pressure that occurs with BiPAP? - correct answer PS (Pressure Support) Which mode of ventilation is most appropriate for an unstable patient, with increased WOB and a Pplat of 35 cmH2O? - correct answer PC-CMV What mode am I? Inspiration begins every four seconds. When inspiration begins, a constant pressure of 18 cmH2O is delivered over a period of one second. About every six seconds, the patient triggers the ventilator and a constant pressure of 18 cmH2O is delievered over a period of one second. Following each inspiratory phase, the pressure returns to five cmH2O. The volumes are fluctuating. - correct answer PC-CMV What does VC-SIMV stand for? - correct answer Volume-Controlled Synchronized Intermittent Mandatory Ventilation During mechanical ventilation, one of the ports on your patient's ventilator circuit inadvertently opens. What effect would this have on PIP and VTe? - correct answer PIP would decrease VTe would decrease A physician wants to ensure that a patient's PaCO2 remains at the person's normal level of 50mmHg. Would volume control ventilation or pressure control ventilation best meet this requirement? - correct answer Volume-Control Ventilating pressure can become very high in patients with acute respiratory distress syndrome. To prevent excessive pressure, what independent variable would be most appropriate, volume or pressure? - correct answer Pressure control ventilation should be used when the goal is to avoid high pressures. Mandatory Breath - correct answer -Time Triggered -also known as controlled