Chapter 8 Final Vent Considerations
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jimmgym on July 3, 2010
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Terms | Definitions |
|---|---|
 Goal of FiO2 selection | Oxygenation....PaO2 60-100 mmHg |
| Pt on O2 prior to ventilation..O2 setting.. | same FiO2, if PaO2 is normal |
| No info on O2, pt on room air,,,,O2 setting... | 50-100%, and titrate down....NBRC 40-60% |
| Desired FiO2....FORMULA | PaO2(desired) x FiO2(known) / PaO2(known) |
| Oxygen Toxicity | 60%...If FiO2 > 60% more than 48 hours. |
| O2 toxicity causes what lung changes?? | absorption atelectasis, nitrogen is washed out of lungs causing them to collapse DECREASE Cl and diffusion, DECREASE surfactant. |
| Nitrogen does what in the lungs.. | Helps keep the alveoli open |
| What to do if you can't wean FiO2 to less than 60% | ADD PEEP |
| Reducing Auto PEEP | INCREASE flow, to increase E time...REDUCE f, LOWER VT(permissive hypercapnia) |
| AUTO PEEP. settings | Need to add same amt of PEEP to overcome auto PEEP, so PT only has to generate a -1 or -2 to trigger a breath...ex.Auto PEEP 10..Need to set PEEP as 10 |
| How to measure auto PEEP | end-expiratory hold on vent.. or flow time graph. |
| Vee | End expiratory Flow |
| Isothermic Saturation Boundary | Humidification...37C..100 relative humidity, 44 mg/L water...happens 4th or 5th subsegment branch(generation) |
| Heated humidification | provides better humidity than HME..."wick" style. |
| Wick style settings | Temp 35-37 C...Alarms(preset) 38C.high, 30 C low |
| Heat Moisture Exchanger HME | absorbs heat and moisture from exhaled air...;pt rebreaths..change every 24 hrs...not as effective as heated..if increase in amt or thickness in secreations, change to heated wick style |
| When giving aerosl...HME | must be removed...HME would filter all the medications before it reaches th pt. |
| Low pressure alarm | Set 10-15 cmH2O below PIP Cause: Leak in circuit or ET, Trach tube....LUNG Improvement(Increase CL) in PCV..Chest tube |
| High pressure alarm | Set 10-15 cmH20 above PIP |
| Low PEEP/CPAP | 2-3 cmH20 below PEEP |
| Apnea alarm | set to no more than 20 secs. available in SPONTANEOUS MODE.pt not breathing enough..leak..disconnect..incorrect sensitivty setting |
| Low exhaled VT | set 10-15 % below exhaled VT Reading(average) |
| Low VE | 10-15 below average VE |
| High VE | 10-15 above average VE |
| High Rate alarm | 30-40 bpm |
| Inverse I:E Alarm | if alarms..need to increase FLOW, decreasing I time |
| Low gas source alarm | air/O2 gas source malfunction |
| Other alarms | Low/High O2 %..loss of power, low battery, ventilator inoperative |
| sigh breaths | deep breath that occurs during normal breathing...also can be given on vent..recruits alvoli, prevents atelectasis, increase oxygenation |
| COPD vent guidelines.. | Try BIPAP first. 0.6-1.2 sec flow(60-100)..PEEP(compensate for air trapping)..VT 8-10ml/kg..f 8-12 bpm, |
| examples of neuromuscular disease | ALS, myasthenia, tetnus, gulliane barre, botulism |
| Neuromuscular disease vent guidelines... | these pts have normal lungs so..VT 6-12 ml/kg..f 8-12 bpm.. |
| Test for muscle weakness | MIP(-20 cmH20), Vital capacity(10-15 ml/kg)..tests for cough and swallow(protection of airway) |
| Can happen if pt can't deep breath | atelectasis, pneumonia, respiratory failure. |
| Iatrogenic hyperventilation | deliberate..to decrease CO2 in pts with increase in ICP(inter cranial pressure)...decrease in PaCO2=cerebral vasoconstriction, decrease in bloodflow, decrease in ICP |
| Target PaCO2 with closed head injury | 25-30 mmHg |
| Closed head injury vent guidelines.. | VT6-12 ml/kg, f 8-12 bpm,but with increase in ICP 15-20 bpm..LIMIT SUCTION |
| ARDS Vent guidelines | RESTRICTIVE, STIFF LUNGS(Decrease in CL and Increase in PIP) O2 can be a problem so..PEEP...Pressure ventilate because of decrease in CL and Increase in PIP |
| ARDS Vent settings | VT 4-8 ml/kg..f 15-25 bpm..PC/AC APRV |
| Status Asthmaticus | Acute exacerbation of Asthma...Increased Raw(bronchospasm) results in air trapping |
| Asthma Tx | 1st bronchodilator...continuos NEB |
| How to reduce air trapping as seen in COPD and ASTHMA | reduce Vt and Lower frequency..CO2 will go up and cause permissive hypercapnia. |
| Pulmonary Edema CHF Tx | Positive pressure(BiPAP, CPAP, IPPB) Inatropic drugs to increase contractility of heart, diuretics(lasix) |
| CHF Vent settings | Vt 6-12 ml/kg..f 8-12 bpm, PEEP(to push fluid out of lungs, reducing the load of heart. LESS BLOOD FLOW< LESS FLUID |
| Pulmonary Edema Def | Left heart failure, fluid backs up from left atrium to lungs...heart not strong enough to pump fluid to body..so it backs up. |
| How much PEEP for CHF Pts? | 5-10...to support cardiac function |
| Normal Spontaneous VE | 100 ml/kg |
| Normal Spontaneous Vt | 5-7 ml/kg |
| Normal Spontaneous f | 12-18 bpm |
| Vent Guidelines Status Asmaticus | f <8 VC or PC..VT=4-8 ml/kg, Flow=80-100, Descending, Ti<1sec, FiO2> or = to 0.5 |
| 3 pulmonary disorders...O2 = 1.0.. | ARDS, CHF, Closed Head Injury |
| 2 pulmonary disorders with high f setting.. | Closed Head Injury, ARDS |
| High PEEP setting Disorders | CHF 5-10, ARDS 5 to >15 |
| Low VT setting Disorders.. | ARDS and ASTHMA |
| Easy way to estimate extrinsic PEEP... | INCREASE PEEP until PIP begins to INCREASE |
| Final Considerations in VENT SETUP.. | check circuit, FILL humidifier(sterile water) and set temp, Check FiO2, Adjust alarms, Have an emergency AW in the room, Provide SX equip, BVM in room |
| Pt on VCV...When chaning to PCV..what Pressure do you initially start with? | Do a Inspiratory hold..get a plateau pressure..use that pressure in VCV |
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