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Establishing the Need for Mechanical Ventilation
Terms in this set (48)
What are the 3 purposes for mechanical ventilation?
1. Support or manipulate pulmonary gas exchange
2. Increase lung volume
3. Reduce work of breathing
What are the 8 clinical objectives for mechanical ventilation?
1. Reverse acute respiratory failure
2. Reverse respiratory distress
3. Reverse hypoxemia
4. Prevent or reverse atelectasis
5. Reverse respiratory muscle fatigue
6. Allow for sedation, paralysis or both
7. Reduce systemic or myocardial oxygen consumption
8. Minimize complications and reduce mortality
How do you determine respiratory distress?
1. Evaluate level of consciousness: are they awake, asleep, alert, oriented
2. Evaluate appearance of skin: cyanosis of lips or nail beds, pale or diaphoretic
3. Evaluate vital signs: RR, HR, BP, body temperature and pulse oximetry
What is acute hypoxemic respiratory failure?
Acute life-threatening or vital organ-threatening tissue hypoxia
What is acute hypercapnic respiratory failure?
cannot achieve adequate ventilation to maintain a normal PaCO2
Acute hypercapnic respiratory failure (AKA: pump failure) treatment?
increase alveolar ventilation
Ventilation pump failure
Respiratory muscles, thoracic cage, and nerves that are controlled by respiratory centers in the brainstem
Acute hypoxemia respiratory failure treatment?
1. oxygen or combination with positive end expiratory pressure (PEEP)
2. continuous positive airway pressure (CPAP)
What is the clinical definition of ARF?
When you have a pH of < 7.25 & PaCO2 > 50 and/or severe oxygen deficit.
What are the 3 indications for mechanical ventilation?
2. ABG: pH <7.3 & PaCO2>50
3. Severe hypoxemia (PaO2 <50) despite increased FiO2
Disorders leading to pump failure?
1. Central nervous system disorders
2. Neuromuscular disorders
3. Increased work of breathing
What is vital capacity?
It is the amount of air from maximum inspiration to maximum expiration.
What is the normal range for VC?
65-75 ml/kg IBW
What values for VC are considered inadequate?
< 10 to 15 ml/kg
What is ideal body weight?
The optimal weight for one's height, age, sex, and body build.
What is tidal volume?
The volume of air inspired into the lungs or expired out of the lungs during one breath.
What is the normal range for tidal volume?
5-8 ml/kg IBW
What tidal volume range is considered unacceptable?
< 5 ml/kg IBW
What is the normal respiratory rate range?
12-20 breaths per minute
Respiratory rate > 35 bpm
inadequate alveolar ventilation or hypoxemia, leading to respiratory muscle fatigue
What is MIP/VC use for?
used to access respiratory muscle strength of patient with neuromuscular disease
When is the NIF measurement most accurate?
When it is measured from Residual volume (after a maximal exhalation) and you take the best of three measurements.
What is the normal MIP (NIF)?
Normal range is -50 to -100 cmH2O
What range of MIP is considered unacceptable?
-20 to 0
Normal maximal expiratory pressure (MEP)
Critical maximal expiratory pressure (MEP)
Normal force expired volume at 1 sec (FEV1)
50 to 60
Critical force expired volume at 1 sec (FEV1)
Normal peak expiratory flow (PEF)
350 to 600
Critical peak expiratory flow (PEF)
75 to 100
At least two of the following factors should be present:
Respiratory rate > 25 breaths/min
Moderate to severe acidosis: pH, 7.25 to 7.30; PaCO2, 45 to 60 mm Hg
Moderate to severe dyspnea with use of accessory muscles and paradoxical breathing pattern
NIV changed to Invasive Ventilation
Respiratory rate > 35 breaths/min
Severe dyspnea with use of accessory muscles and possibly paradoxical breathing
Life-threatening hypoxemia: PaO2 < 40 mm Hg or PaO2/FIO2 < 200
Severe acidosis (pH < 7.25) and hypercapnia (PaCO2> 60 mm Hg)
Hypersomnolence, impaired mental status
Cardiovascular complications (hypotension, shock, heart failure)
Failure of noninvasive positive pressure ventilation
Other circumstances (e.g., metabolic abnormalities, sepsis, pneumonia, pulmonary embolism, barotrauma, massive pleural effusion)
mechanical ventilation indicated
a person can achieve an appropriate level of ventilation to maintain adequate gas exchange and acid-base balance
Intubation and mechanical ventilation indication
If respiratory fatigue occur rapidly in a patient with a neuromuscular disorder and a ARF is imminent
sudden onset typically accompanied by a physical sign of respiratory distress
S/S of respiratory distress
appeared anxious with eyes wide open
may be diaphoretic and flushed
try to sit up upright
if seated lean forward with elbows resting on bedside table or knees
S/S of cardiac distress
use accessory muscles of respiration (sternocledomastoid, scalene & trapezius muscle)
S/S of severe respiratory distress
1. intercostal spaces supraclavicular notch may appear indented (retracted) during active inspiration
2. complained of not getting enough air
3. paradoxical or abnormal movement of the thorax and abdomen may be noted
PaCO2 >70mm Hg, has CNS depressant effect which reduces respiratory drive and ventilation
affect normal reflex (swallowing) response. In these cases do endotracheal intubation to protect airway from aspiration and obstruction (tongue)
Peak expiratory flow (PEF)
good indicator for air resistance and ability to maintain Airway patency
best single indicator of the adequacy of ventilation
PaO2 < 70mm Hg and SpO2 < 90% on oxygen mask
(FiO2 > 0.6)
indicated refractory (not responding) hypoxemia or hypoxemic respiratory failure
PaO2 & SpO2
indicator of severity of acute hypoxemic respiratory failure
PEEP or CPAP
refractory hypoxemic respiratory failure treatment
hypoxemia with increase in work of breathing or rising PaCO2 and falling pH?
copious or viscous secretions
protecting the airway is critical with these condition?
interpret operator settings and produce and regulates the desired output
Recommended textbook explanations
Introduction to Anatomy and Physiology
Michelle Provost-Craig, Susan J. Hall, William C. Rose
Essentials of Human Anatomy and Physiology
Elaine N. Marieb
Loose Leaf Version of Hole's Human Anatomy and Physiology
David N. Shier, Jackie L. Butler, Ricki Lewis
Loose Leaf Version for Hole's Essentials of Human Anatomy and Physiology
David N. Shier, Jackie L. Butler, Ricki Lewis
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