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ventilator advanced

Terms in this set (11)

To understand patient behavior, it is important to understand asynchrony, which includes:
?

in mechanically ventilated patients a P0.1 >? is considered abnormal

In pressure assist control, patient effort should change the flow waveform. In this, it is important to check if the flow ? during inspiration or if there is ? during exhalation to ensure the patient is not experiencing asynchrony with breath timing. This can be adjusted by shortening or lengthening the inspiratory time. Similarly, p0.1 can be monitored to evaluate whether a patient is experiencing excessive effort in which increasing ?. ? can also be adjusted to attempt to improve the patient's drive.

In pressure support, it may be necessary to alter the ? that causes cycling off to eliminate asynchrony. If the patient is demonstrating excessive effort, increasing the pressure support will help decrease the patient's drive. However, if increasing pressure support does not decrease the p0.1, reducing the drive must be prioritized. PEEP can also be adjusted to attempt to improve the patient's drive.

Delayed cycling is another phenomena where the patient wants to ? but ?. In pressure assist control, if there is an increase ? with a subsequent ?, then the patient is most likely experiencing delayed cycling. As a result, the inspiratory time should be ?. However, the time should be not shortened so much that it causes ?, in which the patient's effort lasts longer than the ventilator's cycle off criteria. This will manifest as a dampening in the?. Premature cycling can also occur in pressure support, when the ?. This flow scalar will look similar to that for premature cycling in pressure assist control.

Ineffective efforts are another form of asynchrony that generally occurs when patients are ?. Delayed cycling is a common cause of ineffective efforts.

Reverse triggering is another form of asynchrony where the ventilator triggers a breath that then triggers an effort from the patient. This can also lead to breath stacking. The first thing to check when noting reverse triggering is to see if it is bad timing or reflex. To check this, first ?. After reducing the respiratory rate, if the patient is triggering the breaths, it was simply bad timing.
However, if the reverse triggering still continues, a few steps should be taken:
Turn off ?
Increase ?.
Keep plateau pressure less than or equal to 27 cmH2O, and less than 30cmH2O for COVID-19 patients (typical ARDS guidelines).
If there is a known injurious pattern (breath stacking) and sedation cannot be stopped, consider ?