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mechanical ventilation

Terms in this set (34)

def of mechanical ventilation
a supportive therapy involving of moving air in and out of the lungs through mechanical means
-NOT curative; timing is important
determining the need for MV: criteria
-pulmonary
-cardiac
-neurologic
pulmonary criteria
-respiratory failure: pH less than 7.30 w/ PCO2 >50 OR hypoxemia (PaO2 <60)
-apnea or respiratory arrest
-respiratory muscle fatigue/paralysis

cardiac:
-cardiac insufficiency

neurologic:
-severe neuro compromise (GCS </= 8; coma, unstable breathing pattern)

other: neuromuscular blockade therapy
rationale/goals
-pulmonary
-cardiac
-neuro
-other
-pulmonary: rest respiratory muscles, support ventilation/oxygenation, assure effective breathing pattern
-cardiac: decrease WOB and reduce O2 consumption
-neuro: protect airway, assure effective breathing pattern
-other: protect airway, assure effective breathing pattern
criteria for mechanical ventilation: pulmonary mechanics
-resp rate (f)= >35/min
-vital capacity <15 ml/kg
-maximum inspiratory pressure (MIP) >-20 cm H2O
-minute ventilation (VE): greater than 10 L/min
vital capacity normal and def
biggest strongest best breath
nml: 65-75 ml/kg
maximum inspiratory pressure (MIP)
-def
-nml
the strength of the negative pressure in your chest cavity to pull in a deep breath
nml: -50 to -100 cm H2O
minute ventilation
-def
-nml
tells us about the patient's work of breathing; we don't want this too high; too low they might not be bringing in enough for oxygenation

nml: 5-10 L/min
special risk population: elderly
increased risk for respiratory failure r/t
-stiffer lungs --> increased WOB
-decreased lung volumes and capacities
-increased risk for infection
-more comorbidities (once you put them on the ventilator, you have to worry about them coming off)
describe positive pressure ventilator
pump gases into lungs through an artificial airway and ventilator circuitry
-vents push in breaths with positive pressure, but we breathe with negative pressure
what initial settings will be used?
(standard initial vent settings)
-VE: 3.5-4 X BSA
-Tidal volume (VT): 6-12 mL/kg
-rate (f)= initially 8-12/min
-mode= AC or SIMV
-FiO2= 0.5-1.0 (50-100% oxygen)
-peak inspiratory pressure (PIP)= <35

these are adjusted to meet patient needs (goals):
-PaO2= 60-90
-PaCO2= 40
-pH: 7.35-7.45
-minimized WOB: VE= 5-10 L/min
types of vent cycling
volume
pressure
time
describe volume cycling
-volume controlled; time and pressure vary
-adv: versatile (multiple modes can be used to deliver gas)
-disadv: potential for volutrauma, no weaning component

-set to a certain volume- stops when gets to that volume, but does what it has to to get there, even if PIP is high.
pressure cycling
pressure controlled, time and volume vary
-adv: protects lungs
-disadv: potential for hypoventilation (decreased TV)-- may not be enough volume, because you stopped at a certain pressure
describe spontaneous breath
patient controls the timing (when to breathe) and tidal volume (like natural breathing except through tube!)

respiratory muscles are active
-individual has full control of rate, tidal volume, pressures and airflow
-timing (rate and rhythm), TV, and pressure differ from breath to breath
describe ventilator (mechanical) breath
--lungs can become lazy--
-patient may or may not initiate
-ventilator controls tidal volume and most other presets
-respiratory muscles passive
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