RSPT 2355 MECHANICAL VENTILATION

Transcription

1 1. List 4 indications for mechanical ventilation. RSPT 2355 MECHANICAL VENTILATION 2. List 5 factors affecting airway pressure with volume ventilation. 3. List 5 factors affecting tidal volume with pressure ventilation. 4. List 3 factors affecting mean airway pressure during positive pressure ventilation. 5. A 175-lb, 48-year-old man is placed on mechanical ventilation with the following settings: mode AC, f = 12 bpm, VT = 900 ml, flow = 35 lpm, FIO2 = a. Calculate the following: IT ET I:E V E

2 b. ABGs on the above settings reveal the following: ph 7.51, PaCO2 28 mmhg, PaO2 178 mmhg, SaO2 99%, HCO3-28 meq/l 1) Interpret the ABG results. 2) What specific changes should be made? 6. A 20-year-old, 105-lb woman presents to the Emergency Department. She is apneic owing to a drug overdose. She is intubated and transferred to the ICU where she is placed on mechanical ventilation. a. Select appropriate ventilator settings for this patient: f bpm VT ml FIO2 Mode b. Twenty minutes after the patient is stabilized on mechanical ventilation, her blood gases reveal the following: ph 7.54, PaCO2 25 mmhg, PaO2 70 mmhg, SaO2 96%, HCO3-23 meq/l What specific ventilator changes would you recommend? 7. A 45-year-old, 150-lb man is brought to the ICU after suffering a cardiac arrest. He is placed on mechanical ventilation with the following settings: mode AC, f = 8 bpm, VT = 800 ml, IT % = 25%, FIO2 = ABGs reveal: ph 7.30, PaCO2 47 mmhg, PaO2 52 mmhg, SaO2 84%, HCO3-18 meq/l a. Calculate the following: V E lpm IT sec a/a % ET sec AaDO2 mmhg I:E 2

3 b. What ventilator changes would you make? 8. A 140-lb man presents to the Emergency Department in severe respiratory distress. The patient has crackles over the left posterior basilar lung fields. His temperature is 102 F. Chest radiograph shows an infiltrate in the left lower lobe with hyperaeration throughout both lung fields. The patient, who is 55 years old, states he has smoked 3 packs/day for the past 40 years. ABGs on 2 lpm reveal: ph 7.26, PaCO2 89 mmhg, PaO2 34 mmhg, SaO2 60%, HCO3-36 meq/l. The decision is made to intubate and ventilate the patient. a. Select appropriate ventilator settings for this patient: f bpm VT ml FIO2 Mode b. After stabilization, you determine the patient is air trapping. What changes could you make to help relieve this situation? c. Interpret the ABG obtained in the Emergency Department. d. What type of pulmonary problem does this patient appear to have? 9. A 28 yo, 130-lb woman is admitted to the ICU following an automobile accident with both head and thoracic injuries. The patient is not breathing and her lung/thorax compliance is low. a. Choose appropriate ventilator settings: f bpm VT ml FIO2 Mode 3

4 a. Thirty minutes into mechanical ventilation, the patient suddenly becomes cyanotic, peak pressure rises significantly, and the SpO2 drops from 97% to 70%. What pulmonary problem might you suspect? How would this problem best be treated? 11. List the minimal mechanical values considered necessary to institute weaning (include units): NIP: VC: Resting V E : Spontaneous VT: Spontaneous rate: RSBI: 12. List the 4 phase variables of a mechanical ventilator. 13. List the 4 factors that can trigger (start) a mechanical breath. 14. Define inspiratory time. 15. List the 4 factors that normally cycle (terminate) a mechanical ventilator breath. 4

5 16. Match the following terms in Column 1 with the respective definitions in Column 2. Use each answer only once. COLUMN 1 COLUMN 2 A. B. C. Mandatory breath Continuous mandatory ventilation Intermittent mandatory ventilation The ventilator delivers machine-triggered breaths, with spontaneous breaths allowed in between. The ventilator delivers intermittent (patient- or machine-triggered) mandatory breaths, with spontaneous breaths allowed in between. D. Synchronized intermittent ventilation 3. Inspiration is ventilator-triggered and/or machine cycled. E. Pressure control 4. Every breath is mandatory. 5. The ventilator attempts to maintain a preset airway pressure waveform during inspiration. 17. Match the types of output alarms in Column 1 with the clinical conditions in Column 2. You may use any answer more than once. COLUMN 1 COLUMN 2 A. High pressure alarm 1. Cuff leak B. C. D. E. Low pressure alarm Low volume alarm High minute volume alarm Low PEEP alarm Patient increases spontaneous respiratory rate and volume Exhalation manifold malfunction Kinked endotracheal tube Patient biting endotracheal tube 6. Pneumothorax 18. Mr. Burns, a patient in the intensive care unit, has been mechanically ventilated for 3 weeks. Sputum culture and chest radiograph confirm the presence of ventilator-associated pneumonia (VAP). This condition is most likely caused by: a. aspiration of orpharyngeal secretions b. poor suctioning technique c. use of inline suction device d. incorrect use of antibiotics 5

6 19. Dr. Penn, a first-year resident, asks you to describe the strategy to minimize overdistention (volutrauma) during mechanical ventilation. You would suggest keeping the: a. peak airway pressure less than 50 cmh 2 O b. end-inspiratory plateau pressure less than 30 cmh 2 O c. positive end-expiratory pressure less than 10 cmh 2 O d. tidal volume less than 6 ml/kg 20. Permissive hypercapnia is a lung protection strategy that allows a high during mechanical ventilation by using low. a. SpO 2 ; peak inspiratory pressure b. SpO 2 ; tidal volume c. PaCO 2 ; peak inspiratory pressure d. PaCO 2 ; tidal volume 21. Dr. Sanchez has ordered pressure support ventilation for her patient in the surgical intensive care unit. To benefit from this mode of ventilation, the patient must: a. be breathing spontaneously b. have normal blood gases c. have normal cardiac output d. be using a pressure ventilator 22. The compliance of Mr. Yarbrough, a patient being ventilated with volume-control ventilation, has been decreasing gradually over the last 2 days. On the patient s ventilator flow sheets, you would expect to see a corresponding in. a. increase; lung volume b. increase; peak and plateau pressure c. decrease; lung volume d. decrease; peak and plateau pressure 23. Ms. Warren is being ventilated with pressure-control ventilation. Her physician asks you to increase the delivered mechanical tidal volume. You would: a. increase the peak inspiratory pressure b. increase the peak flow c. decrease the inspiratory time d. decrease the level of auto-peep 24. Positive end-expiratory pressure is used to provide and correct. a. alveolar recruitment; deadspace ventilation b. alveolar recruitment; intrapulmonary shunting c. normal tidal volume; deadspace ventilation d. normal tidal volume; intrapulmonary shunting 25. A heat/moisture exchanger is used during mechanical ventilation to provide: a. air conditioning b. positive end-expiratory pressure c. filtering function d. humidification 6

7 26. Assessment of the symmetry of chest wall movement may be used to evaluate the presence of all of the following except: a. main-stem intubation b. tracheal obstruction c. atelectasis d. pneumothorax 27. During your clinical rotation through the ICU, you notice a therapist performing a maneuver using an end-expiratory pause. This is done to: a. measure the presence of auto-peep b. determine the plateau pressure c. measure the I:E ratio d. shorten the inspiratory time 28. Dr. Manning asks you to evaluate his patient for weaning readiness. After measuring the weaning parameters, you would report that all of the following measurements indicated weaning readiness except: a. V D /V T = 0.50 b. PaO 2 = 70 on an FiO 2 of 40% c. Rapid, shallow breathing index = 140 d. Spontaneous tidal volume = 6 ml/kg 29. The main disadvantage of volume-limited ventilation is: a. delivered volumes are not guaranteed b. inspiratory time is too long c. high peak alveolar pressures can result d. flow rates are not adjustable 30. Which of the following is the major factor determining whether auto-peep will occur? a. length of inspiratory time b. length of expiratory time c. flow rate d. tidal volume 31. Which of the following will increase mean airway pressure? a. increased airway pressure b. increased respiratory rate c. increased flow rate d. all of the above 32. Which of the following is true concerning mechanical deadspace? a. it is the same as volume loss caused by compression b. it is rebreathed gas c. it significantly decreases the volume of gas reaching the lungs d. addition of mechanical V D may cause PaCO 2 levels to drop 7

8 33. Clinical signs of ventilator-patient dys-synchrony may include each of the following except: a. patient agitation b. bradypnea c. chest retractions d. chest-abdominal paradox 34. The best indicator for respiratory muscle fatigue is probably which of the following? a. tachypnea b. abdominal paradox c. increased PaCO 2 d. decreased maximum inspiratory pressure (MIP) 35. After changing the ventilator circuit on a mechanical ventilator, the respiratory care practitioner notes that the volume is registering 300 ml less than before and that the peak pressure is half of what it was. Which of the following could be the source of the problem? a. the circuit has a hole in the circuit b. the humidifier is not assembled tightly and a leak is occurring c. the medication nebulizer is not connected tightly and leaks d. all of the above 36. During time-cycled, volume-controlled ventilation, increasing the inspiratory time will result in which of the following? a. increased PIP b. decreased flow rate c. increased tidal volume d. increased expiratory time 37. Delivery of an aerosol treatment, during mechanical ventilation, with an SVN powered by a wall flowmeter, will result in which of the following? a. decreased sensitivity b. increased PIP c. increased tidal volume d. all of the above 38. Your patient is being mechanically ventilated and requires PEEP to keep an acceptable PaO2. Despite 30 mmhg pressure in the cuff, there is still a significant tidal volume leak. Which of the following should be done? a. Insert a larger diameter ETT with a high volume, low pressure cuff. b. Leave the cuff inflated to 30 mmhg. c. Deflate the cuff to less than 20 mmhg and increase the tidal volume to compensate for the leak. d. Deflate the cuff to less than 20 mmhg and increase the respiratory rate to compensate for the leak. 8