What you should remember from the last week… RET 2264C-10 “Top Ten” Session Review for Mechanical Ventilation Modes and Initial Settings What you should remember from the last week… RET 2264C-10

Question # 1 Which is the primary trigger strategy for VC-CMV and PC-CMV with an apneic pt.?

Which is the primary trigger strategy for VC-CMV and PC-CMV with an apneic pt.? . Pre-set Timed trigger Flow Trigger Pressure Drop in the Airway Dual Flow Pressure Trigger

Question # 2 A male patient with COPD has the following arterial blood gases: pH = 7.21, PaCO2 = 89 mm Hg PaO2 = 55 mm Hg on 24% oxygen HCO3- = 38 mmEq/L. The patient is 65 year old and has an ideal body weight of 140 lbs (64 kg) and a BSA of 1.5 m2 …

What mode of ventilation and would be appropriate? VC-IMV Pressure Support CPAP PC-CMV

Question # 3 This COPD patient is 65 years old and has an ideal body weight of 140 lbs (64 kg) and a BSA of 1.5 m2

The patient is 65 year old and has an ideal body weight of 140 lbs (64 kg) and a BSA of 1.5 m2…What Initial Setting would be appropriate for VE? 3 ml/kg 4.0 x BSA 3.5 x BSA 6 ml/kg

Question # 4 A 5’4” tall 35 y.o. male with Pickwickian syndrome (weight = 340 lbs) is to be placed on mechanical ventilatory support. What strategy should be used for the initial tidal volume he will require?

What procedure would you use to set initial VT for this 340 lb. pt.? 106+6(H-60)/2.2*8ml/kg=VT 105+5(H-60)/2.2*10ml/kg=VT Set VT = 10 ml * 340/2.2 Set VT = 8 ml * 340/2.2

What is the primary Ventilatory challenge for this population of pts? Question # 5 What mode and initial f is appropriate for this Pickwickian pt if he shows a decreased pH, & PaO2 and an increased Pa CO2 despite a spontaneous f or 30/min.?

CPAP with f = 0 VC-IMV with f = 8/min VC-IMV with f = 14 /min What mode and initial f is appropriate for this Pickwickian pt if he shows a decreased pH, & PaO2 and an increased Pa CO2 despite a spontaneous f or 30/min.? CPAP with f = 0 VC-IMV with f = 8/min VC-IMV with f = 14 /min VC CMV with f =12/min

Question # 6 Compared with similar settings on VCV, PCV has been shown to improve oxygenation and gas exchange, increase mean airway pressure, facilitate lung healing. What variable is primarily responsible for thes improvments ?

Increased f control PIP is a plateau FIO2 is increased Compared with similar settings on VCV, PCV has been shown to improve oxygenation and gas exchange, increase mean airway pressure, facilitate lung healing; What variable is primarily responsible for these improvements ? Increased f control PIP is a plateau FIO2 is increased TI is controlled

Question # 7 What is the (default) initial flow pattern for VC-CMV?

What is the (default) initial flow pattern for VC-CMV? Sine Wave Flow Decelerating Flow Constant Flow Accelerating Flow

Question # 8 What is the initial flow pattern for PC-CMV?

What is the initial flow pattern for PC-CMV? Sine Wave Flow Decelerating Flow Constant Flow Accelerating Flow

Common M.V. Flow Patterns SQUARE DECELERATING ACCELERATING SINE Essentials of Ventilator Graphics ©2000 RespiMedu

Question # 9 Contrast Decreasing Compliance and Increasing Raw as problems during M.V. These conditions lead to a reduction in ______ during PC-IMV?

Contrast Decreasing Compliance and Increasing Raw as problems during M Contrast Decreasing Compliance and Increasing Raw as problems during M.V. These conditions leads to a reduction in ______ during PC-IMV? TI f PIP Tidal Volume 6

9.5 The initial setup for a pt in PC-IMV includes setting the FIO2, PEEP, f, PIP and _________? The initial set-up for a pt in VC-IMV includes FIO2, PEEP, f, VT, PIP limit and _________?

Question # 10 Which is more important when determining the VE? height and sex Weight and Age Vs.

Which patient factor is most important for determining Minute Ventilation? Actual Pt weight is the best predictor of tidal volume Ht. is the best predictor of tidal volume Age is the best predictor of tidal volume Gender is the best predictor of tidal volume

More features of Mechanical Ventilation Modes “connect the dots”, including limitations, ABG’s and Alarm issues are Next…