Ventilator changes
Desired RR to change PaCO2 to 40 mmHg when set RR is 20 bpm and PaCO2 is 28 mmHg
20 x 28 / 40 = 14 breaths/min
The volume of air in the alveoli that ventilated but not perfused; therefore does not participate in gas exchange.
Alveolar dead space
Respiratory alkalosis is defined as ____ < 35 mmHg and ____ is > 7.45.
PaCO2; pH
Metabolic acidosis is defined as HCO3 < ____ mEq/L and pH < ____.
HCO3 < 22 mEq/L; pH < 7.35
Define CASS.
Continuous aspiration subglottic secretions
Desired VT to meet a PaCO2 40 mmHg when set VT is 350 mL and PaCO2 is 56 mmHg.
350 x 56 / 40 = 490 mL
Something caused by medical procedure or treatment (Ex. Increasing RR for lower than normal PaCO2)
Iatrogenic (hyperventilation)
Respiratory acidosis is defined as PaCO2 > ____ and pH < ____.
45 mmHg; 7.35
Metabolic alkalosis is defined as ____ > 7.45 and HCO3 > _____
pH > 7.45; HCO3 > 26 mEq/L
What size suction catheter should be used on a size 7.0 ETT?
7.0 x 2 = 14 then go to next lowest size catheter = 12FR
Desired pressure to meet a PaCO2 of 40 mmHg when PIP is 20 cmH20, PEEP is 5 cmH20, VT is 400 mL, and PaCO2 is 50 mmHg.
PC level = PIP-PEEP= 15 cmH20; 15x50/40=18.8 or 19 cmH20.
Ventilator strategies used to protect the lung from injury when using mechanical ventilation
PHY or Permissive hypercapnia
List 4 causes of respiratory acidosis.
Airway diseases (Asthma attack, COPD exacerbation); Parenchymal lung problems (pulmonary edema, pneumonia); Chest wall abnormalities (kyphoscoliosis); Neuromuscular disorders (MG, ALS); CNS problems (drug overdose)
List 4 causes of metabolic acidosis.
Ketoacidosis (alcoholism, diabetes, starvation); Uremic acidosis (renal failure to excrete acid); Loss of HCO3 (diarrhea); Lactic acidosis; Ingested toxins (salicylate, ethylene glycol)
Nebulizer should be placed _____ when using NIV. (Be specific)
closest to the patient (between the leak port and the face mask)
What two things can be adjusted to improve ventilation when using PC-CMV?
I-time and PC level
Breathing pattern between ventilator and patient are not harmonious
Asynchrony (dyssynchrony)
List 4 causes of respiratory alkalosis.
Hypoxia with compensatory hyperventilation; Parenchymal lung diseases (pulmonary edema, pneumonia); Mismanaged ventilator settings; CNS (head trauma); Anxiety; Metabolic problems (sepsis)
List 4 causes of metabolic alkalosis.
Loss of gastric fluid (vomiting, NG sxn); Acid loss in urine (diuretic); Lactate, acetate, or citrate administration; Bicarbonate administration
What drug may be used prior to bronchoscopy to reduce secretion production.
Atropine
What is the best recommendation to improve ventilation (respiratory alkalosis) when a patient is breathing over the set rate when using VC-CMV?
Change mode to SIMV to allow the patient to breathe w/o receiving a mandatory breath with every inspiration.
Condition caused by a deficiency of blood supply to an organ
Ischemic or Ischemia
Persistent respiratory acidosis even after alveolar ventilation has been increased is caused by?
Increased alveolar dead space (low CO, PE, high PEEP levels, auto-peep)
Type of metabolic disturbance caused by sepsis.
Metabolic acidosis
Alternative method for secretion clearance in patients with reduced cardiopulmonary reserve.
Chest vest or oscillating vest