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What is the application of positive pressure above atmospheric pressure at the airway throughout expiration called?
PEEP
What recruits and opens collapsed alveoli, increases the MAP and increases PaO2?
PEEP
What prevents and treats atelectasis and microatelectasis and keeps the alveoli open and stable?
PEEP
What is PEEP set to when baseline is needed to equal atmospheric pressure?
0
Baseline expiratory pressure is always measured and set relative to what pressure?
Atmospheric pressure
What are the physiologic effects of PEEP
1. Restore and increase FRC
2. Decrease shunt fraction (decreases intrapulmonary shunting)
3. Increases PaO2 for a given FIO2
4. Decreases WOB and decreases the O2 consumption
5. Increase lung compliance
6. Decreases the dead space tidal volume ratio (VD/VT)
7. Decreases P(A-a) gradient
To increase FRC and improve gas distribution is a goal of what?
PEEP
What is used to treat chronic refractory hypoxemia?
PEEP
PEEP is used to treat chronic refractory hypoxemia in patients with a FIO2 greater than ____ and PaO2 lower than _____ mmHG
FIO2 = .60, PaO2 = 60
What is used to increase PaO2 and PvO2?
PEEP
What is used to prevent (possibly) and treat ARDS/ALI?
PEEP
Hypotension and hypovolemia are contraindications of what?
PEEP
What are the contraindications of PEEP?
1. Hypotension and hypovolemia
2. Untreated tension pneunothorax
3. Increased intracranial pressure
4. Emphysema
5. Tracheal fistula
6. Excessively high airway pressures
7. Unilateral lung disease
8. Untreated bronchopleural fistula
What are the hazards of PEEP during mechanical ventilation?
1. Increased intrathoracic pressure
2. Decreased venous return
3. Increased ADH and aldosterone-fluid
4. Decreased blood pressure due to decreased Qt
5. Decreased cardiac output
6. Loss of \"thoracic pump\"
7. Barotrauma - pneumothorax
8. Increased intracranial pressure
9. Decreased urine output by 30-50% due to decreased Renal Blood Flow
What i monitored when initiating and/or performing an Optimum PEEP trial
1. B/P, if available cardiac output
2. ABG\'s to check PaO2/SAO2
3. Urinary Output
4. Vital Signs
5. Cardiovascular function
6. Static compliance
7. Shunt fraction
8. P(A-a)O2 gradient
9. C(a-v)O2
10. DO2 (oxygen delivery to the tissues)
When PEEP levels exceed 15cm what needs to be inserted to monitor Cardiovascular function?
Swan-Ganz catheter
How much O2 is delivered to the tissues per minute?
500-1000 mL/minute
How is Delivered O2 calculated?
DO2= CaO2 x Qt
What modes of ventilation can be used with PEEP?
1. SIMV
2. IMV
3. CMV
4. A/C
5.CPAP
6.PSV
When ventilating a patient on CMV and A/C mode with PEEP what needs to be monitored very closely?
Blood pressure
What ventilation mode has a greater hazards with PEEP?
CMV and A/C
What must be adjusted and or increased when PEEP is added or it will be difficult for the patient to initiate a breath also increasing what?
Sensitvity
WOB
When PEEP is decreased why is the sensitivity decreased?
To prevent autocycling.
What modes of ventilation do not require sensitivity to be decreased when PEEP is decreased?
Any mode where a patient triggers a breath
When adding or decreasing PEEP what alarm must be adjusted?
High pressure limit alarm
What is the amount of PEEP that gives the highest PaO2 and the best total lung compliance without compromising the cardiac output and blood pressure?
Optimal PEEP
Optimal PEEP must be _______ above lower inflection point on a pressure/volumme curve.
1-2 cms
On a point pressure curve where is the point here lung compliance begins to improve?
Inflection point
Optimal PEEP maximizes what?
Oxygen delivery and transport to the tissues.
On what modes of ventilation can CPAP be used on?
All spontaneous modes of ventilation
CPAP has the same physiologic effects of what?
PEEP
When compared to PEEP what will be lower on CPAP?
MAP
What is CPAP is for?
1. Treatment of obstructive sleep apnea
2. Prevents oropharyngeal tissue collapse
3. Decreases desaturation events, allowing better REM sleep
4. Reverses the effects of hypercarbia
When weaning a patient off CPAP how man increments is the patients reduced every 6-8 hours?
3-5cm
When weaning a patient off PEEP/CPAP decrease FIO2 to 60% while maintaining a PaO2 of what?
60 or higher
When weaning a patient off PEEP/CPAP what should the patient be check for?
1. Hemodynamic stability
2. Sepsis
What are the home uses for BiPAP/CPAP?
1. Obstructive sleep apnea
2. Very obese patients
What is used in acute care in attempt to avoid endotracheal intubation and conventional CMV?
BiPAP/CPAP
What are the modes used in delivering BiPAP?
1. Spontaneous
2. Spontaneous/Time
3. Time/control
Which BiPAP mode is used in patients with long periods of apnea and apneic spells?
Spontaneous/Time
Which BiPAP mode is used in patients with high WOB and high minute volume?
Time/Control
What are the patient interfaces of BiPAP?
1. Nasal or oral face mask
2. Nasal pillows
3. Prongs
What are the two levels of CPAP delivered by BIPAP to a spontaneously breathing patient?
IPAP and EPAP
Which CPAP level delivered on BiPAP is the continous flow of gas past a patient airway.
IPAP
Which BiPAP level is the same as PIP?
IPAP
What is the highest setting for IPAP?
20 cm
Which BiPAP level is the same as CPAP/PEEP?
EPAP
Which BiPAP level increases FRC and increases PaO2?
EPAP
On BiPAP _______ must always be larger than _______
IPAP must be always be larger than EPAP
Which BiPAP setting is used to address and correct problems with ventilation (PaCO2)?
IPAP
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