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During spontaneous inspiration alveolar pressure (Pa) is about - correct answers - 1 cmH2O Which of the following conditions causes pulmonary compliance to increase? - correct answers emphysema The respiratory therapist should expect which of the following findings while ventilating a patient with acute respiratory distress syndrome (ARDS)? - correct answers an elevated plateau pressure The condition that is associated with an increase in airway resistance is which of the following: - correct answers bronchospasm The respiratory therapist enters modes and parameters into the ventilator with which of the following? - correct answers user interface An increase in airway resistance during pressure-targeted ventilation will have which of the following effects? - correct answers volume decrease The pressure required to maintain alveolar inflation is known as which of the following? - correct answers Transpulmonary pressure How many variables can a ventilator control at one time? - correct answers 1
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An increase in airway resistance during volume-controlled ventilation will have which of the following effects? - correct answers pressure increase A patient who has a decrease in lung compliance due to ARDS during volume limited ventilation will cause which of the following? - correct answers increased peak pressure The ventilator variable that begins inspiration is which of the following? - correct answers trigger A patient who has been sedated and paralyzed by medications is being controlled by the ventilator. The set rate is 15 breaths/min. How many seconds does it take for inspiration and expiration to occur? - correct answers 4 seconds The inspiratory and expiratory flow sensors are reading a base flow of 5 l/min. The flow trigger is set to 2 L/min. The expiratory flow sensor must read what flow to trigger inspiration? - correct answers 3 l/min The RT enters the room of a patient being mechanically ventilated with volume ventilation. The high-pressure alarm is sounding, and the measured exhaled tidal volume is significantly lower than what is set. The variable that is ending inspiration is which of the following? - correct answers pressure The variable that a ventilator uses to end inspiration is known as which of the following? - correct answers cycle
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Calculate the expiratory time (TE) when the ventilator frequency is set to 25 breaths/min and the inspiratory time (TI) is 0.75 s - correct answers 1.65 s What is the flow rate necessary to deliver a tidal volume (VT) of 600 mL, with a constant wave form, at a respiratory rate of 15 breaths/min with an I:E of 1:4? - correct answers 45 L/min Setting flow rates high will cause which of the following to occur? - correct answers increase peak pressures Slow flow rates will cause which of the following to occur? - correct answers shorten expiratory time The flow waveform pattern that provides the shortest inspiratory time (TI) of all the available flow patterns with an equivalent peak flow rate setting is which of the following? - correct answers constant The flow waveform pattern that is created during pressure targeted ventilation is which of the following: - correct answers descending ramp The flow waveform pattern that will decrease peak pressure but at the same time may increase mean airway pressure is which of the following? - correct answers descending ramp
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A patient having an acute, severe asthma exacerbation is intubated and set up on volume controlled continuous mandatory ventilation (VC-CMV). To ensure volume delivery at the lowest peak pressure while providing for better air distribution, which flow waveform should be used? - correct answers descending ramp A 26-year-old, 6'6", 250 lb male patient, is still under the effects of anesthesia following knee surgery. His body temperature is 37° C. He has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following? - correct answers 9.7 L/min A 47-year-old 5'6, 112lb female patient, is still under the effects of anesthesia following a hysterectomy. her body temperature is 37C. She has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following? - correct answers 6.1 L/min The pattern that has shown to improve the distribution of gas in the lungs for an intubated patient on volume controlled continuous mandatory ventilation (VC-CMV) is which of the following: - correct answers descending ramp When changing the control variable from volume control (VC) to pressure control (PC), the initial inspiratory pressure should be set based on which of the following methods?
- correct answers plateau pressure measurement taken during VC ventilation The mode of ventilation that provides pressure limited, time cycled breaths that use a set tidal volume as a feedback control is which of the following: - correct answers pressure regulated volume control (PRVC)
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What is the inspiratory time in the scalar below? - correct answers 1 sec What is the expiratory time in the scalar below? - correct answers 2.5 - 1= 1.5 sec What is the trigger variable for the "A" breath shown in the figure below? - correct answers time What is the inspiratory time for the ventilator breath shown in section B of the figure below? - correct answers 0.5 sec The RT observes the pressure time scalar seen below. Wave A was generated at 1300 hour and Wave B at 1600 hour. The action that is most appropriate for this situation is which of the following: - correct answers administer a bronchodilator The ventilator graphics generated by mechanical ventilation with pressure controlled continuous mandatory ventilation (PC-CMV), rate 18, peak inspiratory pressure (PIP) 25 cm H2O, positive end expiratory pressure (PEEP) 5 cm H2O, are shown in the scalars below. Interpretation of these scalars reveal which of the following? - correct answers There is air trapping that could be due to a high respiratory rate The volume curve on a volume time scalar is consistently dropping below the baseline during exhalation. The first action to take is which of the following? - correct answers When the volume drops below the baseline during exhalation, the cause could be active exhalation or an inspiratory time that is too long
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A patient is receiving full ventilatory support with volume ventilation. At 0700 the RT observes the pressure, volume, and flow time scalars shown in "A" below. Six hours later the RT observes the scalars shown in "B". The most appropriate action to take is which of the following? - correct answers Give a bronchodilator An inadequate flow setting during volume ventilation will cause which of the following?
- correct answers the pressure time curve will appear concave during inspiration The type of flow curve produced by volume ventilation with constant flow is - correct answers rectangular flow curve An increase in airway resistance during pressure ventilation will result in - correct answers the flow time scalar will show a curve that is flatter in appearance. flow will not drop to zero by the time the set inspiratory time is reached A reduction in compliance during pressure ventilation will cause which of the following? - correct answers delivered tidal volume will decrease Delayed termination during pressure support ventilation (PSV) can be avoided with patients who have chronic obstructive pulmonary disease (COPD) by doing which of the following? - correct answers increase flow cycle percent What is the flow cycle setting for the pressure support ventilation (PSV) breaths shown in the scalars below? - correct answers the peak inspiratory flow is 40 L/min. Inspiration ends at 20 L/min. The flow cycle is therefore set at 50%
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The pressure in the potential space between the parietal and visceral pleura is known as ...... At the end of exhalation during spontaneous breathing this pressure is approximately ....... and at the end of inspiration is about.......... - correct answers intrapleural pressure, 5 cm H2O, 10 cm H2O identify the pressure labeled A through E - correct answers A= Pressure at the airway opening (Pawo) B= Airway pressure (Paw) C= Pressure at the body's surface (Pbs) D= Alveolar pressure (Palv) E= Intrapleural pressure (Ppl) Name at least three additional terms for pressure A - correct answers mouth pressure (Pm), airway opening pressure (Pawo), proximal airway pressure, and mask pressure How is intrapleural (ppl) estimated? - correct answers is estimated using the esophageal pressure (PES). PES is obtained by placing a balloon in the esophagus and monitoring pressure changes in the balloon. The pressure gradient between airway opening and alveolus is known as........ This pressure is responsible for the movement of air in the ......... This gradient is calculated by the formula....... - correct answers Transairway pressure (PTA), conductive airways, PTA = pawo - palv
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The pressure required to expand or contract the lungs and the chest wall at the same time is ......... This pressure gradient is calculated by the formula ........... - correct answers Transthoracic pressure (PW or PTT), PW = Palv - Pbs The pressure required to maintain alveolar inflation is known as........ and is calculated by the formula ....... - correct answers Transpulmonary pressure (PL or PTP), PL = Palv
- Ppl The pressure that is required of inflation of the lungs during positive pressure ventilation is called...... and is calculated by the formula....... - correct answers Transrespiratory pressure (PTR), PTR = Pawo - Pbs What pressure gradient is represented by Point A? What is its function during breathing? - correct answers Pawo - Pbs = Transrespiratory pressure (PTR), which is the pressure required to inflate the lungs during positive pressure ventilation What pressure gradient is represented by B? What is its function during breathing? - correct answers Palv - Pbs = Transthoracic pressure (PW or PTT), which is the pressure needed to expand or contract the lungs and chest wall at the same time What pressure gradient is represented by C? What is its function during breathing? - correct answers Palv - Ppl = Transpulmonary pressure (PL or PTP), which is the pressure required to maintain alveolar inflation What pressure gradient is represented by D? What is its function during breathing? - correct answers Pawo - Palv = Transairway pressure (PTA), which is the pressure required to produce airflow in the conductive airways.
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Pulmonary compliance defines as ...... and the formula is written as ....... - correct answers Change in volume that corresponds to the change in pressure, C = ∆V ÷ ∆P Normally, total compliance of the lungs and thorax is about ..... but, it can range from ..... to ...... - correct answers 0.1 L/cm H2O or 100 mL/cm H2O, 0.05-0.17 L/cm H2O While mechanically ventilated, the compliance value for a male with normal lungs is ....... and for a female with normal lungs is ....... - correct answers 40 - 50 mL/cm H2O, 35 45 mL/cm H2O What is the formula used to calculate static compliance? - correct answers CSTAT = ∆V ÷ (Pplat - EEP) When more pressure is required to deliver a set tidal volume (VT), what is likely happening to compliance? - correct answers When more pressure is required to deliver a specific volume, the lung compliance is decreasing Calculate the static compliance when Pplat is 27 cm H20, baseline pressure is 10 cm H20, and Vt is 750 ml - correct answers 750 mL ÷ (27 - 10 cm H2O) = 44 mL/cm H2O What happens to PIP as the lungs become more difficult to ventilate? What happens to lung compliance - correct answers As the lungs become harder to ventilate, PIP will increase. As the lungs become harder to ventilate, lung compliance will decrease.
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Resistance - correct answers is a measurement of the frictional forces that must be overcome during breathing What is the formula for airway resistance (Raw)? - correct answers Raw = (PIP - Pplat) ÷ Flow (L/sec) What is the normal resistance range flow rates of 0.5 L/s? - correct answers 0.6-2. cm H2O/L/sec What lung disease causes both airway resistance and static compliance to increase? - correct answers emphysema Calculate the PTA when PIP is 27 cm H20 and Pplat is 20 cm H20 - correct answers PTA = PIP − Pplat (27 - 20 = 7 ) How much pressure is needed to overcome airway resistance when PIP is 30 cm H and Pplat is 20 cm H20? - correct answers PTA = 30 - 20 = 10 What is the normal amount of pressure lost to airway resistance when a patient has a properly sized endotracheal tube? - correct answers 5 - 7 cm H Calculate Raw for a ventilated patient with the following: PiP 48, Pplat 30 and a set flow rate of 40 L/min - correct answers Raw = (PIP - Pplat) ÷ Flow (L/sec)
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When the PIP is 43 and the Pplat is 18, how much pressure is required to overcome the resistance of the airways? - correct answers 43 - 18 = 25 Name the two types of power sources used by ventilators that provide energy to perform the work of breathing? - correct answers Electrically powered, pneumatically powered Which specific power source does each of the following ventilators use? - correct answers Bird mark 7: Pneumatic power LTV 1000, 1150: electric power Open Loop System - correct answers is an unintelligent system in which the ventilator delivers what is set by the operator but does not have the ability to automatically change its operation Closed loop system - correct answers is called an "intelligent system," because it has the ability to compare a set of control variables and make adjustments to the system The position on the ventilator where the clinician inputs and monitors ventilator parameters is known as the ____________. - correct answers user interface (control panel) List 5 common components that can set by the clinician using dials or touch panels located on the user interface of the ventilator - correct answers - tidal volume
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- rate (or frequency)
- inspiratory time
- alarm's
- FiO From your answer for the last question, what four ventilatory variables do these controls ultimately regulate? - correct answers flow, volume, pressure, and time Inside a ventilator gas flow passes through what type of circuit? - correct answers internal pneumatic circuit After exiting the ventilator, gas flow passes through the ____ on its way to the patient. - correct answers external pneumatic circuit The gas flow from the ventilator's power source goes directly to the patient. This is known as what type of internal pneumatic circuit? - correct answers single circuit The primary goal of mechanical ventilation is to achieve a ....... that matches the patient's needs - correct answers Minute ventilation In a healthy person what are the typical oxygen consumption and carbon dioxide consumption? What is the abbreviation used for each? - correct answers VO2 = 250 mL/min and VCO2 = 200 mL/min 2VO& and 2VCO
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The estimated VT range for a male patient with an IBW of 90 kg is - correct answers 540 - 720 mL What is the normal VT range for a spontaneously breathing patient? - correct answers 5 - 7 mL/kg What is the normal range for the respiratory rate in a spontaneously breathing patient?
- correct answers 12 - 18 Recommend the initial tidal volume, respiratory rate, and minute ventilation for a 71- inch-tall male with COPD - correct answers 106 + 6(71 60) = 172 lb ÷ 2.2 = 78 kg What is the equation for TCT? - correct answers 60/RR What is the equation to calculate the expiratory time (TE)? - correct answers TCT - TI = TE What is the equation to calculate inspiratory time (TI)? - correct answers TI = TCT/ I + E Calculate VT given TI = 1 second and flow of 50 L/min - correct answers 50/60 = 0. L/sec Flow rate × Inspiratory time = Tidal volume.
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Calculate TI given VT = 700 mL and flow of 50 L/min - correct answers 50/60 = 0. TI = Vt/flow rate = 700/0.83 = 0. Increasing the set flow rate while ventilating apneic patient in VC-CMV will cause the Ti to ______, the PIP to ______, and gas distribution to ______. - correct answers shorten, increase, decrease What are the guidelines for setting TI, I:E ratio, and flow rates during CMV in regard to flow rates, TI, TE? - correct answers When slower flow rates are used, the TI will be longer and the TE will be shorter, which may result in air trapping and possible cardiovascular side effects. However, PIP may be reduced, and gas exchange may be improved The type of flow waveform pattern created by pressure ventilation is - correct answers descending or decelerating waveform The flow waveforms most appropriate for normal lungs are - correct answers descending or constant waveforms Why is a descending flow pattern beneficial for patients with hypoxemia and low lung compliance? - correct answers it keeps PIP low and Paw high, improving gas distribution What is an inspiratory pause most frequently used to determine? - correct answers measurement of plateau pressure, which helps estimate alveolar pressure for the calculation of static compliance
