7.
What parameters are included in weaning a patient from the ventilator?
a. RR < 25 bpm, VT >25 mL/kg, VC >10 mL/k, Minute Ventilation 200.
b. RR < 50 bpm, VT >30 mL/kg, VC >12 mL/kg, Minute Ventilation < 8 mL/k
c. RR >20 bpm, VT >15 mL/kg, VC > 8 mL/kg, Minute Ventilation < 10 mL/k
d. RR 20 mL/kg, VC > 10 mL/kg, Minute Ventilation < 12 mL/k
The criteria for RR, VT, VC, and Minute Ventilation have been determined through observation and study of the best techniques and parameters to obtain successful weaning. The Standard Weaning Criteria (SWC) uses the respiratory muscle strength and endurance by using the negative inspiratory force (NIF) and positive expiratory pressure (PEP) to determine how well a patient will do when weaned from the ventilator. The RSBI which is the Respiratory Shallow Breathing Index is used as well. As the patient tires the spontaneous breathing rate becomes rapid and shallow and it is necessary to evaluate muscle fatigue. RSBI =(f/VT) which helps to identify the breathing pattern associated with an unsuccessful weaning. The ratio of success is considered--
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17.
What are the five parameters initially used to set up a ventilator?
a. Tidal Volume: 6-8 mL/kg, RR: 10-12 bpm, PC ventilation:
b. Tidal Volume: 5-10 mL/kg, RR: 20 bpm, AC/PC ventilation: >35 cmH2O, FiO2: 50-100%
c. Tidal Volume: 6-8 mL/kg, RR: 15 bpm, SIMV/PS: 5, PEEP: 5, FiO2: 20-30%
d. None of the above
Tidal Volume: 6-8 mL/kg (6-7 mL/kg is considered ideal), RR: 10-12 bpm, PC ventilation: <35 cmH2O, FiO2: 40-60% are considered the standard protocol. The exceptions are ARDS, ALI, Asthma where the ARDS Net protocol 4-6 mL/kg and 4 mL/kg for Asthmatics should be used. When calculating the VT, calculate a high and low VT for ARDS.
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24.
As Dynamic Compliance can vary at any point, what are three main reasons that Dynamic Compliance may be continually affected?
a. Hyperventilation, water in tube, too long a circuit
b. Bronchoconstriction, Kinked ETT, Secretions
c. Secretions, FiO2 too high, PEEP too low
d. Atelectasis, coughing, sneezing
Bronchoconstriction, Kinked ETT and Secretions are three common, easy to fix issues that affect Dynamic Compliance. Cdyn= Vt/(PIP-PEEP).
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