RT 212 - Advanced Ventilator Management

Credits: 2
Instructional Contact Hours: 2

Presents the advanced theory and application of skills required to monitor, manage, and wean patients on mechanical ventilation.

Prerequisite(s): RT 150 with a minimum grade of "C"
Corequisite(s): RT 207, RT 214, RT 216, RT 226, RT 229, RT 231
Lecture Hours: 26 Lab Hours: 8
Meets MTA Requirement: None
Pass/NoCredit: No

Outcomes and Objectives

Demonstrate an understanding of test data obtained from patients while on mechanical ventilation.
1. Describe the procedure for measuring and calculating tidal volume, minute ventilation, alveolar ventilation, anatomic dead space, and tubing compliance.
2. Correct tidal volume and rate settings based on arterial blood gas results.
3. Select the sigh mode, pressure support mode, and pressure control mode based on patient findings.
4. Identify from a description the presence of a leak in a ventilator circuit.
5. Explain and demonstrate the procedure for finding a leak in a ventilator circuit.
6. Demonstrate the ability to identify changes in peak and plateau pressure and tidal volume and tell when changes in compliance or resistance have occurred.
7. Draw a pressure-volume curve.
8. Identify changes in compliance and resistance from a pressure-volume curve.
9. Change the FIO2 based on arterial blood gas results.
10. List four ways in which the addition of an externally powered nebulizer to a mechanical ventilator circuit can affect the ventilator function or the patient.
11. Describe the findings in a ventilated patient with respiratory distress.
12. List the common causes of a patient's "fighting" the ventilator.
13. Give the first step in managing the ventilated patient in distress.
14. From changes in vital signs, laboratory data, and sputum characteristics, identify a patient that has a respiratory infection.
15. From changes in input and output data, body weight, and physical findings, identify a patient who has fluid retention during mechanical ventilation.
16. Describe the techniques for measuring vital capacity and maximum inspiratory pressure.
17. Make appropriate recommendations for modifying mechanical ventilation based on the patient’s response to therapy.
Demonstrate an understanding of positive pressure therapy
1. Define the following terms: PEEP, CPAP, IPAP, EPAP, CPPB, minimum PEEP, moderate PEEP, maximum PEEP.
2. List the characteristics of a patient in need of PEEP therapy.
3. Give the relative and absolute contraindications for PEEP or CPAP.
4. Describe how the disease process called ARDS affects lung compliance.
5. Explain the effects of PEEP on FRC, pleural pressure, vascular pressures, and lung water.
6. Given data from a PEEP study, select the optimal PEEP level.
7. List the parameters measured during a PEEP study.
8. Describe the effect of PEEP or CPAP on the measurement of pulmonary vascular pressures.
9. Discuss the use of positive pressure in congestive heart failure.
10. List the effects of PEEP or CPAP on cardiac function.
11. Name four methods of applying PEEP or CPAP to the upper airway.
12. Compare the function of a flow resistor with that of a threshold resistor.
13. Give three examples of gravity-dependent PEEP valves and three examples of nongravity-dependent PEEP valves.
14. Draw a graph showing the difference in airway pressure waveforms with CPAP and with sPEEP and explain the effect of each on work of breathing.
15. From a drawing, identify a freestanding CPAP system and a freestanding demand flow sPEEP system.
16. Describe the use of PEEP with assisted ventilation, IMV, SIMV, PC, and PS.
17. Explain the procedure for weaning from PEEP or CPAP.
18. Compare the effects of mean airway pressure and flow patterns on tissue oxygenation.
19. Define PCIRV and VCIRV.
20. Describe three methods of obtaining IRV on a conventional volume-controlled ventilator.
21. Discuss the effect mechanical ventilation has on hemodynamic monitoring.
22. Discuss which phase of the ventilatory cycle hemodynamic measurements should be taken to obtain a more accurate reading.
23. Calculate PCWPtm.
Demonstrate an understanding of monitoring devices.
1. Name the two parameters that are measured by pulse oximetry and the two physical principles that are the basis for its operation.
2. List the PO2 associated with each of the following saturations: 100%, 97%, 90%, 80%, 75%,
3. Describe the basic principle of operation of the pulse oximeter.
4. Explain how pulse oximetry readings are affected by abnormal hemoglobins, such as HbCO.
5. Explain what a capnometer measures.
6. Name the two types of capnometers.
7. Discuss the normal components of a capnogram.
8. Explain the changes in end-tidal CO2 during hyperventilation and hypoventilation.
9. Identify or describe the fast PETCO2 tracing that occurs with the following: apnea, hypoperfusion (drop in blood pressure or decreased cardiac output), mechanical dead space, obstructive airway disease, esophageal intubation.
10. Give the normal value for P(a - ET)CO2 and list four disorders in which this value is greater than normal.
11. Explain the value of arterial-maximum end-expiratory PCO2 measurements.
12. Using the information from the following sources, make appropriate recommendations for modifications in a patient care plan:
  1. Physical assessment
  2. Arterial blood gases
  3. Mixed venous blood gases
  4. Systemic vascular resistance
  5. Pulmonary vascular resistance
  6. Chest x-ray
  7. Hemodynamic monitoring
  8. Cardiac output, a-v DO2 , VD/VT, A-a DO2, and shunt
  9. Capnography
  10. Other lab data
13. Describe the effects of positive pressure mechanical ventilation on the following:
  1. Cardiovascular system
  2. Renal system
  3. Cerebral pressures and intracranial pressure
  4. Musculoskeletal system
  5. Psychological changes
Demonstrate an understanding of liberation from mechanical ventilation
1. State the number-one factor to be considered when evaluating a patient for ventilator discontinuation or weaning.
2. Summarize the steps that should be taken to optimize patient condition prior to attempting ventilator discontinuation.
3. List all commonly used weaning parameters and include the range of values for each which are considered favorable for ventilator discontinuation.
4. Summarize the procedure used to achieve classic or conventional ventilator weaning.
5. Summarize the procedure used during weaning when using IMV or SIMV.
6. Compare the rationales for conventional weaning and IMV or SIMV.
7. Explain the rationale for the use of pressure support and mandatory minute volume as adjunctive ventilation techniques to facilitate ventilator discontinuation.
8. List common causes for causes for failure in efforts to achieve ventilator discontinuation and explain each.
9. Given clinical scenarios, successfully wean patients from mechanical ventilation.
Demonstrate an understanding of high frequency ventilation.
1. Identify and explain the function of the controls, alarms, and monitors on the assigned infant ventilators.
2. Describe the modes of operation available on the assigned infant ventilators.
3. Describe the effect of control changes on patient ventilation with the assigned infant ventilators.
4. Demonstrate the ability to set-up, monitor, and correct malfunctions of the assigned infant ventilators.
5. Define High Frequency Ventilation (HFV)
6. Describe the following HFV techniques:
  1. HFPPV
  2. HFJV
  3. HFO
7. Explain how gas exchange is theorized to take place with HFV.
8. Describe clinical applications of HFV.
9. Explain the technical problems associated with the use of HFV.