LEARNING OBJECTIVES

Upon completion of this section, you will have mastered the following learning objectives:

1. Discuss the goals of the critical care areas.
2. Describe the indications and the positive physiological effects for each of the following modalities.
   • SIMV
   • PEEP
   • CPAP
   • PSV
   • AMV
3. Describe the hazards and side effects of each of the following modalities:
   • SIMV
   • PEEP
   • CPAP
   • PSV
   • AMV
4. Describe and identify the pressure, volume, and flow waveforms for each of the following modalities:
   • SIMV
   • PEEP
   • CPAP
   • PSV
   • AMV
5. List the four basic techniques that are used to assess the patient at the bedside.
6. Describe the factors that should be noted in each of the following areas of bedside patient assessment and be able to describe normal findings and interpret abnormal findings in each assessment area:
   • Neurological assessment
   • Pulmonary assessment
   • Cardiovascular assessment
7. Define and explain the significance of the following terms:
   • Dyspnea
   • Cyanosis
8. Describe the indications and significance of data obtained from the following monitoring devices or lines:
   • Oximeters
   • CO2 monitors
   • Arterial lines
   • Swan-Ganz lines
   • CVP lines
9. Define the following terms associated with arterial blood gas analysis and interpretation:
   • Acidosis
   • Alkalosis
   • Hypoxia
   • Hyperoxia
   • Acidemia
   • Alkalemia
   • Hypercapnia
   • Hypocapnia
   • Respiratory acidosis
   • Respiratory alkalosis
   • Hypoventilation
   • Hyperventilation
   • Hypoxemia
   • Hyperoxemia
   • Metabolic acidemia
   • Metabolic alkalosis
10. Describe the physiological and clinical significance of each of the following arterial blood gas parameters:
    • pH
    • PaCO2
    • PaO2
11. Be able to differentiate between the various types of compensation that can occur in arterial blood gases.
12. Given a set of arterial blood gases, be able to interpret them in terms of the acid- base and oxygenation status.
13. Describe the normal and primary abnormal findings associated with each of the following aspects of a chest x-ray.
    • Bony structure
    • Pleural space
    • Heart
    • Diaphragm
    • Lung fields
    • Airways
14. Describe the etiology, clinical manifestations, management, complications, and prognosis for each of the following diseases when mechanical ventilation is required:
    • COPD
    • Asthma
    • ARDS
    • Blunt-chest trauma
    • Post-surgical recovery
    • Myasthenia gravis
    • Guillain-Barré
    • Pulmonary edema
15. Describe various kinds of problems that can exacerbate respiratory failure and give examples for each general category.
16. Describe the general clinical picture of the patient in impending or frank respiratory failure and the kinds of variations that can occur.
17. How is respiratory failure definitively diagnosed?
18. Describe the indications and procedure for establishing an airway in the patient in respiratory failure.
19. Describe the procedure for establishing the initial ventilator parameters for the patient in respiratory failure.
20. Discuss the significance of the following factors in the ventilator patient for whom ventilator discontinuance or weaning is contemplated:
    • Physiological preparation
    • Cardiovascular status
    • Nutrition
    • Fatigue
    • Fluid balance
21. Discuss the normal limits and usefulness of the following assessment procedures used to evaluate the ventilator patient's spontaneous entilatory reserve:
    • Arterial blood gases
    • Alveolar-arterial oxygen gradient
    • Peak inspiratory pressure
    • Spontaneous minute ventilation
    • Maximal voluntary ventilation
    • Respiratory rate
    • Vital capacity
    • Forced expiratory volume in 1 second
    • Spontaneous tidal volume
    • VD/VT ratio
    • Shunt fraction
22. Describe the application, advantages, and disadvantages of each of the following methods of ventilator discontinuance or weaning:
    • Spontaneous breathing trials
    • SIMV
    • Pressure support
    • AMV