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COVID-19 and Oxygen Delivery/Ventilation, Exams of Medical Sciences

This document provides a comprehensive overview of the key concepts related to oxygenation and ventilation in the context of COVID-19 management. It covers various oxygen delivery methods, non-invasive and invasive ventilation techniques, the Berlin definition of ARDS, and the management of COVID-19-related ARDS. It also discusses evolving treatment strategies, including the use of antivirals and anti-inflammatory agents. This resource offers valuable insights for healthcare professionals managing COVID-19 patients.

Typology: Exams

2023/2024

Available from 08/27/2024

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COVID-19 & O2 Delivery/Ventilation (Ko)
what is oxygenation? - correct answer process of adding oxygen to body
-provides O2 assistance
what is ventilation? - correct answer movement of air into and out of the lungs
-helps w gas exchange
list 4 methods of O2 delivery that provides oxygenation assistance - correct answer nasal cannula
(NC)
mask or oxymask
nonrebreather (NRB)
high-flow nasal cannula (HFNC)
which non-invasive ventilation method provides oxygenation & ventilation (gas exchange)? -
correct answer BiPAP (Bilevel Positive Airway Pressure) -> most common
-a mask, pt is not intubated
which invasive ventilation methods provides oxygenation & ventilation (gas exchange)? - correct
answer via:
-endotracheal tube (intubation)
-tracheostomy (a surgical airway) -put directly into trachea
high-flow nasal cannula (HFNC) % O2 delivered (FiO2), reason to use, supports pt's ________ -
correct answer 100% (full oxygenation)
-can deliver high FiO2, is more comfortable vs mask longer-term
-used often for COVID-19
-supports pt's oxygenation
BiPAP (Bilevel Positive Airway Pressure) % FiO2, reason to use, drawbacks, supports pt's ______
- correct answer start at 100% -> titrate down to 40%
-delivers O2 but also assists ventilation by forcefully pushing air into airways, opening alveoli to
inc gas exchange
-forceful pressure into airway is not comfortable, high aspiration risk!
-supports pt's oxygenation & ventilation
what is aspiration? - correct answer inhaling fluid (secretions or when drinking) into lungs
-irritates lungs -> can develop pneumonia
what are 2 common clinical scenarios that use BiPAP? - correct answer 1. acute decompensated
HF w/ pulm edema (commonly seen)
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COVID-19 & O2 Delivery/Ventilation (Ko)

what is oxygenation? - correct answer process of adding oxygen to body

  • provides O2 assistance what is ventilation? - correct answer movement of air into and out of the lungs
  • helps w gas exchange list 4 methods of O2 delivery that provides oxygenation assistance - correct answer nasal cannula (NC) mask or oxymask nonrebreather (NRB) high-flow nasal cannula (HFNC) which non-invasive ventilation method provides oxygenation & ventilation (gas exchange)? - correct answer BiPAP (Bilevel Positive Airway Pressure) - > most common
  • a mask, pt is not intubated which invasive ventilation methods provides oxygenation & ventilation (gas exchange)? - correct answer via:
  • endotracheal tube (intubation)
  • tracheostomy (a surgical airway) - put directly into trachea high-flow nasal cannula (HFNC) % O2 delivered (FiO2), reason to use, supports pt's ________ - correct answer 100% (full oxygenation)
  • can deliver high FiO2, is more comfortable vs mask longer-term
  • used often for COVID- 19
  • supports pt's oxygenation BiPAP (Bilevel Positive Airway Pressure) % FiO2, reason to use, drawbacks, supports pt's ______
  • correct answer start at 100% - > titrate down to 40%
  • delivers O2 but also assists ventilation by forcefully pushing air into airways, opening alveoli to inc gas exchange
  • forceful pressure into airway is not comfortable, high aspiration risk!
  • supports pt's oxygenation & ventilation what is aspiration? - correct answer inhaling fluid (secretions or when drinking) into lungs
  • irritates lungs - > can develop pneumonia what are 2 common clinical scenarios that use BiPAP? - correct answer 1. acute decompensated HF w/ pulm edema (commonly seen)
  1. hypercapnic resp failure (severe COPD) - > high CO what is another advantage of BiPAP for ADHF/pulm edema? - correct answer + pressure ventilation (PPV) that pushes air into lungs via BiPAP - > inc intrathoracic pressure - > inc cardiac output via dec afterload & dec venous return, which dec preload how does PPV resolves acute pulm edema? - correct answer PPV pushes fluid out of lungs BiPAP for ADHF/pulm edema: what would pt be benefit from? what is an effect of this? - correct answer - benefit from BiPAP + nitrogen drip (in addition to diuretics!) - > dec preload & afterload -

quickly resolves pulm edema intubation & mechanical ventilation % FiO2, what can be adjusted, why do we use? - correct answer start at 100% - > titrate down to 40%

  • pressure, vol, RR - > all adjusted
  • full control over oxygenation & ventilation what are drawbacks of intubation & mechanical ventilation? - correct answer - pts must be given analgesia & sedation, usually in IV infusions of opioid + sedative
  • risk of VAP (G- common), stress ulcers, VTE, other complications what are 3 common clinical scenarios that use intubation & mechanical ventilation? - correct answer resp failure obtunded (= no resp effort) during surgery oxygen support (simple O2) provides what? but pt MUST be able to do what? - correct answer - provides higher % O2 to pt vs what is found in room air, but pt must be able to breathe on their own ventilation support helps w what? - correct answer improve gas exchange which methods provide both oxygenation & ventilation? - correct answer noninvasive ventilation (such as BiPAP), and intubation & mechanical ventilation what does BiPAP provides? this helps w what? - correct answer - provides + pressure ventilation -

helps reduce pulm edema associated w ADHF (pushing fluid out of lungs) intubation & mechanical ventilation allows for what? but req. what? - correct answer - allows for complete control of pt's oxygenation & ventilation, but req. sedation/analgesia & multidisciplinary team care Poll Q: what is berlin definition of ARDS? - correct answer PaO2:FiO2 ratio - > determine mild, mod, severe ARDs

is there treatment for ARDS itself? - correct answer NO specific tx

  • supportive ICU care is given, pharmD plays large role in prevention & management of complications ARDS tx: what should be minimized? why? - correct answer - minimize fluid intake from IV meds = use max conc - > minimize risk of pulm edema on top of lung damage what is ventilator synchrony? - correct answer sedatives, neuromuscular blockers DEXA-ARDS trial 2020 shows what? - correct answer corticosteroids have possible mortality benefit
  • dexamethasone use 10 days course in ARDS list 2 other supportive care for ARDS - correct answer - inhaled pulm vasodilators (epoprostenol) -

inc blood flow - > inc gas exchange

  • supportive ICU care COVID-19 specific tx in severe cases: what should be done? - correct answer delay/avoid intubation if at all possible: HFNC (maintain O2 levels) +/- inhaled pulm vasodilators (inc O2 in blood) +/- prone positioning what is prone positioning? for which pts? - correct answer placing pt w breathing difficulties on their stomach to help them breathe better
  • reserved for sedated pts who req. a breathing machine (ventilator), may be beneficial for awake pts w COVID COVID-19 specific tx in severe cases: use of what in early disease course? - correct answer antivirals COVID-19 specific tx in severe cases: if late disease stage, use what? - correct answer anti- inflammatory:
  • dexamathasone at COVID-19 dosing (6 mg daily x 10 days or until discharge) use of dexamethasone has mortality benefit for which pts? - correct answer pts needing O which agents should be considered if elevated CRP & req. O2 to target gas exchange - correct answer - tocilizumab (anti-IL 6 IV)--studies w conflicting results
  • baricitinib (JAK inhibitor - > prevents IL-6 activiation) PO in early pandemic, COVID-19 ARDS was what? - correct answer severe & had a high mortality rate

COVID-19 therapies incl what early in disease and what drugs in later stage? - correct answer early: antiviral agents late: anti-inflammatory drugs targeted therapies against what are known to be inc in COVID-19 were tested w mixed results? - correct answer cytokines