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Effective: Summer 2015
RSPT 50CTHERAPEUTICS & INTRODUCTION TO MECHANICAL VENTILATION5 Unit(s)

Prerequisites: Prerequisite: RSPT 50B.
Grade Type: Letter Grade Only
Not Repeatable.
FHGE: Non-GE Transferable: CSU
2 hours lecture, 3.5 hours laboratory, 6 hours clinical laboratory. (138 hours total per quarter)

Student Learning Outcomes -
  • The student will be able to explain concepts and theory related to the initiation, monitoring, and discontinuing of ventilatory support.
  • The student will be able to perform procedures pertaining to mechanical ventilation by completing all lab competencies and a lab practical with a 70% or higher.
Description -
Practice of skills in the clinic setting. Topics to be covered include respiratory failure, introduction to invasive and non-invasive mechanical ventilation. This course is intended for students accepted and enrolled in the Respiratory Therapy Program.

Course Objectives -
The student will be able to:
  1. Define acute respiratory failure.
  2. Discuss the causes of respiratory failure.
  3. Differentiate between Type I, Type II and Type I and Type II respiratory failure.
  4. Discuss the indications for ventilatory support.
  5. Classify ventilators and describe how they work.
  6. Classify and define different modes of ventilation.
  7. Identify the physiologic effects of ventilatory support.
  8. Initiating and adjusting invasive ventilatory support.
  9. Discuss application of noninvasive ventilation (NIV).
  10. Discuss the principle of monitoring the patient in the intensive care unit.
  11. Describe discontinuing ventilatory support.
Special Facilities and/or Equipment -
Ventilators, ventilator tubing, and lung simulators.

Course Content (Body of knowledge) -
  1. Define acute respiratory failure
    1. Definition
    2. Sign and symptoms
    3. Arterial blood gas analysis
  2. Discuss the causes of respiratory failure
    1. Hypoxemic respiratory failure (Type I)
    2. Hypercapneic respiratory failure (Type II)
    3. Chronic respiratory failure (Type I and Type II)
  3. Differentiate between Type I, Type II and Type I and Type II respiratory failure
    1. Hypoxemic respiratory failure (Type I)
      1. Ventilation/perfusion mismatch
      2. Shunt
      3. Alveolar hypoventilation
      4. Diffusion impairment
      5. Perfusion/diffusion impairment
      6. Decreased inspired oxygen
      7. Venous admixture
      8. Differentiating the causes of acute hypoxemic respiratory failure
    2. Hypercapneic respiratory failure (Type II)
      1. Insidious exposure
      2. Increased carbon dioxide production
      3. Impairment in respiratory control
      4. Impairment in respiratory effectors
    3. Chronic respiratory failure (Type I and Type II)
      1. Acute-on-chronic respiratory failure
      2. Complications of acute respiratory failure
      3. Clinical presentation
  4. Indications for ventilatory support
    1. Inadequate alveolar ventilation
    2. Inadequate lung expansion
    3. Inadequate muscle strength
    4. Increased work of breathing
    5. Hypoxemia
  5. Ventilators
    1. How they work
      1. Input power
      2. Power transmission and conversion
      3. Control system
    2. Output waveforms
      1. Pressure
      2. Volume
      3. Flow
    3. Operator interface
      1. Input displays
      2. Output displays
    4. Types of ventilators
      1. Critical care
      2. Conventional
      3. Subacute care
      4. Home care
      5. Transport
      6. Noninvasive
  6. Modes of ventilation
    1. Control variables
      1. Pressure control
      2. Volume control
    2. Breath sequence
      1. Spontaneous breaths
      2. Mandatory breaths
      3. Continuous mandatory ventilation (CMV)
      4. Intermittent mandatory ventilation (IMV)
      5. Continuous spontaneous ventilation (CSV)
      6. Breathing pattern
    3. Targetting scheme
      1. Open loop control
      2. Closed loop control
  7. Physiologic effects of ventilatory support
    1. Pressure and pressure gradients
    2. Effects of mechanical ventilation on ventilation
    3. Effects of mechanical ventilation on oxygenation
    4. Effects of mechanical ventilation on lung mechanics
    5. Minimizing adverse pulmonary effects of positive pressure mechanical ventilation
    6. Physiologic effects of ventilatory modes
    7. Cardiovascular effects of positive pressure mechanical ventilation
    8. Effects of positive pressure mechanical ventilation on other body systems
    9. Complications of mechanical ventilation
  8. Initiating and adjusting invasive ventilatory support
    1. Goals
    2. Initial ventilator settings
    3. Adjusting ventilatory support
    4. Oxygenation
    5. Ventilation
  9. Application of noninvasive ventilation (NIV)
    1. History and development of NIV
    2. Indications for NIV
    3. Patient selection
    4. Equipment selection
    5. Management of NIV
    6. Complications of NIV
  10. Monitoring the patient in the intensive care unit
    1. Respiratory monitoring
    2. Cardiac monitoring
    3. Neurologic monitoring
    4. Renal and Liver function monitoring
    5. Nutritional monitoring
    6. Global monitoring indices
  11. Discontinuing ventilatory support
    1. ventilator dependance
    2. Patient evaluation
    3. Methods
    4. Monitoring the patient during weaning
    5. Extubation
Methods of Evaluation -
  1. Based on clinical evaluation, lab performance, and written exams.
  2. May include: quizzes, midterm, final exam, laboratory performance, and laboratory final.
Representative Text(s) -
Kacmarek, Stoller & Heuer. Egan's Fundamentals of Respiratory Care. 10th edition. St Louis: Elsevier, 2012. ISBN: 9780323082037
Kacmarek & Wehrman. Workbook for Egan's Fundamentals of Respiratory Care. 10th edition. St Louis: Elsevier, 2012. ISBN: 9780323082020
Hinski. Respiratory Care Clinical Competency Lab Manual, St Louis: Elsevier, 2014. ISBN:9780323100571

Disciplines -
Respiratory Technologies
 
Method of Instruction -
  1. Lecture
  2. Discussion
  3. Laboratory
  4. Demonstration
  5. Lab competencies demonstrated in skills
 
Lab Content -
  1. Ventilators
    1. How they work
      1. Input power
      2. Power transmission and conversion
      3. Control system
    2. Output waveforms
      1. Pressure
      2. Volume
      3. Flow
    3. Operator interface
      1. Input displays
      2. Output displays
    4. Types of ventilators
      1. Critical care
      2. Conventional
      3. Subacute care
      4. Home care
      5. Transport
      6. Noninvasive
  2. Modes of ventilation
    1. Control variables
      1. Pressure control
      2. Volume control
    2. Breath sequence
      1. Spontaneous breaths
      2. Mandatory breaths
      3. Continuous mandatory ventilation (CMV)
      4. Intermittent mandatory ventilation (IMV)
      5. Continuous spontaneous ventilation (CSV)
      6. Breathing pattern
    3. Targetting scheme
      1. Open loop control
      2. Closed loop control
  3. Initiating and adjusting invasive ventilatory support
    1. Goals
    2. Initial ventilator settings
    3. Adjusting ventilatory support
    4. Oxygenation
    5. Ventilation
  4. Application of noninvasive ventilation (NIV)
    1. History and development of NIV
    2. Indications for NIV
    3. Patient selection
    4. Equipment selection
    5. Management of NIV
    6. Complications of NIV
  5. Monitoring the patient in the intensive care unit
    1. Respiratory monitoring
    2. Cardiac monitoring
    3. Neurologic monitoring
    4. Renal and Liver function monitoring
    5. Nutritional monitoring
    6. Global monitoring indices
  6. Discontinuing ventilatory support
    1. ventilator dependance
    2. Patient evaluation
    3. Methods
    4. Monitoring the patient during weaning
    5. Extubation
 
Types and/or Examples of Required Reading, Writing and Outside of Class Assignments -
  1. Reading assignments
  2. Workbook assignments
  3. Competencies related to course content