NurseReview.Org - Introduction to Mechanical Ventilation

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NurseReview.Org - Introduction to Mechanical Ventilation

  1. 1. Introduction to Mechanical Ventilation Craig A. Hawkins BS RRT RCP Respiratory Therapy Supervisor Presbyterian Hospital
  2. 2. Indications for Mechanical Ventilation <ul><li>Impending Respiratory Failure </li></ul><ul><li>Acute Respiratory Failure/Arrest </li></ul><ul><li>Post-Operatively </li></ul>
  3. 3. Indications for Mechanical Ventilation <ul><li>Impending Respiratory Failure </li></ul><ul><ul><li>Progressively worsening clinical appearance. </li></ul></ul><ul><ul><li>Worsening CXR. </li></ul></ul><ul><ul><li>Hypoxemic Respiratory Failure. </li></ul></ul><ul><ul><li>Hypercapnic Respiratory Failure. </li></ul></ul>
  4. 4. Indications for Mechanical Ventilation <ul><li>Acute Respiratory Failure/Arrest </li></ul><ul><ul><li>Acute change in ABG results </li></ul></ul><ul><ul><li>Respiratory Arrest/Status Post CPR </li></ul></ul><ul><ul><li>Acute epiglottitis/anaphylaxis </li></ul></ul>
  5. 5. Indications for Mechanical Ventilation <ul><li>Postoperatively </li></ul><ul><ul><li>Oversedation/paralytics </li></ul></ul><ul><ul><li>Pain Control </li></ul></ul><ul><ul><li>Proper Immobilization </li></ul></ul>
  6. 6. Key Terms in Mechanical Ventilation <ul><li>Tidal Volume (Vt) </li></ul><ul><ul><li>The volume of air inhaled and exhaled from the lungs. </li></ul></ul><ul><li>Breaths per Minute (RR, f) </li></ul><ul><ul><li>Also known as frequency. </li></ul></ul><ul><li>Positive End Expiratory Pressure (PEEP) </li></ul><ul><ul><li>Maintenance of above atmospheric pressure at the airway throughout exp. phase. </li></ul></ul>
  7. 7. Key Terms in Mechanical Ventilation <ul><li>Minute Ventilation (VE) </li></ul><ul><ul><li>The total amount of volume moving in and out of the lung in one minute. </li></ul></ul><ul><li>Fractional Inspired Oxygen (FiO2) </li></ul><ul><ul><li>Correctly written with decimal place (21%-0.21; 100%-1.0) </li></ul></ul><ul><li>Inspiratory:Expiratory Ratio (I:E ratio) </li></ul><ul><ul><li>Normal I:E ratio 1:2-3 </li></ul></ul>
  8. 8. Negative Pressure Ventilation <ul><li>Rarely Used; Currently used for patients with neuromuscular diseases. </li></ul><ul><li>Thoracic cage is encased where negative pressure is applied across the chest wall. </li></ul><ul><li>Generates subatmospheric pressures creating a difference in pressure gradients. </li></ul><ul><li>During exhalation, negative pressure is replace by atmospheric pressure allowing the lungs to deflate. </li></ul>
  9. 9. Negative Pressure Ventilation <ul><li>Types of Negative Pressure Ventilators </li></ul>
  10. 10. Iron Lung circa 1950’s
  11. 11. Modern(ized) Iron Lung
  12. 12. Chest Cuirass
  13. 13. Complications with Negative Pressure Ventilation <ul><li>Limited access for patient care. </li></ul><ul><li>Inability to properly monitor pulmonary mechanics. </li></ul><ul><li>Patient discomfort. </li></ul>
  14. 14. Positive Pressure Ventilation <ul><li>Defined as the application of pressure to the lungs in order to improve gas exchange. </li></ul><ul><li>The Lungs are physically filled/ventilated with air using machinery. </li></ul><ul><li>Multiple modes, methods, and theory. </li></ul>
  15. 15. Positive Pressure Ventilation <ul><li>Basically broken into two categories: </li></ul><ul><ul><li>Control Modes. </li></ul></ul><ul><ul><li>Supportive Modes. </li></ul></ul>
  16. 16. Control Modes of Ventilation <ul><li>Assist/Control (usually abbreviated A/C also known as Volume Control VC). </li></ul><ul><ul><li>Tidal Volume is set and remains constant. </li></ul></ul><ul><ul><li>Respiratory Rate is set. </li></ul></ul><ul><ul><li>Airway Pressure will vary according to lung compliance. </li></ul></ul><ul><ul><li>Ventilator will deliver set volume whether patient triggers a breath or mandatory breath is being delivered. </li></ul></ul>
  17. 17. Control Modes of Ventilation <ul><li>Pressure Control Ventilation (usually abbreviated PCV or sometimes PCIRV). </li></ul><ul><ul><li>Upper Airway Pressure Level is set and remains constant. </li></ul></ul><ul><ul><li>Respiratory Rate is set. </li></ul></ul><ul><ul><li>Tidal volumes will vary according to lung compliance. </li></ul></ul><ul><ul><li>Ventilator will deliver set pressure level whether patient triggers a breath or mandatory breath is being delivered. </li></ul></ul>
  18. 18. Control Modes of Ventilation <ul><li>Pressure Regulated Volume Control (usually abbreviated PRVC). </li></ul><ul><ul><li>Tidal Volume is set, however may or may not remain constant. </li></ul></ul><ul><ul><li>Respiratory Rate is set. </li></ul></ul><ul><ul><li>Ventilator will deliver volume however volume may decrease according to patient’s lung compliance. </li></ul></ul><ul><ul><li>A lung protective mode. </li></ul></ul>
  19. 19. Supportive Modes of Ventilation <ul><li>Synchronized Intermittent Mandatory Ventilation (usually abbreviated SIMV). </li></ul><ul><ul><li>Tidal Volume is set and delivered on each mandatory breath. </li></ul></ul><ul><ul><li>Respiratory Rate is set. </li></ul></ul><ul><ul><li>When a patient triggers the ventilator spontaneously , the patient receives a Pressure Supported breath. </li></ul></ul>
  20. 20. Supportive Modes of Ventilation <ul><li>Pressure Support Ventilation (PSV) </li></ul><ul><ul><li>Is a strictly patient dependant mode; patient must be breathing spontaneously. </li></ul></ul><ul><ul><li>An upper (inspiratory) pressure level is adjusted to provide adequate tidal volumes for each patient triggered breath. </li></ul></ul><ul><ul><li>PEEP is also adjusted as an independent pressure from the upper pressure level and is active during expiration. </li></ul></ul><ul><ul><li>PSV is a weaning mode. </li></ul></ul>
  21. 21. Supportive Modes of Ventilation <ul><li>Volume Support (VS) </li></ul><ul><ul><li>Is a strictly patient dependant mode; patient must be breathing spontaneously. </li></ul></ul><ul><ul><li>Tidal Volume is set. </li></ul></ul><ul><ul><li>Each spontaneous breath is supported with dialed volume. </li></ul></ul>
  22. 22. Supportive Modes of Ventilation <ul><li>Continuous (Constant) Positive Airway Pressure (CPAP) </li></ul><ul><ul><li>Is a strictly patient dependant mode; patient must be breathing spontaneously. </li></ul></ul><ul><ul><li>Closely resembles Pressure Support, however CPAP is a constant set pressure that does not change during inspiration or expiration. </li></ul></ul><ul><ul><li>CPAP is a weaning mode. </li></ul></ul>
  23. 23. Drager Evita II
  24. 24. Puritan Bennett 840
  25. 25. Servo 900c
  26. 26. Servo 300a
  27. 27. Servo i
  28. 28. One of the Most Famous Ventilators
  29. 29. Complications to Mechanical Ventilation <ul><li>Ventilator Induced Lung Injury (VILI) </li></ul><ul><ul><li>Induced by excessive pressure (barotrauma) </li></ul></ul><ul><ul><li>Induced by excessive Volume (volutrauma) </li></ul></ul><ul><li>Ventilator Associated Pneumonia (VAP) </li></ul><ul><ul><li>Most commonly Pseudomonas, Gram Negative Bacilli, and staphylococci. </li></ul></ul>
  30. 30. Ventilatory Discontinuance <ul><li>Weaning </li></ul><ul><ul><li>Process of discontinuing ventilatory support, regardless of the time frame involved. </li></ul></ul><ul><ul><li>Categories </li></ul></ul><ul><ul><ul><li>Quick removal; routine </li></ul></ul></ul><ul><ul><ul><li>More gradual reduction in support (trach collar trials) </li></ul></ul></ul><ul><ul><ul><li>Ventilator dependent patients </li></ul></ul></ul>
  31. 31. Ventilatory Discontinuance <ul><li>Success in discontinuing ventilatory support is related to the patients conditions in four main areas: </li></ul><ul><ul><li>Ventilatory workload </li></ul></ul><ul><ul><li>Oxygenation status </li></ul></ul><ul><ul><li>Cardiovascular function </li></ul></ul><ul><ul><li>Psychological factors. </li></ul></ul>
  32. 32. Ventilatory Discontinuance <ul><li>Common indices in successful weaning: </li></ul>FiO2 < 0.4-0.5 PaO2 > 60 PaO2/FiO2 ratio > 200 PaCO2 < 50 pH > 7.35 RSBI < 100
  33. 33. Questions?

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