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NurseReview.Org - Introduction to Mechanical Ventilation

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