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Nursing Care of the              Mechanically Ventilated PatientCreate PDF files without this message by purchasing novaPD...
Nursing Care of the              Mechanically Ventilated Patient                        • Nursing care of patients who are...
Precaution & Care            • Tracheobronchial Hygiene:            • Placement of tube:                                  ...
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Care of the Ventilator Patient        • Observe and document                                                        • Prov...
Nursing Care of the Mechanically                Ventilated Patient    • Pulmonary assessment is perhaps never as      impo...
Nursing Assessment                    Components: Breath Sounds           • Breath sounds should be assessed at least     ...
Nursing Assessment Components:                  Rate & Volume         • Make sure to assess and document the           pat...
AnatomyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Nursing Assessment                    Components:Pulse Oximetry         • Pulse oximetry is a useful monitoring tool, but ...
• Monitoring:          Continuous and Periodic monitoring of    • Vital parameters such as temperature,SpO2, Pulse,      B...
Remember that            • PaO2 depends on FiO2 & PEEP            • PaCO2 depends on Tidal volume & Rate              In I...
ABG - Setting            •    pH = 7.16                                                       •     A       VT = 500      ...
PH=7.49                       PaCO2=30            ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬                       BE= +0.5    ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ...
PH=7.46                  PaCO2=56        ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬                  BE=+13 ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬                  ...
PH=7.25                  PaCO2=48         ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬                  BE=-6.5 ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬                ...
PH=7.٢٨                     PaCO2=۶٩ ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬                     BE=+٢.۵ ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬                  ...
ABG - Setting            •    pH = 7.4                                                        •     A       VT = 400      ...
Nebulisation    • It is advisable to put all the patients on      bronchodilators on regular basis.    • Nebulise as per t...
Pain related to Mechanical                   ventilation & ET tube placement                      • Positioning of the tub...
Eye & Mouth care            • For unconscious patients              eyes are kept closed by              taping.          ...
Monitoring for infection            • Colour, consistency, and amount of the              sputum / secretions with each   ...
Nutrition:            • Enteral nutrition to support the              patient’s metabolic needs and defend              ag...
Nutritional support         Important :         Skeletal muscle weakness  Difficult weaning         Hypophosphatemia  ...
Stress gastric ulcer            • Very common in critically ill patients            • Send stools for occult blood and    ...
Positioning:            • Place the patient in low or semi              Fowler’s position to improve comfort              ...
In the absence of medical contraindication(s).         CDC Guideline for Prevention of Healthcare Associated Pneumonias, 2...
Signs and Symptoms of Acute                          Hypoxia            •    Tachycardia                                  ...
Oxygen Delivery Methods                             Mechanical Ventilation              • Allows administration of 100% ox...
Hazards of Oxygen Therapy            • Oxygen induced hypoventilation with the              following risk criteria:      ...
Signs of Oxygen Toxicity            • Substernal pain                                                    • Decreased      ...
Oxygen toxicity            • Try and maintain a SpO2 of > 90% and              PaO2 of 60 – 90 mmHg with minimum          ...
Suction            • Should be done on PRN basis            • Ascultate and assess            • View the chest X-ray      ...
Nursing Care of the Patient with an              Tracheostomy Tube    • Trach care should be performed at least every shif...
Closed suction systemsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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Albert, NEJM 1981; Preston, AJM 1981; Tablan, 1994Create PDF files without this message by purchasing novaPDF printer (htt...
Oral Cavity                        • Suction the oral cavity                        • Swab the oral cavity every 4 hours a...
Oropharyngeal Suctioning                      • Suction every 12 hours to remove                        secretions from th...
Brush Teeth            • Brush teeth 2 times per day to remove              dental plaqueCreate PDF files without this mes...
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Communication:            • If conscious, explain the environment,              procedures, co-operation expected etc.    ...
Teach……           • Co-operation with medical and nursing             interventions           • Certain breathing techniqu...
Nursing Care of the Ventilator            • Record and document                                                • NEVER use...
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Injury during Mechanical Ventilation            • Possibility of ventilator associated lung              injury, baro-trau...
Alarms            • Never keep alarm system muted            • Never ignore even when you know the              cause for ...
Weaning            • Assess for readiness to wean.            • Follow a clear cut protocol            • Provide emotional...
Methods of Weaning            1- T-piece trial,            2- Continuous Positive Airway Pressure              (CPAP) wean...
1- T-Piece trial            • It consists of removing the patient from the              ventilator and having him / her br...
2-Synchronized Intermittent Mandatory                     Ventilation ( SIMV) Weaning            • SIMV is the most common...
3-Continuous Positive Airway Pressure (                         CPAP) Weaning            • When placed on CPAP, the patien...
4- Pressure Support Ventilation (PSV)                                Weaning            • The patient must initiate all pr...
Ventilator Weaning              •     Vital Capacity at least 10 – 15 ml/kg              •     Tidal Volume > 5 ml/kg     ...
Predictions of the outcome                         of weaning                Variables used to predict weaning            ...
Weaning success prediction                •    Tidal volume            > 325 ml                •    Tidal volume/BW       ...
Rapid Shallow Breathing Index(RSBI)                                       RSBI<105                                       I...
Extubation Procedure              •     Explain procedure to patient              •     RT must be at bedside             ...
Complications of Mechanical                              Ventilation       • One of the reasons for such a frequent and   ...
Complications of Mechanical                             Ventilation       • Positive Pressure Ventilation:        can cau...
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Nursing care in mechanical ventilation

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  1. 1. Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  2. 2. Nursing Care of the Mechanically Ventilated PatientCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  3. 3. Nursing Care of the Mechanically Ventilated Patient • Nursing care of patients who are being mechanically ventilated requires some special considerations. • Some special considerations relate specifically to the type of tube via which the patient is being ventilated (i.e. endotracheal or tracheostomy) and others related to the patient, and the ventilator itself.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  4. 4. Precaution & Care • Tracheobronchial Hygiene: • Placement of tube: Chest movement Auscultation Post intubation X-ray • Cuff pressure: If insufficient- Leak Displacement of the tube Aspiration If high pressure - Tracheal stenosis Desired Pressure - 20-30cm waterCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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  6. 6. NormalCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  7. 7. Care of the Ventilator Patient • Observe and document • Provide oral care prn – Airway type, size, and • Reapply ETT tape position q24h and prn – Character of insertion site • Provide trach care and replace inner – Date airway inserted cannula q12h and – Pulmonary assessment prn • Inspection • Palpation • Monitor for • Percussion complications • Auscultation • Suction as needed • Wean and extubateCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  8. 8. Nursing Care of the Mechanically Ventilated Patient • Pulmonary assessment is perhaps never as important as it is in the mechanically ventilated patient. • These patients require frequent reassessments on a schedule and on an “as needed” basis. • Further assessments can be documented in Protouch under “Reassessments”.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  9. 9. Nursing Assessment Components: Breath Sounds • Breath sounds should be assessed at least every four hours, and more frequently as needed. • Both the anterior and the posterior chest need to be auscultated bilaterally. • Clearly document any adventitious breath sounds that are heard, and report significant alterations to the Physician.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  10. 10. Nursing Assessment Components: Rate & Volume • Make sure to assess and document the patient’s spontaneous respiratory rate and tidal volume. This information tells you a lot about the patient’s respiratory functioning. • Note any changes in this area, and report significant findings to the patient’s Physician.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  11. 11. AnatomyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  12. 12. Nursing Assessment Components:Pulse Oximetry • Pulse oximetry is a useful monitoring tool, but provides minimal indication of the patient’s ventilatory or acid-base status. • Readings can be affected by abnormal hemoglobins, vascular dyes, and poor perfusion. • Plus, the machine can’t distinguish between normal and abnormal hemoglobins, so a patient with carbon monoxide poisoning could have a pulse ox reading of 100%.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  13. 13. • Monitoring: Continuous and Periodic monitoring of • Vital parameters such as temperature,SpO2, Pulse, BP,ECG pattern, breath rate etc. • Ventilator settings: All settings should be recorded – as per the doctors order • Sensorium • Intake and output • Level of comfort • Arterial blood gases – p r n or twice dailyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  14. 14. Remember that • PaO2 depends on FiO2 & PEEP • PaCO2 depends on Tidal volume & Rate In ICU, our primary aim is • To get a PaO2 of 60-90 mmHg & • PaCO2 of 30-50mmHg. • Ensure that plateau inspiratory pressure does not exceed 30cm of H2O ( risk of VALI – Ventilator Associated Lung Injury)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  15. 15. ABG - Setting • pH = 7.16 • A VT = 500 • PaCO2 = 81 mmHg • B RR = 12 • HCO3 = 28 mEq/L • C O2 = 50 • PaO2 = 36 mmHg • D PEEP = 5 • SaO2 = 69%Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  16. 16. PH=7.49 PaCO2=30 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ BE= +0.5 ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬ HCO3 = 22.6 ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن درﻟﯿﺘﺮ‬ PaO2= 72 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ Sao2=95.8%Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  17. 17. PH=7.46 PaCO2=56 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ BE=+13 ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬ - HCO3 =40‫ﻣﯿﻠﯽ اﮐﯽ واﻻن درﻟﯿﺘﺮ‬ PaO2=58 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ Sao2=90.7%Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  18. 18. PH=7.25 PaCO2=48 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ BE=-6.5 ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬ - HCO3 =20.6‫ﻣﯿﻠﯽ اﮐﯽ واﻻن درﻟﯿﺘﺮ‬ PaO2=56 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ Sao2=83.4%Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  19. 19. PH=7.٢٨ PaCO2=۶٩ ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ BE=+٢.۵ ‫ﻣﯿﻠﯽ اﮐﯽ واﻻن در ﻟﯿﺘﺮ‬ HCO3 =٣٢‫ﻣﯿﻠﯽ اﮐﯽ واﻻن درﻟﯿﺘﺮ‬ PaO2= 49 ‫ﻣﯿﻠﯽ ﻣﺘﺮ ﺟﯿﻮه‬ Sao2=٧٨%Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  20. 20. ABG - Setting • pH = 7.4 • A VT = 400 • PaCO2 = 50 mmHg • B RR = 13 • HCO3 = 30 mEq/L • C O2 = 44 • PaO2 = 60 mmHg • D PEEP = 11 • SaO2 = 90% • Pplat = 33 cmH2OCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  21. 21. Nebulisation • It is advisable to put all the patients on bronchodilators on regular basis. • Nebulise as per the doctor’s orderCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  22. 22. Pain related to Mechanical ventilation & ET tube placement • Positioning of the tube, pulling of the circuits, in appropriate flow rates, sensitivity setting that requires patient’s greater efforts, etc. • Prevent all the above as much as possible.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  23. 23. Eye & Mouth care • For unconscious patients eyes are kept closed by taping. • Goggles can also be used. • Regular & proper mouth care should be given.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  24. 24. Monitoring for infection • Colour, consistency, and amount of the sputum / secretions with each suctioning should be observed. • Fever and other parameters have to closely observed for any other infection. (central line, etc)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  25. 25. Nutrition: • Enteral nutrition to support the patient’s metabolic needs and defend against infection. • Avoid high carbohydrate diet during weaning. NG tube if necessary – relieves gastric distension and prevents aspiration.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  26. 26. Nutritional support Important : Skeletal muscle weakness  Difficult weaning Hypophosphatemia  Poor contractility diaphragm that accompany with ARF & ARDS Caloric in take  (Hyper alimentation)  CO2 Production   Necessitating VA Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  27. 27. Stress gastric ulcer • Very common in critically ill patients • Send stools for occult blood and gastric juice for pH estimation • Auscultate bowel movements • Sedation and antacids adequately.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  28. 28. Positioning: • Place the patient in low or semi Fowler’s position to improve comfort and facilitate respiration.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  29. 29. In the absence of medical contraindication(s). CDC Guideline for Prevention of Healthcare Associated Pneumonias, 2003 Drakulovic et al, Lancet, 1999,354:1851Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  30. 30. Signs and Symptoms of Acute Hypoxia • Tachycardia • Anxiety • Tachypnea • Arrhythmias • Dyspnea • Decreased PaO2 • Euphoria • HTN • Stupor • Impaired judgment • Tremors • Blurred Vision • Hyperreactive • Coma/Death reflexesCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  31. 31. Oxygen Delivery Methods Mechanical Ventilation • Allows administration of 100% oxygen • Controls breathing pattern for patients who are unable to maintain adequate ventilation • Is a temporary support that “buys time” for correcting the primary pathologic processCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  32. 32. Hazards of Oxygen Therapy • Oxygen induced hypoventilation with the following risk criteria: – Pts baseline PaCO2 > 50 mmHg – Baseline O2 saturation < 90% – With supplemental O2, PaO2 doesn’t exceed 60 mmHg • Absorption atelectasis with the following risk criteria: – FiO2 > 50% – Decreasing alveolar volumes – Airway obstructionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  33. 33. Signs of Oxygen Toxicity • Substernal pain • Decreased • Cough compliance • Dyspnea • Pulmonary edema • Anxiety • Atelectasis • Paresthesia • Decreased vital • Fatigue capacity • Pulmonary • Increased shunting infiltrates (V/Q mismatching) • Decreased PaO2Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  34. 34. Oxygen toxicity • Try and maintain a SpO2 of > 90% and PaO2 of 60 – 90 mmHg with minimum possible FiO2 to prevent O2 toxicity. • Especially for COPD patients : Maintain SpO2 of 85 – 90% and PaO2 of 55 – 70 mmHg.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  35. 35. Suction • Should be done on PRN basis • Ascultate and assess • View the chest X-ray • Determine the need and for effective suctioning • Hyperoxygenation & ventilation – ambu/normal • Keep strict vigil on the cardiac monitor pulse oximeter during and soon after suctioning • If necessary carry out effective chest physioCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  36. 36. Nursing Care of the Patient with an Tracheostomy Tube • Trach care should be performed at least every shift, and as needed as ordered by the patient’s Physician. • The patient should always be pre-oxygenated with 100% oxygen prior to suctioning. • Saline should not be routinely instilled into the airway. Saline installation has been shown to increase infection rates and to cause decreased oxygen levels for longer periods of time than suctioning without it.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  37. 37. Closed suction systemsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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  39. 39. Albert, NEJM 1981; Preston, AJM 1981; Tablan, 1994Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  40. 40. Oral Cavity • Suction the oral cavity • Swab the oral cavity every 4 hours and PRN to cleanse and maintain oral mucosal integrity • Moisturize oral cavity every 4 hoursCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  41. 41. Oropharyngeal Suctioning • Suction every 12 hours to remove secretions from the oropharyngeal area above the vocal cords.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  42. 42. Brush Teeth • Brush teeth 2 times per day to remove dental plaqueCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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  44. 44. Communication: • If conscious, explain the environment, procedures, co-operation expected etc. • Use verbal & non verbal methods • Use paper & pen if necessary • Provide calling bell if necessary • Reassurance and support the patient during the period of anxiety, frustration and hopelessness • Document patient’s emotional response and any signs of psychosis • Include family in the careCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  45. 45. Teach…… • Co-operation with medical and nursing interventions • Certain breathing techniques • The patient to recognize the importance of breathing techniques. • Frequent assessment of consciousness level, adequate rest etc. are necessary.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  46. 46. Nursing Care of the Ventilator • Record and document • NEVER use the top of the following settings per the ventilator as a unit standards desk – Rate (mech and spont) – FiO2 • NEVER sit liquids on – Tidal volume (mech & or near the ventilator spont) – PS/PEEP/CPAP • NEVER make – Peak pressure (PIP) changes to ventilator – SpO2 settings • Refer to RT, MD, or Charge Nurse as neededCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  47. 47. 47Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  48. 48. Injury during Mechanical Ventilation • Possibility of ventilator associated lung injury, baro-trauma, tracheal necrosis etc have to be detected in time and take appropriate action. • Use soft restrainers whenever necessary.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  49. 49. Alarms • Never keep alarm system muted • Never ignore even when you know the cause for the alarm and may not be fatalCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  50. 50. Weaning • Assess for readiness to wean. • Follow a clear cut protocol • Provide emotional support and decrease the patient’s fear and anxiety • Never try weaning at night • If weaning once failed ( fatigue, sweating, dyspneic etc..) do not attempt for the next 24- 48 hours. • Once weaning is successful, switch over to T piece • Before extubation, do a leak test and cough test . • if the above tests are positive -extubate by following proper protocolCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  51. 51. Methods of Weaning 1- T-piece trial, 2- Continuous Positive Airway Pressure (CPAP) weaning, 3- Synchronized Intermittent Mandatory Ventilation (SIMV) weaning, 4- Pressure Support Ventilation (PSV) weaning.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  52. 52. 1- T-Piece trial • It consists of removing the patient from the ventilator and having him / her breathe spontaneously on a T-tube connected to oxygen source. • During T-piece weaning, periods of ventilator support are alternated with spontaneous breathing. • The goal is to progressively increase the time spent off the ventilator.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  53. 53. 2-Synchronized Intermittent Mandatory Ventilation ( SIMV) Weaning • SIMV is the most common method of weaning. • It consists of gradually decreasing the number of breaths delivered by the ventilator to allow the patient to increase number of spontaneous breathsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  54. 54. 3-Continuous Positive Airway Pressure ( CPAP) Weaning • When placed on CPAP, the patient does all the work of breathing without the aid of a back up rate or tidal volume. • No mandatory (ventilator-initiated) breaths are delivered in this mode i.e. all ventilation is spontaneously initiated by the patient. • Weaning by gradual decrease in pressure valueCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  55. 55. 4- Pressure Support Ventilation (PSV) Weaning • The patient must initiate all pressure support breaths. • During weaning using the PSV mode the level of pressure support is gradually decreased based on the patient maintaining an adequate tidal volume (8 to 12 mL/kg) and a respiratory rate of less than 25 breaths/minute. • PSV weaning is indicated for :- - Difficult to wean patients - Small spontaneous tidal volume.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  56. 56. Ventilator Weaning • Vital Capacity at least 10 – 15 ml/kg • Tidal Volume > 5 ml/kg • Resting minute volume <10 L per minute • ABG’s adequate on < 40% FiO2 • Stable vital signs • Intact airway protective reflexes (strong cough) • Absence of dyspnea, neuromuscular fatigue, pain, diaphoresis, restlessness, use of accessory musclesCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  57. 57. Predictions of the outcome of weaning Variables used to predict weaning success: Gas exchange • PaO2 of > 60 mmHg with FiO2 of < 0.35 • PaO2/FiO2 ratio of > 200Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  58. 58. Weaning success prediction • Tidal volume > 325 ml • Tidal volume/BW > 4 ml/kg • Dynamic Compliance > 22 ml/cmH2O • Static compliance > 33 ml/cmH2O • Rapid shallow breathing index < 105 breaths/min/LCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  59. 59. Rapid Shallow Breathing Index(RSBI) RSBI<105 In spontaneous breathing or CPAP mod PSV=5-7cmH2o Respiratory(f)/Tidal volume(VT)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  60. 60. Extubation Procedure • Explain procedure to patient • RT must be at bedside • Wash your hands • Suction airway and oropharynx for pooled secretions (prevents aspiration of secretions atop balloon) • Place a towel on patient’s chest • Assure new oxygen setup is ready to use • Deflate cuff and remove tube instructing patient to cough as tube is removed • Apply supplemental oxygen • Monitor pt for distress (stridor, coughing, anxiety)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  61. 61. Complications of Mechanical Ventilation • One of the reasons for such a frequent and thorough assessment of the pulmonary system while patients are being mechanically ventilated is due to the many complications that can occur with the use of mechanical ventilation. • Thorough assessments can lead to the early discovery of potential complications, heading off more serious complications later.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  62. 62. Complications of Mechanical Ventilation • Positive Pressure Ventilation:  can cause: hypotension decreased venous return decreased cardiac output  Other complications: pneumothorax subcutaneous emphysema air embolus localized pulmonary hyperinflation nosocomial infections increased intracranial pressure (cerebral edema)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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