Monitoring ventilated patients

1. MONITORING THE MECHANICALL
Y VENTILATOR PATIENT
1. CARDIOVASCULAR:-
- ECG.
- Hemodynamic Parameters.
2. NEUROLOGICAL :-
- Mental / emotional status.

2. 3. RESPIRATORY /AIRWAY:
• Assessment of Mechanics During Mechanical Ventilation
 Airway Pressure
 Auto-PEEP
 Mean Airway Pressure
 Compliance
 Resistance
 Breath sound.

3. 3. RESPIRATORY /AIRWAY:
• Assessment of Mechanics During Mechanical Ventilation
 Chest movement .(Accessory muscle use, fatigue, dyspnea(
 WOB.
 ETT placement, size, stability, cuff pressure, patent.
 Skin color.
 Spontaneous rate , volume , pattern.
 Secretion (amount , color , odor)

4. 4. SUBJECTIVE:-
 Comfort.
 Complaints.
 Synchrony (fighting)
5. VITAL SIGNS :- HR, RR, BP, TEM
P.

5. 6. OTHER:-
 Response to drug therapy.
 Effectiveness of resp. therapy.
 Positional changes.

6. 7. MEASURMENT:-
 ABGs.
 Pulse Oximetry, Capnography, and Transcutaneous P
o2 (Ptco2) Monitoring
 Chest X-Ray.
 Lab. Data.
 Intake /Out Pot.
 Bedside PFTs.

7. • Oxygenation
 Partial Pressure of Oxygen
 Oxygen Saturation
 Oxygen Content and Oxygen Delivery
 Alveolar Po2
 Pressure-Based Indices
 Pulmonary Shunt
 Oxygen Delivery and Oxygen Consumption
• Ventilation
 Partial Pressure of Carbon Dioxide
 Dead Space and Alveolar Ventilation
ABGs:-

8. • Acid-Base Balance
 Anion Gap and Osmol Gap
 Strong Ion Difference
• Mixed Venous Blood Gases
 Mixed Venous P02
 Mixed Venous and Central Venous
 Oxygen Saturation
 Mixed Venous PC02
• Brain Tissue Po2
• Temperature Adjustment of Blood Gases and pH

10. 1. The goal of vent. Alarm is to warn the operator of eve
nt .
 Alarms may be audible , visual or both . depending on the serio
usness.
 VISUAL ALARAM :- -Simple as colored lights.
-Complex as messages.
2. It is particularly important that all alarms are correc
tly set on the ventilator.
3. The most important alarm is the pt ,disconnect alarm
4. Which can be a low-pressure alarm or a low exhaled
volume alarm.
5. A sensitive alarm should be detect not only disconnec
tion but also leaks in the system .

11. Conditions that triggered low pressure or low volume alarm

12.  High VE :- 10—15% above set VE.
 Low VE:- 10—15% below set VE .
 High VT: 10—15%above set VT.
 Low VT:- 10—15% below set VT.
 High pressure/L :- 10 cm H2O above average PIP .
 Low pressure/L:- 5—10cm H2O below average PIP.
 Low PEEP/CPAP:- 3—5cm H2O below set PEEP/CPAP.
 FiO2 :- +_ 5% of set FiO2 .
 Apnea alarm :- 10—20second.

13. PRESSURE ALARMS
1. ↓PIP:- Leak: ETT too small or displaced ,cuff defl
ation or leak ,TE fistula.
- No leak:- ↓ Raw (↓ secretions , relief bronch
ospasm)
- ↑ Compliance (↓ Atelectasis, chang
e in positions, ↓ pul. edema)
- Pt: - Ventilation asynchrony.
- Circuit: - Disconnected or Leak.
- Machine: - Altered settings, Internal leak.

14. PRESSURE ALARMS
2. ↑PIP(VCV) :- ↑ Raw : Bronchospasm , ↓ cough, ↑ secretions
plugs, ETT in Rt. main stream, or touch carina, kinked.
- ↓ Compliance:- Abdominal distention, atelectasi
s, pneumonia, Pneumothorax, Position change, pul. edema.
- Pt : - Ventilator a synchrony.
- Circuit: - Tubing kinked, H2O in circuit.
- Machine: - Altered settings ,internal problem..

15. 3. ↓ PEEP/CPAP: - Altered settings .
- Leak.
- ↑ Exp-flows from ventilator
- ↓ Pt. insp. flow.
4. ↑ PEEP/CPAP: - Altered setting.
- Auto-peep. (short I:E).
- Pt fighting.

16. VOLUME ALAMS:-
1. ↓ Expired volume:-
- Leak.
- Circuit disconnection
- Malfunction of transducer.
2. ↑ Expired volume:-
- Altered setting.
- Transducer malfunction.

17. FLOW ALARM:-
 High or Low ventilatory frequency (hyperventilat
ion or machine self triggering) or apnea.
 Inappropriate inspiratory time.
 Inappropriate expiratory time.

18. INPUT POWER ALARMS:-
 Battery back up. in the case of electrical
power failure.

19. GAS SUPPLY ALARMS:-
 Decrease or loss of gas pressure in gas sour
ce.
 Machine malfunction.