This document discusses mechanical ventilation, including its purposes, types, modes, settings, complications, weaning process, and nursing care of patients on ventilators. The main types are negative pressure ventilators like iron lungs and positive pressure ventilators. Common modes include assist-control, SIMV, PSV and APRV. Key settings include tidal volume, rate, sensitivity and PEEP. Weaning involves gradually reducing support in stages. Nursing care focuses on airway management, ventilation, safety, communication and weaning progress.

1. objective of seminar
-The student will be able to list the indications
for mechanical ventilation (MV).
-The student will be able to describe common
modes of MV,
-The student will be able to describe the process
of ventilator weaning.
-The student will be able to distinguish
alternative modes of MV and the basic
principles of non-invasive ventilation.

2. Presented by
Mohammed
Faris
Abdalghany

3. Mechanical ventilation
is a positive- or negative-pressure
breathing device that can maintain
ventilation and oxygen delivery for a
prolonged period.
Caring for a patient on mechanical
ventilation has become an very important
part of nursing care in critical care or general
medical-surgical units

4. Purposes:
• To maintain or improve ventilation, & tissue
oxygenation.
• To decrease the work of breathing & improve
patient’s comfort.

5. Indications:
-decrease in oxygenation (PaO2)
-increase in arterial carbon dioxide levels (PaCO2)
-persistent acidosis (decreased pH)
-Conditions such as thoracic or abdominal Surgery
-drug overdose, neuromuscular disorders, inhalation
injury,

6. Indications:
-COPD.
-Multiple trauma
-Shock
-multisystem failure
-Infectious diseases of the lung such as
pneumonia, tuberculosis.
-Acute respiratory failure

7. Classification of Ventilators
Mechanical ventilators are classified according
to the method by which they support
ventilation. The two general categories are
1-negative-pressure
2- positive-pressure ventilators.

8. Negative-Pressure Ventilators
Negative-pressure ventilators exert a negative
pressure on external chest. Decreasing the
intrathoracic pressure during inspiration
Physiologically, this type of assisted
ventilation is similar to spontaneous
ventilation. It is used mainly in chronic
respiratory failure associated with
neuromuscular conditions, such as
poliomyelitis, muscular dystrophy, lateral
sclerosis, and myasthenia gravis.

9. types of negative-pressure
ventilators
Iron Lung
The iron lung is a negative-pressure chamber
used for ventilation. It was used extensively
during polio in the past and currently is used
and patients with other neuromuscular
disorders (e.g., lateral sclerosis, muscular
dystrophy).

11. types of negative-pressure
ventilators
Body Wrap
The body wrap and chest cuirass are portable
devices that require a rigid cage or shell to
create a negative-pressure chamber
around the thorax and abdomen.

12. Contraindication of NIPPV
1-experienced respiratory arrest,
2 serious dysrhythmias,
3-cognitive impairment,
4-head or facial trauma.

13. Positive-Pressure Ventilators
Today, the most common ventilators use
positive pressure. Positive-pressure ventilators
inflate the lungs by exerting positive pressure on
the airway, pushing air in, similar to a bellows
mechanism, forcing the alveoli to expand
during inspiration and Expiration occurs
passively

14. Positive-Pressure Ventilators
Pressure-Cycled Ventilators
flow of air (inspiration) until it reaches a preset
pressure, and then cycles off, and
Expiration occurs passively.
Time-Cycled Ventilators
control inspiration after a preset time.
The volume of air the patient receives is regulated
by the length of inspiration and the flow rate of
the air.

15. Positive-Pressure Ventilators
Volume-Cycled Ventilators
most commonly used positive-pressure
ventilators today
mandatory ventilation, pressure support
ventilation, and airway pressure release
ventilation

17. noninvasive positive-pressure
ventilation
is a method of positive-pressure ventilation that
can be given via face masks that cover the nose
and mouth, nasal masks, or other oral or nasal
devices
It eliminates the need for endotracheal
intubation or tracheostomy and decreases the
risk of nosocomial infections such as pneumonia

18. noninvasive positive-pressure
ventilation
if they have acute or chronic respiratory failure,
1-acute pulmonary edema, 2-COPD,3- chronic
heart failure, or a 4- sleep-related breathing
disorder.
The technique also may be used at home to
improve tissue oxygenation and to rest the
respiratory muscles while patients sleep at
night.

19. Continuous positive airway pressure
(
(CPAP
-(CPAP) provides positive pressure to the airways
throughout the respiratory cycle.
Although it can be used as an assistant to
mechanical ventilation with a cuffed
endotracheal tube or tracheostomy tube to
open the alveoli
-CPAP is the most effective treatment for
obstructive sleep apnea,

20. Ventilator Modes
Ventilator mode refers to how breaths are The
most commonly used modes are
1-assist–control.
2-intermittent mandatory ventilation.
3-synchronized intermittent mandatory
ventilation.
4- pressure support ventilation.
5-airway pressure release ventilation.

21. Assist–control (A/C) ventilation
provides full ventilatory support by delivering a
preset tidal volume and respiratory rate. If the
patient initiates a breath between the machine’s
breaths, the ventilator delivers at the preset volume
Client can breathe at a higher rate than the preset
number of breaths/minute
-The total respiratory rate is determined by the
number of spontaneous inspiration initiated by the
patient plus the number of breaths set.

22. Synchronized intermittent mandatory
ventilation
(SIMV)
delivers a preset tidal volume and number of
breaths per minute. Between ventilator-
delivered breaths, the patient can breathe
spontaneously with no assistance from the
Ventilator
Used to when wean the patient from the
mechanical ventilator.

23. Intermittent mandatory ventilation
(IMV)
provides a combination of mechanically assisted
breaths and spontaneous breaths.
Mechanical breaths are delivered at preset
intervals and a preselected tidal volume,
Although the patient can increase the
respiratory rate by initiating inspiration between
ventilator-delivered breaths, efforts.
regardless
of the patient’s

24. Pressure support ventilation (PSV)
patient-triggered inspiration to decrease resistance
within the tracheal tube and ventilator tubing. The
inspiratory pressure level, respiratory rate, and
inspiratory–expiratory (I:E) ratio must be selected.
Pressure support is reduced gradually as the patient’s
strength used when the risk of barotrauma is high.
The nurse must closely observe the patient’s
respiratory rate and tidal volumes on initiation of
PSV.

25. Airway pressure release
ventilation (APRV
time triggered, pressure-limited, time-cycled
mode of mechanical ventilation that allows
unrestricted, spontaneous breathing
throughout the ventilatory cycle.
The inflation period is long, and breaths may be
initiated spontaneously as well as by the
ventilator.

26. Ventilator Settings
1-tidal volume required(10 to 15 mL/kg).
2-lower FiO2 to maintain normal PaO2 (80
to 100 mm Hg).
A/C).
-
APRV
-
3-Set mode(SIMV-PCV-IMV
4-And rate as pt. condition
5-Adjust sensitivity so that the patient can
trigger the ventilator with a minimal effort
(usually 2 mm Hg negative inspiratory
force).

27. Ventilator Settings
6-set the PEEP
7-Record minute volume and obtain ABGs to
measure carbon dioxide (PaCO2), pH, and PaO2
after 20 minutes of continuous mechanical
ventilation.
8-Adjust setting (FiO2 and rate) according to
results of arterial blood gas analysis

28. PEEP advantage
• Prevent atelectasis or collapse of alveoli
• Improve gas exchange & oxygenation
• Treat pulmonary edema ( pressure help fluids out
from alveoli )

29. ● Fraction of inspired oxygen (FIO2)
• The percent of oxygen concentration that the
patient is receiving from the ventilator. (Between
21% & 100%)
(room air has 21% oxygen content).
• Initially a patient is placed on a high level of FIO2 .
• Subsequent changes in FIO2 are based on ABGs
• For infants, and especially in premature infants,
high levels of FiO2 (>60%) should be avoided.

30. ● Tidal Volume (VT)
• The volume of air delivered to a patient during a
ventilator breath.
• The amount of air inspired and expired with each
breath.
• Usual volume selected is between 5 to 15 ml/ kg
body weight)

31. ● I:E Ratio (Inspiration to
Expiration Ratio):-
• The ratio of inspiratory time to expiratory
time during a breath
(Usually = 1:2)

32. Signs and symptoms of oxygen toxicity :-
1- Flushed face
2- Dry cough
3- Dyspnea
4- Chest pain
5- Tightness of chest
6- Sore throat

33. ● Respiratory Rate/ Breath
Rate / Frequency ( F)
• The number of breaths the ventilator will
deliver/minute (10-16 b/m).
• Total respiratory rate equals patient rate plus
ventilator rate.
• The nurse double-checks the functioning of the
ventilator by observing the patient’s respiratory
rate.

34. ● Sensitivity(trigger Sensitivity)
• The sensitivity function controls the amount of
patient effort needed to initiate an inspiration
• Increasing the sensitivity (requiring less negative
force) decreases the amount of work the patient
must do to initiate a ventilator breath.
• Decreasing the sensitivity increases the amount of
negative pressure that the patient needs to initiate
inspiration and increases the work of breathing.

35. Complications
of Mechanical Ventilation:-
I- Airway Complications,
II- Mechanical complications,
III- Physiological Complications,
IV- Artificial Airway Complications.

36. I- Airway Complications
1- Aspiration
2- Decreased clearance of secretions
3- Nosocomial or ventilator-acquired
pneumonia

37. II- Mechanical complications
1- Hypoventilation with atelectasis with respiratory
acidosis or hypoxemia.
2- Hyperventilation with hypocapnia and respiratory alkalosis
3- Barotrauma
a- Closed pneumothorax,
b- Tension pneumothorax,
c- Subcutaneous emphysema.
4- Inadequate nebulization or humidification
5- Overheated inspired air, resulting in hyperthermia

38. III- Physiological Complications
1- Fluid overload with humidified air and
sodium chloride (NaCl) retention
2- Depressed cardiac function and
hypotension
3- Stress ulcers
4- Paralytic ileus
5- Gastric distension
6- Starvation

39. Causes of Ventilator Alarms
High pressure alarm
• Increased secretions
• Kinked ventilator tubing or endotracheal
tube (ETT)
• Patient biting the ETT
• Water in the ventilator tubing.
• ETT advanced into right mainstem bronchus.

40. Causes of Ventilator Alarms
High pressure alarm
• Increased secretions
• Kinked ventilator tubing or endotracheal
tube (ETT)
• Patient biting the ETT
• Water in the ventilator tubing.
• ETT advanced into right mainstem bronchus.

41. High respiratory rate alarm
• Episodes of tachypnea,
• Anxiety,
• Pain,
• Hypoxia,
• Fever.
-

42. Nursing process of patients on mechanical
ventilation
Assessment:
1- Assess the patient
2- Assess the artificial airway (tracheostomy
or endotracheal tube)
3- Assess the ventilator

43. Nursing Diagnoses
1-Impaired gas exchange related to underlying
illness
2-Ineffective airway clearance related to
3_increased mucus Production
4-Risk for trauma and infection
5-Impaired physical mobility
6-Impaired verbal communication

44. Planning and Goals
The major goals for the patient may include
1-achievement of optimal gas exchange,
maintenance of a patent airway,
2- absence of trauma or infection, optimal
mobility
3-adjustment to nonverbal methods of
communication
4-absence of complications.

45. Nursing Interventions
1-Maintain airway patency & oxygenation
2- Promote comfort
3- Maintain fluid & electrolytes balance
4- Maintain nutritional state
5- Maintain urinary & bowel elimination
6- Maintain eye , mouth and cleanliness and
integrity
7- Maintain mobility/ musculoskeletal function

46. Nursing Interventions
8- Maintain safety:-
9- Provide psychological support
10- Facilitate communication
11- Provide psychological support &
information to family
12- Responding to ventilator alarms
/Troublshooting
ventilator alarms
13- Prevent nosocomial infection
14- Documentation

47. Respiratory weaning,
the process of withdrawing the patient from
dependence on the ventilator,
takes place in three stages:
the patient is gradually removed from the
ventilator, then
from the tube, and finally from oxygen.

48. Criteria for Weaning
Careful assessment determine whether the
patient is ready to be removed from mechanical
ventilation Stable vital signs and arterial blood
gases are also important
predictors of successful weaning. Once
readiness has
been determined, the nurse records baseline
measurements
of weaning indices to monitor progress.

49. Criteria for weaning
• Awake and alert
• Hemodynamically stable,
• Arterial blood gases (ABGs) normalized or at
patient’s baseline
- PaCO2 acceptable
- PH of 7.35 – 7.45
- PaO2 > 60 mm Hg ,
- SaO2 >92%
- FIO2 ≤40%

50. • Chest x-ray reviewed for correctable factors;
treated as indicated,
• Major electrolytes within normal range,
• Hematocrit >25%,
• Core temperature >36°C and <39°C,
• Adequate management of
pain/anxiety/agitation,
• Adequate analgesia/ sedation (record scores
on flow sheet),
• No residual neuromuscular blockade.

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.

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.

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 breaths

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 all ventilation is spontaneously
initiated by the patient.
• Weaning by gradual decrease in pressure value

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.