Acute Respiratory Failure Mechanical Ventilation

5,688 views

Published on

Published in: Health & Medicine
1 Comment
11 Likes
Statistics
Notes
No Downloads
Views
Total views
5,688
On SlideShare
0
From Embeds
0
Number of Embeds
25
Actions
Shares
0
Downloads
242
Comments
1
Likes
11
Embeds 0
No embeds

No notes for slide

Acute Respiratory Failure Mechanical Ventilation

  1. 1. Acute Respiratory Failure Mechanical Ventilation
  2. 2. Acute Respiratory Failure <ul><li>Characterized by </li></ul><ul><ul><li>PaO 2 < 60 </li></ul></ul><ul><ul><li>O 2 Sat < 90 </li></ul></ul><ul><ul><li>PaCO 2 > 50 </li></ul></ul><ul><ul><li>pH < 7.30 </li></ul></ul>
  3. 3. Types of Failure <ul><li>Ventilatory Failure </li></ul><ul><li>Oxygenation Failure </li></ul><ul><li>Combined Ventilatory/Oxygenation Failure </li></ul>
  4. 4. Ventilatory Failure <ul><li>V/Q </li></ul><ul><li>Adequate Perfusion </li></ul><ul><li>Inadequate ventilation </li></ul><ul><ul><li>Insufficient air movement </li></ul></ul><ul><ul><li> O 2 to alveoli </li></ul></ul><ul><ul><li>CO 2 retention </li></ul></ul><ul><li>Caused by </li></ul><ul><ul><li>Mechanical abnormality of lungs or chest wall </li></ul></ul><ul><ul><li>Defect in respiratory control center </li></ul></ul><ul><ul><li>Impaired function of respiratory muscles </li></ul></ul>
  5. 5. Oxygenation Failure <ul><li>Adequate ventilation </li></ul><ul><li>Decreased perfusion </li></ul><ul><li>Inadequate oxygenation of pulmonary blood </li></ul><ul><li>Caused by </li></ul><ul><ul><li>Pulmonary Embolism </li></ul></ul><ul><ul><li>Inadequate hemoglobin </li></ul></ul>
  6. 6. Combined Ventilatory/Oxygenation Failure <ul><li>Hypoventilation </li></ul><ul><li>Inadequate gas exchange </li></ul><ul><li>Occurs in clients with abnormal lungs </li></ul><ul><li>Cardiac failure </li></ul><ul><ul><li>Cannot compensate for  O 2 </li></ul></ul>
  7. 7. Assessment <ul><li>Signs of Hypoxemia </li></ul><ul><li>Decreased PO 2 </li></ul><ul><ul><li>Dyspnea, tachypnea </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Restlessness </li></ul></ul><ul><ul><li>Apprehension </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Dysrhythmias </li></ul></ul><ul><ul><li>Metabolic acidosis </li></ul></ul><ul><li>Signs of Hypercapnia </li></ul><ul><li>Increased P CO 2 </li></ul><ul><ul><li>Dyspnea  resp. depression </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Coma </li></ul></ul><ul><ul><li>Systemic vasodialation </li></ul></ul><ul><ul><li>Heart failure </li></ul></ul><ul><ul><li>Respiratory acidosis </li></ul></ul>
  8. 8. Interventions <ul><li>Correct underlying cause </li></ul><ul><li>Support ventilation </li></ul><ul><li> PO 2 and  PCO 2 </li></ul><ul><ul><li>O 2 therapy </li></ul></ul><ul><ul><li>Positioning </li></ul></ul><ul><ul><li> anxiety </li></ul></ul><ul><ul><li>Energy conservation </li></ul></ul><ul><ul><li>Bronchodialators </li></ul></ul>
  9. 9. Mechanical Ventilation <ul><li>Unresponsive to interventions </li></ul><ul><li>Hypoxemia </li></ul><ul><li>Progressive alveolar hypoventilation with respiratory acidosis </li></ul><ul><li>Respiratory support after surgery </li></ul>
  10. 10. Endotracheal Intubation <ul><li>Short term (10-14 days) </li></ul><ul><li>Maintain patent airway </li></ul><ul><li> work of breathing </li></ul><ul><li>Remove secretions </li></ul><ul><li>Provide ventilation & O 2 </li></ul>
  11. 11. Types of Ventilators <ul><li>Negative Pressure (Mimic spontaneous breaths) </li></ul><ul><ul><li>Iron Lung </li></ul></ul><ul><li>Positive Pressure (Push air into lungs) </li></ul><ul><ul><li>Pressure cycled </li></ul></ul><ul><ul><ul><li>Air delivered until preset pressure reached </li></ul></ul></ul><ul><ul><li>Time cycled (Pediatrics/Neonates) </li></ul></ul><ul><ul><ul><li>Push air in with preset time </li></ul></ul></ul><ul><ul><ul><li>Tidal volume & pressure variable </li></ul></ul></ul><ul><ul><li>Volume cycled </li></ul></ul><ul><ul><ul><li>Push air in until preset volume reached </li></ul></ul></ul><ul><ul><ul><li>Constant tidal volume </li></ul></ul></ul><ul><ul><ul><li>Variable pressure </li></ul></ul></ul>
  12. 12. Modes of ventilation <ul><li>Controlled ventilation </li></ul><ul><li>Assist-control (A/C) </li></ul><ul><li>Synchronized Intermittent Mandatory Ventilation (SIMV) </li></ul>
  13. 13. Controlled ventilation <ul><li>Least used </li></ul><ul><li>All breaths delivered at preset tidal volume, pressure & rate </li></ul><ul><li>Client with no spontaneous effort </li></ul><ul><ul><li>Severe ICP </li></ul></ul><ul><ul><li>Brain death </li></ul></ul><ul><ul><li>Voluntary paralysis of muscles </li></ul></ul>
  14. 14. Assist-Control Ventilation <ul><li>Most commonly used </li></ul><ul><li>Tidal volume & rate preset </li></ul><ul><li>Client does not trigger breath, ventilator will deliver breath </li></ul><ul><li>Advantage- client controls rate of breathing </li></ul><ul><li>Disadvantage -  respiratory rate  hyperventilation  respiratory alkalosis </li></ul>
  15. 15. SIMV <ul><li>Similar to A/C ventilation </li></ul><ul><li>Spontaneous breathing between ventilator breaths at clients own rate & tidal volume </li></ul><ul><li>Used as primary ventilator mode or weaning mode </li></ul>
  16. 16. Ventilator Settings <ul><li>Tidal Volume (V T ) </li></ul><ul><ul><li>Volume of air delivered each breath </li></ul></ul><ul><ul><li>7-10 cc/kg body wt. </li></ul></ul><ul><ul><ul><li>75 kg = 750 cc </li></ul></ul></ul><ul><li>Rate </li></ul><ul><ul><li># of breath/minute </li></ul></ul><ul><ul><li>10-14 BPM </li></ul></ul><ul><li>Fraction of inspired O 2 (F I O 2 ) </li></ul><ul><ul><li>Oxygen concentration </li></ul></ul><ul><ul><li>21% (room air) to 100% </li></ul></ul>
  17. 17. Ventilator Settings <ul><li>Peak Airway (Inspiratory) Pressure (PIP) </li></ul><ul><ul><li>Pressure needed to deliver set tidal volume </li></ul></ul><ul><ul><li>Highest pressure indicated during inspiration </li></ul></ul><ul><ul><li> airway resistance </li></ul></ul><ul><ul><ul><li>Bronchospasms </li></ul></ul></ul><ul><ul><ul><li> secretions </li></ul></ul></ul><ul><ul><ul><li>Pulmonary edema </li></ul></ul></ul><ul><ul><ul><li> pulmonary compliance </li></ul></ul></ul><ul><ul><li>Prevents barotrauma </li></ul></ul><ul><ul><ul><li>Lung damage from excessive pressure </li></ul></ul></ul>
  18. 18. Ventilatory Settings <ul><li>Continuous Positive Airway Pressure (CPAP) </li></ul><ul><ul><li>Spontaneous respirations </li></ul></ul><ul><ul><li>Intubation or tight fitting mask </li></ul></ul><ul><ul><li>Positive pressure during the entire respiratory cycle (5-15 cm H 2 O) </li></ul></ul><ul><ul><li>Keeps alveoli open during inspiration </li></ul></ul><ul><ul><li>Prevents alveoli collapse during expiration </li></ul></ul><ul><ul><li>Improves gas exchange & oxygenation </li></ul></ul><ul><ul><li>Used during weaning </li></ul></ul><ul><ul><li>Nasal CPAP, B I PAP </li></ul></ul>
  19. 19. Ventilatory Settings <ul><li>Positive End-Expiratory Pressure (PEEP) </li></ul><ul><ul><li>Must be intubated </li></ul></ul><ul><ul><li>Positive pressure exerted during expiration </li></ul></ul><ul><ul><li>(+5 to +15 cm H 2 O) </li></ul></ul><ul><ul><li>Keeps alveoli open between breaths </li></ul></ul><ul><ul><li>Improves oxygenation </li></ul></ul><ul><ul><li>Enhances gas exchange </li></ul></ul><ul><ul><li>Treatment for persistent hypoxemia </li></ul></ul>
  20. 20. Ventilatory Settings <ul><li>Pressure Support Ventilation (PSV) </li></ul><ul><ul><li>Client’s inspiratory effort is assisted to a certain level of pressure </li></ul></ul><ul><ul><li> work of breathing &  comfort through  control by client </li></ul></ul><ul><ul><li>PSV 5-20 </li></ul></ul>
  21. 21. Management <ul><li>Anxiety </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Alarms </li></ul></ul><ul><ul><ul><li>Treat client first, then ventilator </li></ul></ul></ul>
  22. 22. Management <ul><li>Assessment </li></ul><ul><ul><li>Client response to treatment </li></ul></ul><ul><ul><li>Continuous O 2 saturation </li></ul></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Lung Sounds </li></ul></ul><ul><ul><li>Ventilator settings & alarms </li></ul></ul><ul><ul><li>Management of secretions </li></ul></ul><ul><ul><ul><li>Closed suction system </li></ul></ul></ul>
  23. 23. Prevent Complications <ul><li>Cardiac </li></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><ul><li>Application of positive pressure  intrathoracic pressure   venous return to heart   cardiac output </li></ul></ul></ul><ul><ul><ul><li>Dehydration </li></ul></ul></ul><ul><ul><ul><li>Requires high PIP </li></ul></ul></ul><ul><ul><li>Fluid retention </li></ul></ul><ul><ul><ul><li> cardiac output  stimulation of renin-angiotensin-aldosterone response  fluid retention </li></ul></ul></ul>
  24. 24. Prevent Complications <ul><li>Lungs </li></ul><ul><ul><li>Barotrauma </li></ul></ul><ul><ul><ul><li>COPD </li></ul></ul></ul><ul><ul><ul><li>Pneumothorax, subq emphysema </li></ul></ul></ul><ul><ul><li>Volutrauma </li></ul></ul><ul><ul><li>Acid-base abnormalities </li></ul></ul><ul><li>Infection </li></ul><ul><ul><li>Within 48 hrs of intubation, bacteria colonization </li></ul></ul>
  25. 25. Prevent Complications <ul><li>Electrolyte Imbalances </li></ul><ul><ul><li>Monitor K+, Ca++, Mg++, phosphate levels </li></ul></ul><ul><ul><li>Efficiency of respiratory muscle function </li></ul></ul><ul><li>Muscular </li></ul><ul><ul><li>Immobility </li></ul></ul><ul><ul><li> muscle tone & strength </li></ul></ul><ul><ul><li>Facilitates gas exchange </li></ul></ul>
  26. 26. Prevent Complications <ul><li>Ventilator Dependence </li></ul><ul><ul><li>Respiratory muscle fatigue </li></ul></ul><ul><ul><li>Client unable to resume independent breathing </li></ul></ul><ul><li>Extubation </li></ul><ul><ul><li>Monitor respiratory effort </li></ul></ul><ul><ul><li>Supplemental O 2 </li></ul></ul><ul><ul><li>Monitor O 2 saturation </li></ul></ul>
  27. 27. Weaning from Ventilator <ul><li>Parameters set for PaO 2, O 2 Sat, PaCO 2 & pH </li></ul><ul><li> F I O 2  spontaneous effort by client </li></ul><ul><li>Remain on T-piece after ventilator before extubation  aerosol mask </li></ul><ul><li>Minimal sedation while weaning </li></ul><ul><li>Monitor respiratory effort & rate, vital signs </li></ul>

×