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mechanical ventilation

  1. 1. BASICS……?????  Respiration-Ventilation 3D Medical Animation.avi
  2. 2.  Mechanics of Breathing - 1 2.avi
  3. 3.  Intubation and Mechanical Ventilation.avi
  4. 4. MEANING  A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period
  5. 5. INDICATIONS  Protection of airway  Respiratory arrest or rate < 8/min  Tachypnoea > 35/min  Inability to tolerate oxygen mask/CPAP/NIV, e.g. agitation,confusion  Removal of secretions  Hypoxaemia (Pa O2 < 8 kPa (< 60 mmHg); Sp O2 < 90%),despite CPAP with F iO2 > 0.6
  6. 6.  Hypercapnia if conscious level impaired or risk of raised intracranial pressure  Worsening respiratory acidosis  Vital capacity falling below 1.2 L in patients with neuromuscular disease  Removing the work of breathing in exhausted patients
  7. 7. CLINICAL CONDITIONS  Post-operative • e.g. After major abdominal or cardiac surgery
  8. 8.  Respiratory failure  ARDS  Acute severe asthma  Pneumonia  Aspiration  COPD  Smoke inhalation, burns
  9. 9.  Circulatory failure  Low cardiac output: cardiogenic shock  Following cardiac arrest Pulmonary oedema
  10. 10.  Neurological disease Coma of any cause  Status epilepticus  Drug overdose Respiratory muscle failure (e.g. Guillain– Barré syndrome, poliomyelitis, myasthenia gravis)  Head injury: to avoid hypoxaemia and hypercapnia, and reduce intracranial pressure  Bulbar abnormalities causing risk of aspiration (e.g. cerebrovascular accident, myasthenia gravis)
  11. 11. TERMINOLOGY  TRIGGER  TIDAL VOLUME  RESPIRATORY RATE  POSITIVE END EXPIRATORY PRESSURE  FLOW RATE  INSPIRATORY TIME EXPIRATION
  12. 12. INVASIVE IPPV FULL SUPPORT CMV VOLUME CONTROL PRESSURE CONTROL PARTIAL SUPPORT SIMV PSV
  13. 13. NON INVASIVE +ve pressure via nasal or face mask NIPPV BiPAP -ve pressur e CURAS S TANK IRON LUNG
  14. 14. Intermittent positive pressure ventilation (IPPV)
  15. 15. Controlled mandatory ventilation (CMV)
  16. 16. Synchronised intermittent mandatory ventilation (SIMV)
  17. 17. Pressure-controlled ventilation (PCV)
  18. 18. Pressure support ventilation (PSV)/Assisted spontaneous breathing (ASB)
  19. 19. Positive end-expiratory pressure (PEEP)
  20. 20. Continuous positive airways pressure (CPAP)
  21. 21. Bi-level positive airway pressure (BiPAP/BIPAP)
  22. 22. Non-invasive positive pressure ventilation (NIPPV/NIV)
  23. 23. Inverse ratio ventilation
  24. 24. High-frequency ventilation (hfv)
  25. 25. Liquid ventilation
  26. 26. INITIAL VENTILATOR SETTINGS  Assess the mode  Tidal volume and rate  Patient or time triggered MINUTE VENTILATION=RATE X TIDAL VOLUME IMV AND SIMV TOTAL MINUTE VENTILATION= MINUTE VOLUME MACHINE+ MINUTE VOLUME SPONTANEOUS
  27. 27. TOTAL MINUTEVOLUME= (MACHINE TIDAL VOLUME X MACHINE RATE )+ AVERAGE SPONATANEOUS TIDAL VOLUME X SPONATNEOUS RATE) INSPIRATORY FLOW RATE= SET MINUTE VENTILATION/PERCENTAGE INSPIRATORY TIME X 0.01 AIRWAY RESISTANCE = INCREASING PEAK PRESSURE- PLATEAU PRESSURE/ INSPIRATORY FLOW(L/S)
  28. 28.  FIO2 REQUIRED =  PaO2 DESIRED PaO2 /PAO2 PaCO2 X 12.5) 1 PB- PH2O
  29. 29. INITIAL PaO2/FiO2 = DESIRED PaO2/FiO2 Optimal peep DO2 = QT X CAO2 Alveolar ventilation VA =( VT – V D) F PaCO2 = 0.863X VCO2/ VA
  30. 30. INITIAL PaCO2 X VA= DESIRED PaCO2 X VA INITIAL PACO2 X F = DESIRED PaCO2 X F INITIAL PACO2 X VT = DESIRED PaCO2 X VT
  31. 31. ASSESSING THE EQUIPMENT
  32. 32. COMPLICATIONS
  33. 33. MANAGEMENT
  34. 34. WEANING  Vital capacity:10 to 15 mL/kg  Maximum inspiratory pressure (MIP) at least –20 cm H2O  Tidal volume: 7 to 9 mL/kg  Minute ventilation: 6 L/min  Rapid/shallow breathing index: below 100 breaths/minute/L; PaO2 _60 mm Hg with FiO2 less than 40%
  35. 35. NURSE WHAT YOU DO..???
  36. 36. REFERENCES  Mason R.J, Braaddus V.C.Murray and Nadel`s :Textbook of Respiratory Medicine. 5th edn. Philadelphia:Saunders;2010.  George R.B,Light R.W. Chestmedicine:Essentials of Pulmonary and Critical Care Medicine. 4th edn . Philadelphia:Lippincott;2000.  Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill; 2008  Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11th edn. Philadelphia:Lippincott;2008.  Black M.J, Hawks H.K. Medical Surgical Nursing. 7th edn. Missouri: Saunders;2005
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