1) This document outlines basic ventilator settings and modes of mechanical ventilation. It discusses indications for ventilation, parameters like tidal volume and PEEP, and modes like volume-controlled, pressure-controlled, and non-invasive ventilation.
2) Key ventilator parameters that are described include tidal volume, respiratory rate, FiO2, PEEP, flow rate, I:E ratio, and triggers. Common modes covered are volume-limited ventilation, pressure-limited ventilation, and pressure support ventilation.
3) Non-invasive ventilation is discussed as well, including indications like COPD exacerbation and cardiogenic pulmonary edema, as well as contraindications and modes like assist-control and PSV
The document provides an overview of mechanical ventilation, including its history and various modes. It begins with the origins of negative-pressure ventilators like iron lungs and the later development of positive-pressure ventilators. The main goals of ventilation are to facilitate carbon dioxide release and oxygen delivery. Various modes are described that can be used for invasive or non-invasive ventilation. Settings like PEEP, respiratory rate, tidal volume, and FiO2 are outlined that can be adjusted to optimize oxygenation and ventilation. Indications for intubation and criteria for safely extubating patients are also reviewed.
This document provides information on mechanical ventilation, including indications, criteria, principles, terminology, modes, pressures, and settings. The key points are:
1. Mechanical ventilation is indicated for respiratory failure (type I or II) or to provide airway protection. Criteria include clinical assessment, ABGs, and physiological parameters.
2. Ventilation aims to facilitate CO2 release while maintaining normal PaCO2. Oxygenation aims to maximize O2 delivery by improving V/Q matching.
3. Common modes include controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV), and synchronized IMV (SIMV). Settings must be tailored to the individual patient.
NIV, or non-invasive ventilation, is a form of ventilation therapy that is applied non-invasively through a mask rather than an endotracheal tube. It is commonly used to treat conditions like COPD exacerbations, pulmonary edema, and respiratory failure. Key settings that must be adjusted include IPAP, EPAP, Ti min/max, trigger sensitivity, and backup rate. Modes include spontaneous, timed, and bi-level positive airway pressure. Proper mask fitting and troubleshooting issues like leaks are important for ensuring effective ventilation. Regular monitoring of parameters like ABGs, SpO2, and ventilation is needed to optimize NIV therapy.
This document provides an overview of various modes of mechanical ventilation. It begins by defining key terms like peak inspiratory pressure, plateau pressure, PEEP, and CPAP. It then describes the basic modes of ventilation: volume-controlled, pressure-controlled, and pressure support. Various advanced modes are also outlined such as SIMV, BiPAP, APRV, and ASV. Factors related to weaning a patient from mechanical ventilation are discussed. Throughout, details are provided on the objectives, physiology, advantages, and disadvantages of each ventilation mode.
This document defines key terms and concepts related to mechanical ventilation and interprets blood gas results to guide ventilator adjustments. It describes various ventilator modes, appropriate initial settings, priorities for weaning, and criteria for extubation. Volume control delivers a set tidal volume while pressure control uses a fixed pressure. Pressure-regulated volume control aims for a target minute ventilation. Complications include barotrauma, pneumonia, and cardiac/GI issues. Physical exams and pressure patterns can localize causes of acute deterioration. Neurologic, cardiovascular, and pulmonary status must be optimized before extubation.
The document discusses mechanical ventilation settings and principles. It indicates that the goals of ventilation are to facilitate CO2 release and maintain normal PaCO2 levels. Different modes of ventilation are described, including assist-control mode, SIMV, and PSV. Key settings discussed include tidal volume, respiratory rate, I:E ratio, PEEP, and FiO2. The document notes that patients with COPD should aim for controlled hypercapnia to limit high airway pressures. For ARDS patients, a low tidal volume ventilation strategy is recommended based on clinical trial evidence showing lower mortality.
Mechanical ventilation uses positive pressure to deliver gas to the lungs. There are several modes that have evolved over time including negative pressure ventilation and newer microprocessor controlled positive pressure systems. The basic function is to deliver gas to the lungs while parameters like tidal volume, respiratory rate, pressures and timing are adjusted based on the patient's condition and response. Common modes include controlled mandatory ventilation which provides all breaths from the ventilator, assist control which provides mandatory breaths plus additional breaths if patient triggers, and synchronized intermittent mandatory ventilation which aims to prevent breath stacking by synchronizing mandatory breaths with patient effort.
This document provides an overview of basic concepts and applications of mechanical ventilation. It discusses various ventilation modes including controlled, assisted, assist-control, IMV, and SIMV modes. It also covers settings such as tidal volume, respiratory rate, I:E ratio, and FIO2. Key aspects of setting up and monitoring mechanical ventilation are summarized, including how to initially set parameters based on patient size and desired minute ventilation. Factors that affect oxygenation and ventilation are outlined. Waveforms and pressure-volume loops are presented to illustrate lung mechanics under different conditions. The importance of monitoring airway pressures and compliance is emphasized to optimize ventilation.
The document provides an overview of mechanical ventilation, including its history and various modes. It begins with the origins of negative-pressure ventilators like iron lungs and the later development of positive-pressure ventilators. The main goals of ventilation are to facilitate carbon dioxide release and oxygen delivery. Various modes are described that can be used for invasive or non-invasive ventilation. Settings like PEEP, respiratory rate, tidal volume, and FiO2 are outlined that can be adjusted to optimize oxygenation and ventilation. Indications for intubation and criteria for safely extubating patients are also reviewed.
This document provides information on mechanical ventilation, including indications, criteria, principles, terminology, modes, pressures, and settings. The key points are:
1. Mechanical ventilation is indicated for respiratory failure (type I or II) or to provide airway protection. Criteria include clinical assessment, ABGs, and physiological parameters.
2. Ventilation aims to facilitate CO2 release while maintaining normal PaCO2. Oxygenation aims to maximize O2 delivery by improving V/Q matching.
3. Common modes include controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV), and synchronized IMV (SIMV). Settings must be tailored to the individual patient.
NIV, or non-invasive ventilation, is a form of ventilation therapy that is applied non-invasively through a mask rather than an endotracheal tube. It is commonly used to treat conditions like COPD exacerbations, pulmonary edema, and respiratory failure. Key settings that must be adjusted include IPAP, EPAP, Ti min/max, trigger sensitivity, and backup rate. Modes include spontaneous, timed, and bi-level positive airway pressure. Proper mask fitting and troubleshooting issues like leaks are important for ensuring effective ventilation. Regular monitoring of parameters like ABGs, SpO2, and ventilation is needed to optimize NIV therapy.
This document provides an overview of various modes of mechanical ventilation. It begins by defining key terms like peak inspiratory pressure, plateau pressure, PEEP, and CPAP. It then describes the basic modes of ventilation: volume-controlled, pressure-controlled, and pressure support. Various advanced modes are also outlined such as SIMV, BiPAP, APRV, and ASV. Factors related to weaning a patient from mechanical ventilation are discussed. Throughout, details are provided on the objectives, physiology, advantages, and disadvantages of each ventilation mode.
This document defines key terms and concepts related to mechanical ventilation and interprets blood gas results to guide ventilator adjustments. It describes various ventilator modes, appropriate initial settings, priorities for weaning, and criteria for extubation. Volume control delivers a set tidal volume while pressure control uses a fixed pressure. Pressure-regulated volume control aims for a target minute ventilation. Complications include barotrauma, pneumonia, and cardiac/GI issues. Physical exams and pressure patterns can localize causes of acute deterioration. Neurologic, cardiovascular, and pulmonary status must be optimized before extubation.
The document discusses mechanical ventilation settings and principles. It indicates that the goals of ventilation are to facilitate CO2 release and maintain normal PaCO2 levels. Different modes of ventilation are described, including assist-control mode, SIMV, and PSV. Key settings discussed include tidal volume, respiratory rate, I:E ratio, PEEP, and FiO2. The document notes that patients with COPD should aim for controlled hypercapnia to limit high airway pressures. For ARDS patients, a low tidal volume ventilation strategy is recommended based on clinical trial evidence showing lower mortality.
Mechanical ventilation uses positive pressure to deliver gas to the lungs. There are several modes that have evolved over time including negative pressure ventilation and newer microprocessor controlled positive pressure systems. The basic function is to deliver gas to the lungs while parameters like tidal volume, respiratory rate, pressures and timing are adjusted based on the patient's condition and response. Common modes include controlled mandatory ventilation which provides all breaths from the ventilator, assist control which provides mandatory breaths plus additional breaths if patient triggers, and synchronized intermittent mandatory ventilation which aims to prevent breath stacking by synchronizing mandatory breaths with patient effort.
This document provides an overview of basic concepts and applications of mechanical ventilation. It discusses various ventilation modes including controlled, assisted, assist-control, IMV, and SIMV modes. It also covers settings such as tidal volume, respiratory rate, I:E ratio, and FIO2. Key aspects of setting up and monitoring mechanical ventilation are summarized, including how to initially set parameters based on patient size and desired minute ventilation. Factors that affect oxygenation and ventilation are outlined. Waveforms and pressure-volume loops are presented to illustrate lung mechanics under different conditions. The importance of monitoring airway pressures and compliance is emphasized to optimize ventilation.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdfAdamu Mohammad
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdfAdamu Mohammad
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Non invasive ventilation 24th oct 2014 finalArchana Ravi
This document provides an overview of non-invasive ventilation (NIV), including what it is, the types of NIV, its goals and indications. NIV supports breathing without intubation by using techniques like continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP). It is commonly used to treat acute respiratory failure from conditions like COPD exacerbations and heart failure. The document discusses NIV interfaces, settings, monitoring, weaning and potential complications. The goal of NIV is to improve ventilation and oxygenation while avoiding intubation and its risks.
This document provides information on settings for mechanical ventilation. It discusses how to improve oxygenation by increasing FIO2, PEEP, and inspiratory time. It also discusses how to manage increased Paco2 by increasing tidal volume and respiratory rate. It then covers the different settings used in volume control and pressure control modes of ventilation. It provides recommendations for tidal volume based on patient condition and formulas for calculating ideal body weight. Other settings discussed include frequency, FIO2, inspiratory flow rate, PEEP, inspiratory time, and inspiratory-to-expiratory ratio. Precautions for different settings are also outlined.
overview of mechanical ventilation and nursing carePallavi Rai
This document provides an overview of mechanical ventilation including its objectives, definitions, types, modes, components, parameters, indications, contraindications, complications, and nursing responsibilities. It defines mechanical ventilation as ventilation of the lungs by artificial means using a mechanical ventilator. The main types discussed are positive pressure ventilators which deliver gas under positive pressure, and negative pressure ventilators which are no longer used. Common modes covered include controlled mandatory ventilation, synchronized intermittent mandatory ventilation, and pressure support ventilation.
This document describes a 65-year-old male patient who was intubated and connected to a mechanical ventilator for acute exacerbation of COPD and cor pulmonale. It then provides details on the history, components, modes, and goals of mechanical ventilation. Various modes discussed include controlled mandatory ventilation, assist-control ventilation, synchronized intermittent mandatory ventilation, and pressure-controlled ventilation. The document outlines the responsibilities of nurses in monitoring patients on mechanical ventilation. It also briefly introduces newer ventilation methods such as high frequency oscillation, bipap, airway pressure release ventilation, and liquid ventilation.
This document provides information on basic mechanical ventilation. It discusses various indications for mechanical ventilation including conditions like pneumonia, ARDS, pulmonary edema, and neuromuscular disorders. It then describes the basic components and functions of a mechanical ventilator including volume change, time, gas flow, and pressure difference. Key parameters like compliance, PEEP, and I:E ratio that are important for mechanical ventilation are explained. Different ventilator modes are outlined including pressure control, volume control, SIMV, and PSV. Settings like tidal volume, pressure, and respiratory rate that should be optimized are also reviewed.
Mechanical ventilators generate a controlled flow of gas into a patient's airways using various modes of ventilation. There are both positive and negative pressure machines that can be either invasive or non-invasive. Modes include volume cycled, pressure cycled, time cycled, and flow cycled. Ventilators aim to provide oxygenation through settings like FIO2 and PEEP, and ventilation through tidal volume and respiratory rate. They are indicated for conditions causing respiratory failure and can have complications like lung injury, infection, and decreased blood pressure. Settings must be adjusted based on blood gas results and the patient's condition. Weaning involves gradually reducing support as the patient improves. Non-invasive ventilation
Resp failure talk 9 10 bipap and hfnc emphasisStevenP302
This document discusses respiratory failure and the use of high flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP). It describes the three types of respiratory failure - inability to oxygenate, inability to ventilate, and inability to protect airway. HFNC provides high flow oxygen but no positive pressure, while BiPAP provides adjustable inspiratory and expiratory pressures for both oxygenation and ventilatory support. The document reviews indications, advantages, disadvantages, settings and monitoring for BiPAP use in treating respiratory failure.
This document provides information on non-invasive ventilation (NIV). It discusses the types of NIV including negative pressure ventilation and positive pressure ventilation. The advantages of NIV include avoiding complications of intubation, ease of application and removal, intermittent use, use in non-ICU settings, improved comfort, and preservation of speech and swallowing. NIV can be used for conditions like COPD exacerbations, cardiac pulmonary edema, and immunocompromised patients. Settings and protocols for initiating and monitoring NIV are outlined. Troubleshooting tips are provided for issues like low oxygen levels or high carbon dioxide levels.
1. The document discusses various modes of mechanical ventilation including volume control, pressure control, SIMV, and PSV. It describes the settings, parameters, and considerations for each mode.
2. Initial ventilator settings should aim for adequate oxygenation and ventilation while minimizing work of breathing. Settings like tidal volume, respiratory rate, and PEEP are adjusted based on factors like patient size and condition.
3. Weaning from mechanical ventilation involves gradually reducing support through methods like spontaneous breathing trials, decreasing SIMV frequency, and lowering pressure support levels to assess the patient's ability to breathe independently. Readiness criteria and a stepwise protocol are
The document discusses various aspects of mechanical ventilation including indications for use, parts of the ventilator, measurements of ventilatory mechanics, types of ventilation modes including non-invasive and invasive modes, initial ventilator settings, and criteria for weaning patients off the ventilator. It provides details on modes like volume control, pressure control, SIMV, and PSV as well as parameters to monitor and consider when setting up the ventilator for a patient and assessing readiness to wean.
The document outlines non-invasive positive pressure ventilation (NPPV), including its definition, goals, indications, patient selection criteria, contraindications, equipment, modes of ventilation, how to initiate NPPV, complications, monitoring, and troubleshooting. NPPV can be used to treat acute exacerbations of COPD, asthma, acute cardiogenic pulmonary edema, and other conditions. The goals of NPPV are to avoid intubation, relieve symptoms, enhance gas exchange, and improve patient comfort.
This document provides an overview of mechanical ventilation including:
- Indications for mechanical ventilation including respiratory and cardiac failure.
- Basic anatomy and physiology of ventilation including the roles of airways, alveoli, and pressures.
- Common modes of ventilation like assist-control, IMV, SIMV and their characteristics.
- Factors to consider when selecting initial settings like rate, pressures, and tidal volumes.
- How to adjust settings to impact oxygenation and ventilation.
- Potential problems that can arise with mechanical ventilation.
Acute Respiratory Failure
Impending Respiratory Failure
Prophylactic Ventilatory Support
Hyperventilation Therapy
Respiratory failure is imminent in spite of therapies
Patient is barely maintaining (or experiencing gradual deterioration) of normal blood gases at the expense of significant WOB
Clinical conditions in which there is a high risk of future respiratory failure
Ventilatory support is instituted to:
Decrease the WOB
Minimize O2 consumption and hypoxemia
Reduce cardiopulmonary stress
Control airway with sedation
Examples: Brain injury, heart muscle injury, major surgery, prolonged shock, smoke injury
Ventilatory support is instituted to control and manipulate PaCO2 to lower than normal levels
Acute head injury
These slides represent how to manage patients on a mechanical ventilator? Easy understanding of using ventilators. indication of mechanical ventilator use. How to wean a patient from a mechanical ventilator? How to fine-tune the ventilator settings?
Final newer modes and facts niv chandanChandan Sheet
THIS IS THE BASIC POINTS REGARDING NIV, THIS IS COMPILED AND ARRANGED FROM DIFFERENT BOOKS, JOURNALS AND PPTs.
The author is grateful to the teachers and authors of pulmonology and critical care.
Mechanical ventilation in neonates by dr naved akhterDr Naved Akhter
Mechanical ventilation is used to support gas exchange and clinical status in neonates. The goals are to maintain sufficient oxygenation and ventilation until the underlying disease resolves, while protecting the lungs from damage. Modes of ventilation include mandatory, SIMV, assist/control, and pressure support. Parameters like tidal volume, PIP, PEEP, and FiO2 are adjusted based on blood gas levels to optimize oxygenation and ventilation. Ventilator graphics and pulmonary monitoring are used to assess patient-ventilator interaction and guide management.
An arterial blood gas (ABG) test measures the levels of oxygen and carbon dioxide in the blood and how acidic or alkaline (pH) the blood is. This provides important information about how well the lungs are working and delivering oxygen to tissues and removing carbon dioxide. The document discusses various aspects of mechanical ventilation including indications, equipment, settings, modes, and monitoring including ABG tests to evaluate ventilation effectiveness.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdfAdamu Mohammad
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdfAdamu Mohammad
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Non invasive ventilation 24th oct 2014 finalArchana Ravi
This document provides an overview of non-invasive ventilation (NIV), including what it is, the types of NIV, its goals and indications. NIV supports breathing without intubation by using techniques like continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP). It is commonly used to treat acute respiratory failure from conditions like COPD exacerbations and heart failure. The document discusses NIV interfaces, settings, monitoring, weaning and potential complications. The goal of NIV is to improve ventilation and oxygenation while avoiding intubation and its risks.
This document provides information on settings for mechanical ventilation. It discusses how to improve oxygenation by increasing FIO2, PEEP, and inspiratory time. It also discusses how to manage increased Paco2 by increasing tidal volume and respiratory rate. It then covers the different settings used in volume control and pressure control modes of ventilation. It provides recommendations for tidal volume based on patient condition and formulas for calculating ideal body weight. Other settings discussed include frequency, FIO2, inspiratory flow rate, PEEP, inspiratory time, and inspiratory-to-expiratory ratio. Precautions for different settings are also outlined.
overview of mechanical ventilation and nursing carePallavi Rai
This document provides an overview of mechanical ventilation including its objectives, definitions, types, modes, components, parameters, indications, contraindications, complications, and nursing responsibilities. It defines mechanical ventilation as ventilation of the lungs by artificial means using a mechanical ventilator. The main types discussed are positive pressure ventilators which deliver gas under positive pressure, and negative pressure ventilators which are no longer used. Common modes covered include controlled mandatory ventilation, synchronized intermittent mandatory ventilation, and pressure support ventilation.
This document describes a 65-year-old male patient who was intubated and connected to a mechanical ventilator for acute exacerbation of COPD and cor pulmonale. It then provides details on the history, components, modes, and goals of mechanical ventilation. Various modes discussed include controlled mandatory ventilation, assist-control ventilation, synchronized intermittent mandatory ventilation, and pressure-controlled ventilation. The document outlines the responsibilities of nurses in monitoring patients on mechanical ventilation. It also briefly introduces newer ventilation methods such as high frequency oscillation, bipap, airway pressure release ventilation, and liquid ventilation.
This document provides information on basic mechanical ventilation. It discusses various indications for mechanical ventilation including conditions like pneumonia, ARDS, pulmonary edema, and neuromuscular disorders. It then describes the basic components and functions of a mechanical ventilator including volume change, time, gas flow, and pressure difference. Key parameters like compliance, PEEP, and I:E ratio that are important for mechanical ventilation are explained. Different ventilator modes are outlined including pressure control, volume control, SIMV, and PSV. Settings like tidal volume, pressure, and respiratory rate that should be optimized are also reviewed.
Mechanical ventilators generate a controlled flow of gas into a patient's airways using various modes of ventilation. There are both positive and negative pressure machines that can be either invasive or non-invasive. Modes include volume cycled, pressure cycled, time cycled, and flow cycled. Ventilators aim to provide oxygenation through settings like FIO2 and PEEP, and ventilation through tidal volume and respiratory rate. They are indicated for conditions causing respiratory failure and can have complications like lung injury, infection, and decreased blood pressure. Settings must be adjusted based on blood gas results and the patient's condition. Weaning involves gradually reducing support as the patient improves. Non-invasive ventilation
Resp failure talk 9 10 bipap and hfnc emphasisStevenP302
This document discusses respiratory failure and the use of high flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP). It describes the three types of respiratory failure - inability to oxygenate, inability to ventilate, and inability to protect airway. HFNC provides high flow oxygen but no positive pressure, while BiPAP provides adjustable inspiratory and expiratory pressures for both oxygenation and ventilatory support. The document reviews indications, advantages, disadvantages, settings and monitoring for BiPAP use in treating respiratory failure.
This document provides information on non-invasive ventilation (NIV). It discusses the types of NIV including negative pressure ventilation and positive pressure ventilation. The advantages of NIV include avoiding complications of intubation, ease of application and removal, intermittent use, use in non-ICU settings, improved comfort, and preservation of speech and swallowing. NIV can be used for conditions like COPD exacerbations, cardiac pulmonary edema, and immunocompromised patients. Settings and protocols for initiating and monitoring NIV are outlined. Troubleshooting tips are provided for issues like low oxygen levels or high carbon dioxide levels.
1. The document discusses various modes of mechanical ventilation including volume control, pressure control, SIMV, and PSV. It describes the settings, parameters, and considerations for each mode.
2. Initial ventilator settings should aim for adequate oxygenation and ventilation while minimizing work of breathing. Settings like tidal volume, respiratory rate, and PEEP are adjusted based on factors like patient size and condition.
3. Weaning from mechanical ventilation involves gradually reducing support through methods like spontaneous breathing trials, decreasing SIMV frequency, and lowering pressure support levels to assess the patient's ability to breathe independently. Readiness criteria and a stepwise protocol are
The document discusses various aspects of mechanical ventilation including indications for use, parts of the ventilator, measurements of ventilatory mechanics, types of ventilation modes including non-invasive and invasive modes, initial ventilator settings, and criteria for weaning patients off the ventilator. It provides details on modes like volume control, pressure control, SIMV, and PSV as well as parameters to monitor and consider when setting up the ventilator for a patient and assessing readiness to wean.
The document outlines non-invasive positive pressure ventilation (NPPV), including its definition, goals, indications, patient selection criteria, contraindications, equipment, modes of ventilation, how to initiate NPPV, complications, monitoring, and troubleshooting. NPPV can be used to treat acute exacerbations of COPD, asthma, acute cardiogenic pulmonary edema, and other conditions. The goals of NPPV are to avoid intubation, relieve symptoms, enhance gas exchange, and improve patient comfort.
This document provides an overview of mechanical ventilation including:
- Indications for mechanical ventilation including respiratory and cardiac failure.
- Basic anatomy and physiology of ventilation including the roles of airways, alveoli, and pressures.
- Common modes of ventilation like assist-control, IMV, SIMV and their characteristics.
- Factors to consider when selecting initial settings like rate, pressures, and tidal volumes.
- How to adjust settings to impact oxygenation and ventilation.
- Potential problems that can arise with mechanical ventilation.
Acute Respiratory Failure
Impending Respiratory Failure
Prophylactic Ventilatory Support
Hyperventilation Therapy
Respiratory failure is imminent in spite of therapies
Patient is barely maintaining (or experiencing gradual deterioration) of normal blood gases at the expense of significant WOB
Clinical conditions in which there is a high risk of future respiratory failure
Ventilatory support is instituted to:
Decrease the WOB
Minimize O2 consumption and hypoxemia
Reduce cardiopulmonary stress
Control airway with sedation
Examples: Brain injury, heart muscle injury, major surgery, prolonged shock, smoke injury
Ventilatory support is instituted to control and manipulate PaCO2 to lower than normal levels
Acute head injury
These slides represent how to manage patients on a mechanical ventilator? Easy understanding of using ventilators. indication of mechanical ventilator use. How to wean a patient from a mechanical ventilator? How to fine-tune the ventilator settings?
Final newer modes and facts niv chandanChandan Sheet
THIS IS THE BASIC POINTS REGARDING NIV, THIS IS COMPILED AND ARRANGED FROM DIFFERENT BOOKS, JOURNALS AND PPTs.
The author is grateful to the teachers and authors of pulmonology and critical care.
Mechanical ventilation in neonates by dr naved akhterDr Naved Akhter
Mechanical ventilation is used to support gas exchange and clinical status in neonates. The goals are to maintain sufficient oxygenation and ventilation until the underlying disease resolves, while protecting the lungs from damage. Modes of ventilation include mandatory, SIMV, assist/control, and pressure support. Parameters like tidal volume, PIP, PEEP, and FiO2 are adjusted based on blood gas levels to optimize oxygenation and ventilation. Ventilator graphics and pulmonary monitoring are used to assess patient-ventilator interaction and guide management.
An arterial blood gas (ABG) test measures the levels of oxygen and carbon dioxide in the blood and how acidic or alkaline (pH) the blood is. This provides important information about how well the lungs are working and delivering oxygen to tissues and removing carbon dioxide. The document discusses various aspects of mechanical ventilation including indications, equipment, settings, modes, and monitoring including ABG tests to evaluate ventilation effectiveness.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
Can Allopathy and Homeopathy Be Used Together in India.pdfDharma Homoeopathy
This article explores the potential for combining allopathy and homeopathy in India, examining the benefits, challenges, and the emerging field of integrative medicine.
2. Learning objectives
• Indications of ventilator support
• Basic Ventilator Parameters
• Modes of ventilation
• Troubleshooting ventilator for simples issues
• Basics of NIV
3. Mechanical ventilation
Mechanical ventilation is a form of life support.
A mechanical ventilator is a machine that takes over
the work of breathing when a person is not able to
breathe enough on their own.
4.
5. Indications of mechanical ventilation
• Alveolar filling processes – Pulmonary edema, Tumour
• Pulmonary vascular disease – Pulmonary embolism, amniotic
fluid embolism
• Central airway obstruction – Tumour, tracheal stenosis, Laryngeal
angioedema
• Distal airway obstruction – AEBA/AECOPD
• Hypoventilation
a) Decreased Central Drive - GA, Drug overdose
b) Peripheral Nervous/Resp. Muscle dysfunction – Myasthenia
gravis, GBS, cervical quadriplegia
c) Chest wall & pleural disease – pneumothorax, flail chest
• Increased ventilatory demand – severe sepsis, septic shock,
severe metabolic acidosis
6.
7. Basic Ventilator Parameters
• Tidal Volume
• Frequency / Respiratory rate
• FiO2
• PEEP
• Flow rate
• I:E ratio
• Trigger
• Mode
8.
9. Tidal Volume
• the lung volume representing the
normal volume of air displaced between normal
inhalation and exhalation when extra effort is not
applied
• 6-8ml/kg
• ARDS, low tidal volume ventilation (4-8ml/kg)
10. Frequency
• Number of breaths per min
• 12-16/min
• > 20/min, associated with auto-PEEP
11. FiO2
• Initial, set at 100%
• Adjust after ABG, aim PaO2 80 to 100mmHg
• Best keep below 50% to avoid oxygen induced lung
injury
12. Positive end-expiratory pressure
(PEEP)
• Reinflates collapsed alveoli and maintain inflation
during exhalation
• Increases FRC, useful to treat refractory hypoxemia
• Initial PEEP : 5 cm H2O
13. Flow rate
• Peak flow rate: max flow delivered by ventilator
during inspiration
• Inspiratory flow needs to be sufficient to overcome
pulmonary and ventilatory impedance
• 60 L /min
14. I:E Ratio
• Usually, 1: 2 to 1:4
• Larger I:E ratio, possibility of air trapping, auto-
PEEP
• Inverse I:E ratio, to correct refractory hypoxemia in
ARDS patients
18. Volume-limited ventilation
• Aka volume-controlled/volume-cycled ventilation
• We set the Tidal Volumes, peak flow rate, RR, PEEP, Fi O2,
but
Airway pressures (peak, plateau, and mean) varies
Pressure-limited ventilation
• Aka pressure-cycled ventilation
• We set the inspiratory pressure, I:E ratio, RR, PEEP, Fi O2,
but
Tidal volume varies
• Peak airway pressure = IP + PEEP is a constant
19. Volume-limited ventilation
• Controlled mechanical ventilation (CMV): minute ventilation is
based on set RR & TV, patient does not initiate additional breath
• Assist control (AC): minute ventilation is based on set RR & TV,
plus patient’s initiated breaths. Each patient-initiated breath
receives the set tidal volume from the ventilator.
• Intermittent mandatory ventilation (IMV): same as AC except
patients increase the minute ventilation by spontaneous
breathing, rather than patient-initiated ventilator breaths.
• Synchronised intermittent mandatory ventilation(SIMV): variation
of IMV, in which the ventilator breaths are synchronized with
patient inspiratory effort
20. Pressure-limited ventilation
• Pressure controlled ventilation similar to CMV
• Pressure-limited assist control (triggering additional
ventilator-assisted, pressure-limited breaths.)
• pressure-limited intermittent mandatory
ventilation (IMV) or synchronized intermittent
mandatory ventilation (SIMV) (increase the minute
ventilation by initiating spontaneous breaths.)
21.
22. Pressure support ventilation (PSV)
• a flow-limited mode of ventilation that delivers
inspiratory pressure until the inspiratory flow
decreases to a predetermined percentage of its
peak value. This is usually 25 percent
• Set IP, PEEP, FiO2
• No RR, patient triggers each breath
23. CPAP
• delivery of a continuous level of positive airway pressure.
• functionally similar to PEEP.
• no additional pressure above the level of CPAP is provided
• patients must initiate all breaths.
• Indications: OSA, cardiogenic pulmonary edema, obesity
hypoventilation syndrome
24. Bilevel Positive Airway Pressure
(BPAP)
• used during noninvasive positive pressure ventilation
(NPPV)
• delivers a preset inspiratory positive airway pressure (IPAP)
and expiratory positive airway pressure (EPAP)
• The tidal volume correlates with the difference between the
IPAP and the EPAP.
• Bigger difference between IPAP & EPAP, bigger is the TV
25. Airway Pressure Release
Ventilation (APRV)
a high continuous positive airway pressure (P high) is
delivered for a long duration (T high) and then falls to a lower
pressure (P low) for a shorter duration (T low)
26. Airway Pressure Release
Ventilation (APRV)
• transition from P high to P low deflates the lungs and
eliminates carbon dioxide.
• Alveolar recruitment is maximized by the high
continuous positive airway pressure
• difference between P high and P low is the driving
pressure
• T high and T low determine the frequency
• Spontaneous breathing is possible at both P high and P
low
27. APRV
When do we use it?
- No universally accepted indications
- APRV, to recruit alveoli and improve oxygenation
- Contraindications: severe obstructive airway
disease or high ventilatory requirement
28. Initial setting
• Mode : SIMV / VC / PC
• Fi O2 0.5
• VT 6-8ml/kg
• RR 15
• PEEP 5cm H2O
• IP 5cmH20
34. Indications of NIV
• Conditions known to respond to NIV:
1. AECOPD with hypercapnia acidosis
2. Cardiogenic pulmonary edema
3. Acute hypoxemic respiratory failure
4. Prevent post-extubation respiratory failure
35. Contraindications of NIV
●Cardiac or respiratory arrest
●Inability to cooperate, protect the airway, or clear secretions
●Severely impaired consciousness
●Nonrespiratory organ failure that is acutely life threatening
●Facial surgery, trauma, or deformity
●High aspiration risk
●Prolonged duration of mechanical ventilation anticipated
●Recent esophageal anastomosis
36. Mode of ventilation
• Assist control: get a guaranteed minimal minute
ventilation
• PSV: maximize patient comfort and synchrony
• CPAP: use for patients with acute respiratory failure
due to cardiogenic pulmonary edema
37. What’s next?
• Monitoring for success or failure?
- Any improvement of pH & PaCO2 after 1-2hours
- Inability to tolerate the interfaces, worsening
oxygenation, inability to clear secretions, agitation,
worsening encephalopathy
• Complications: Local skin damage, eye irritation,
sinus pain, mild gastric distension
Obsolete, used in 1920 for polio, muscular failure, muscular dystrophy
SIMV and AC are the most frequently used forms of volume-limited mechanical ventilation [5]. Possible advantages of SIMV compared to AC include better patient-ventilator synchrony, better preservation of respiratory muscle function, lower mean airway pressures, and greater control over the level of support [6]. In addition, auto-PEEP may be less likely with SIMV. In contrast, AC may be better suited for critically ill patients who require a constant tidal volume or full or near-maximal ventilatory support.
SIMV and AC are the most frequently used forms of volume-limited mechanical ventilation [5]. Possible advantages of SIMV compared to AC include better patient-ventilator synchrony, better preservation of respiratory muscle function, lower mean airway pressures, and greater control over the level of support [6]. In addition, auto-PEEP may be less likely with SIMV. In contrast, AC may be better suited for critically ill patients who require a constant tidal volume or full or near-maximal ventilatory support.
The work of breathing is inversely proportional to the pressure support level, provided that inspiratory flow is sufficient to meet patient demand [13,14]. In other words, increasing the level of pressure support decreases the work of breathing. The work of breathing is also inversely proportional to the inspiratory flow rate. Increasing the inspiratory flow rate shortens the time until the maximal airway pressures are achieved, which decreases the work of breathing
Potential uses — PSV seems particularly well suited for weaning from mechanical ventilation because it tends to be a comfortable mode, giving the patient greater control over the inspiratory flow rate and respiratory rate. However, clinical studies have failed to show that PSV improves weaning. (See "Methods of weaning from mechanical ventilation", section on 'Choosing a weaning method'.)
PSV is frequently combined with synchronized intermittent mandatory ventilation (SIMV). The ventilator delivers the set respiratory rate using SIMV, but patient-initiated breaths beyond the set respiratory rate are delivered using PSV. The purpose of adding PSV for patient-initiated breaths is to overcome the resistance of the endotracheal tube and ventilator circuit. The necessary level of pressure support is unknown and generally estimated. Resistance of the endotracheal tube is related to the tube diameter and inspiratory flow rate [16]. With small endotracheal tubes (eg, <7 mm), a pressure support level ≥10 cm H2O may be needed to overcome the resistance [17,18]. Levels of pressure support higher than that required to overcome resistance will augment tidal volume.
Disadvantages — PSV is poorly suited to provide full or near-full ventilatory support. The following characteristics of PSV are disadvantages in that setting:
●Each breath must be initiated by the patient. Central apnea may occur if the respiratory drive is depressed due to sedatives, critical illness, or hypocapnia due to excessive ventilation [19].
●An adequate minute ventilation cannot be guaranteed because tidal volume and respiratory rate are variable.
●Ventilator asynchrony can occur when PSV is employed for full ventilatory support, potentially prolonging the duration of mechanical ventilation [20,21].
●PSV is associated with poorer sleep than AC. Specifically, there is greater sleep fragmentation, less stage 1 and 2 non-rapid eye movement (NREM) sleep, more wakefulness during the first part of the night, and less stage 3 and 4 NREM sleep during the second part of the night [22].
●Relatively high levels of pressure support (eg, >20 cm H2O) are required during full ventilatory support to prevent alveolar collapse (which can lead to cyclic atelectasis and ventilator-associated lung injury) and to attain a stable breathing pattern [23,24]. Such high levels of pressure support are not as comfortable as moderate levels (eg, 10 to 15 cm H2O) [25]. (See "Ventilator-induced lung injury".)
While PSV is poorly suited to provide full or nearly full ventilatory support in general, it is a particularly poor choice for patients who also have increased airway resistance (eg, COPD or asthma exacerbation). Minute ventilation is more likely to be insufficient when airway resistance is high, which may be related to decreased airflow causing inspiration to be terminated after a smaller than optimal tidal volume has been delivered [26,27]. In addition, PSV does little to decrease auto-positive end-expiratory pressure (auto-PEEP, also known as intrinsic PEEP), which can increase patient work and worsen respiratory muscle fatigue [28]. Choosing a higher percentage of the peak inspiratory flow as the trigger to end inspiration may improve auto-PEEP slightly [29].
BiPAP is the name of a portable ventilator manufactured by Respironics Corporation; it is just one of many ventilators that can deliver BPAP.
The exact size of the tidal volume is related to both the driving pressure and the compliance.
T high is set to 5.4 seconds and whose T low is set to 0.6 seconds has an inflation-deflation cycle lasting 6 seconds. This allows 10 inflations and deflations to be completed each minute.
Spontaneous breathing is possible at both P high and P low, although most spontaneous breathing occurs at P high because the time spent at P low is brief. This is a novel feature that distinguishes APRV from other types of inverse ratio ventilation (IRV).
The exact size of the tidal volume is related to both the driving pressure and the compliance.
T high is set to 5.4 seconds and whose T low is set to 0.6 seconds has an inflation-deflation cycle lasting 6 seconds. This allows 10 inflations and deflations to be completed each minute.
Spontaneous breathing is possible at both P high and P low, although most spontaneous breathing occurs at P high because the time spent at P low is brief. This is a novel feature that distinguishes APRV from other types of inverse ratio ventilation (IRV).
Contraindications — APRV and its related modes are infrequently used in patients with severe obstructive airways disease or a high ventilatory requirement because hyperinflation, high alveolar pressure, and pulmonary barotrauma may result.
Special attention should be paid to the possible adverse effects of raising PEEP which can cause barotrauma and hypotension. Raising FiO2 does not come without its concerns as high FiO2 can cause oxidative damage in the alveoli. Another important aspect of managing oxygen content is to define a goal for oxygenation. In general, there is little benefit from keeping oxygen saturation above 92-94% except for cases of carbon monoxide poisoning for example. A sudden drop in oxygen saturation should raise suspicion for tube misplacement, pulmonary embolism, pneumothorax, pulmonary edema, atelectasis, or development of mucus plugs.
Consideration has to be made while increasing the rate, as this will also increase the amount of dead space and might not be as effective as tidal volume. While increasing volume or rate special attention should be paid to the flow-volume loop to prevent the development of auto-PEEP.
Special attention should be paid to the possible adverse effects of raising PEEP which can cause barotrauma and hypotension. Raising FiO2 does not come without its concerns as high FiO2 can cause oxidative damage in the alveoli. Another important aspect of managing oxygen content is to define a goal for oxygenation. In general, there is little benefit from keeping oxygen saturation above 92-94% except for cases of carbon monoxide poisoning for example. A sudden drop in oxygen saturation should raise suspicion for tube misplacement, pulmonary embolism, pneumothorax, pulmonary edema, atelectasis, or development of mucus plugs.
Consideration has to be made while increasing the rate, as this will also increase the amount of dead space and might not be as effective as tidal volume. While increasing volume or rate special attention should be paid to the flow-volume loop to prevent the development of auto-PEEP.
Special attention should be paid to the possible adverse effects of raising PEEP which can cause barotrauma and hypotension. Raising FiO2 does not come without its concerns as high FiO2 can cause oxidative damage in the alveoli. Another important aspect of managing oxygen content is to define a goal for oxygenation. In general, there is little benefit from keeping oxygen saturation above 92-94% except for cases of carbon monoxide poisoning for example. A sudden drop in oxygen saturation should raise suspicion for tube misplacement, pulmonary embolism, pneumothorax, pulmonary edema, atelectasis, or development of mucus plugs.
Consideration has to be made while increasing the rate, as this will also increase the amount of dead space and might not be as effective as tidal volume. While increasing volume or rate special attention should be paid to the flow-volume loop to prevent the development of auto-PEEP.
nasal mask, facemask, or nasal plugs
Generally, the straps should be loose enough to allow one or two fingers to pass between the face and the strap. When a nasal mask or prongs are used, a chin strap is usually necessary to maintain closure of the mouth.
trial that randomly assigned 26 patients, (COPD) exacerbation complicated by hypercapnia to receive NIV via face mask, nasal mask, or nasal prongs (pillows) [23]. The face mask conferred the greatest physiologic improvement, but the nasal mask was best tolerated.
Based on these studies, the oronasal mask is generally preferred over a nasal mask or nasal prongs during the initiation of NIV
Most patients with acute respiratory failure are mouth breathers; therefore, NIV delivered by a nasal mask or prongs (pillows) may result in a large air leak through the mouth and a worse outcome [26].
●The nasal air passages offer significant resistance to airflow, which can reduce the beneficial effects of NIV if a low level of positive airway pressure is used [20,27].
●The primary disadvantage of the full face and oronasal masks is that monitoring for aspiration is more difficult [28].
●Regardless of the interface chosen, heated humidification brings the relative humidity back toward the ambient range. This enhances patient comfort [29].
Refer table 3 comparison
Hypercapnic encephalopathy may be an exception to the rule that severely impaired consciousness is a contraindication to NIV [12,13]. Clinicians who choose to try NIV in this setting should monitor such patients closely. Improved consciousness should be apparent within one to two hours after the initiation of NIV. Patients who deteriorate or fail to improve should be promptly intubated. The likelihood that hypercapnic encephalopathy will respond to NIV is inversely related to the severity of the hypercapnia. Respiratory acidosis is NOT a contraindication to NIV
Initiate setting similar to intubated ventilation
Complications are due to local and related to the tightly fitting mask
Most complications due to NIV are local and related to the tightly fitting mask:
●Local skin damage may occur due to the pressure effects of the mask and straps [130]. Cushioning the forehead and the bridge of the nose prior to attaching the mask can decrease the likelihood of these problems.
●Modest mask leaks are common and do not preclude NIV. A mask leak can often be remedied by using a different mask or different ventilator settings.
●Eye irritation, sinus pain, or sinus congestion may occur and require either a lower inspiratory pressure or a facial mask rather than a nasal mask.
●Mild gastric distention occurs frequently but is rarely clinically significant at usual levels of inspiratory pressure. Routine use of a nasogastric tube is not warranted.