The respiratory intensive care unit provides specialized care and monitoring for patients with acute or chronic respiratory failure through non-invasive or invasive mechanical ventilation. Patients receive constant monitoring of their cardiovascular and respiratory functions. Mechanical ventilation is used when patients are unable to breathe effectively on their own, and involves intubation and use of a ventilator to pump air into the lungs. There are different types of ventilators that provide ventilation through either positive or negative pressure. Nursing care for patients on ventilators focuses on monitoring for complications like pneumonia, impaired communication, and weaning the patient off the ventilator as their condition improves.

1. Care of patients in
Respiratory
intensive care unit
and ventilator care
MEHAK NABI

2. Respiratory Intensive Care Units
The respiratory intensive care unit (RICU) is a
section of the Pulmonology and Respiratory
Rehabilitation departments. It consists of eight to ten
beds situated in a suitably well-lit and spacious
environment equipped with centrally controlled
systems for oxygen delivery, air- suction and air-
conditioning

3. Respiratory intensive care units are
specialized units and mainly developed
to the monitoring and treatment of acute
or chronic respiratory failure by non-
invasive mechanical ventilation but also
to weaning from invasive mechanical
ventilation

4. The main Goal of RIC units is
To provide greater clinical control and constant
monitoring of cardiovascular function, ventilator
support if required, and especially a greater
level of nursing care They are thus highly
specialized facilities requiring highly qualified
medical, nursing and rehabilitation personne
suitably trained to offer the patient, high quality
of care through a multidisciplinary approach

5. Endotracheal Intubation
Patients who are unable to breathe
effectively and maintain adequate
oxygenation because of airway obstruction
or respiratory failure are intubated with a
special endotracheal tube (ET) through
nose or mouth into the trachea. Most of
the intubated patients are mechanically
ventilated.
Since incubation can damage vocal cords
and surrounding tissues, it is usually a
short term intervention

8. Mechanical Ventilation
Mechanical ventilation is the process of providing
respiratory support by means of a mechanical
device called a ventilator. A mechanical ventilator
is a positive pressure or negative pressure
breathing device that can maintain ventilation and
oxygenation for a prolonged period of time. These
devices provide ventilation for patients who are
unable to breathe effectively on their own

11. Indications
.Patients with acute
respiratory failure
. Apnea with respiratory arrest
•Cardiopulmonary arrest
.Chronic obstructive
pulmonary disease

12. .Paralysis of diaphragm due to
GBS, myasthenia gravis,spinal
cord injury
• Respiratory paralysis is due to
effect of anesthesia and muscle
relaxant drugs
.Acute respiratory distress
manifested by
tachycardia,retractions and
other physical signs

13. . Acute respiratory acidosis in with
PCO2 >50 mg/Hg
.Hypoxemia with PO2 <55 mm of
Hg & pH <7.25
. Hypotension shock.

14. Classification of
Ventilators
Ventilators are generally
classified into positive
pressure
and negative pressure
ventilators.

15. Non-invasive Negative Pressure
Ventilators :It exerts a negative pressure
in the external chest.
Decreasing the intrathoracic pressure during
inspiration allows the air to flow into the lung,
filling its volume. Negative pressure
ventilators are simple to use and do not
require intubation of the airway. Air can be
drawn into lungs through mouth and nose if
sub atmospheric pressure could be
developed around abdomen and thorax.

16. There are several types of negative
pressure ventilators.
.Iron lung (body tank):is a form of
medical ventilator that enables a person
to breathe when normal muscle control
has been lost or the work of breathing
exceeds the person's ability
• Body wrap: Nylon or plastic jackets
that surround the chest and abdomen

17. Iron lung

18. Iron lung

19. Body wrap

20. Positive Pressure Ventilators
It inflates the lungs by exerting
positive pressure on the airway
forcing the alveoli to expand during
inspiration Expiration occurs
passively. Endotracheal intubation is
needed.

21. There are three types of positive pressure
ventilators
1.Volume cycled: The volume of air to
be delivered with each inspiration is
preset. The volume of air delivered is
constant.
2. Pressure cycled: It delivers a flow of
air until it reaches preset pressure and
then cycles off and expiration occurs
passively.

22. 3.Time cycled: It controls or terminates
inspiration after a period of time. They
deliver oxygenated air over a preset
length of time. The volume of air the
patien received is regulated by the
length of inspiration and the rate of flow.
This type is most frequently used in
infants and children

23. Non-invasive Positive Pressure
Ventilation (NIPPV) This refers to all
modalities that assist ventilation without
the use of an endotracheal tube. It is
given via face masks, nasal masks or
other such devices which are non-
invasive to the patient.

24. NIPPV is an alternative to intubation and
mechanical ventilation for patients who are able
to breathe on their own but are unable to
maintain normal blood gases Patients with
severe respiratory disease sleep apnea or
neuromuscular disease that weakens respiratory
muscle can benefit from this treatment.

25. There are two types of NIPPV
1. Continues positive airway pressure (CPAP):
It provides positive pressure on inspiration and
expiration to keep alveoli open in a
spontaneously breathing patient. The same
amount of positive pressure is maintained
throughout. CPAP maintains positive pressure in
the airway during sleep and is used in people with
sleep apnea, type 1 respiratory failure

26. 2. Bilevel positive airway
pressures (BIPAP): In
BIPAP lower level of
positive pressure is used
on expiration. Used in
Type 2 respiratory failure
or for both

27. Nursing Management of a Patient
Receiving Mechanical
Mechanical ventilation can be a
temporary or chronic life saving therapy.
Its purpose is to maintain adequate
ventilation by delivering preset
concentration of oxygen at an adequate
tidal volume. Although the mechanical
ventilator facilitate movement of gases
into and out of pulmonary system
(ventilation), it cannot ensure gas
exchange at the pulmonary and tissue
levels (respiration)

28. Nursing Diagnosis

29. 1)Impaired gas exchange related to underlying cause
(metabolic causes, respiratory muscles fatigue,
postoperative period, acute respiratory failure).
o Assess the respiratory rate, pattern
and depth of respiration, use of
respiratory muscles. Changes will
indicate early signs of respiratory
problems.
oAssess BP and heart rate to detect
hypotension and hypoxia.
o Use pulse oximetry to monitor oxygen
saturation. It is useful in detecting early
changes in oxygenation

30. o Monitor blood gas analysis. Altered ABG values
indicate signs of respiratory failure. o Auscultate
lung sounds to detect deterioration or
improvement early.
o Assess for changes in level of consciousness.
Altered level of consciousness indicated signs of
hypoxia.
O Monitor ventilator settings to assess proper
functioning of the machine.

31. 2) Ineffective airway clearance Related factors are
endotracheal intubation and excessive secretions
o Auscultate lungs for presence of normal and adventitious breath sound.
Diminished lung the sounds may indicate an obstructed airway and the
need for suctioning.
o Observe the color, amount, consistency and odor of secretions. Thick
and foul smelling sputum indicates infections.
o Monitor arterial blood gases - Checking of arterial blood gases help to
identify hypoxemia. o Explain the suctioning procedure to reduce anxiety
and win the cooperation of the patient.
O Suction the airway using aseptic technique as needed to decrease
infection rate.

32. o suctioning the airway using aseptic technique as
needed to decrease infection rate.
o Administer pain medication, muscle paralyzing
agents and sedatives as needed.
o Put off the ventilator alarms before suctioning
and reset after sanctioning
o Administratier an adequate intake of fluid.
o Initiate - IV fluids or nasogastric feeds as
appropriate.

33. Change the patient's position every
two hours. It will help to mobilize the
secretion and prevent ventilator
associated pneumonia.
Provide the chest physiotherapy with
the help of a respiratory therapist.
Chest physiotherapy includes the
technique of postural drainage and
chest percussion to loosen and
mobilize secretions.

34. 3)Impaired verbal communication due to the
presence of endotracheal tube
.Speak to the patient and explain everything you
do for the patient
.Provide the patient writing pad and pencil, word
and phrase cards.
• Encourage visiting by family and friends.

35. 4)Potential for ventilator associated pneumonia
(VAP)
o Assess for pulmonary infection - fever, purulent
secretion.
. Wash hands before and after suctioning.
.follow aseptic technique while doing suction.
o Keep the head end of the bed elevated to 30-40°Elevation
promotes better lung expansion. It also reduces gastric
reflux and aspiration.
o Provide oral hygiene 2-3 times a day with soft tooth
brushes and 12% chlorhexidine solution.
• Maintain adequate nutrition via nasogastric feeding as per
the protocol

36. 5)Potential for ventilator-related
problems.
o Monitor ventilator equipment, check ventilator settings every
hour. Monitor ventilator rate and check the functioning of the
equipment frequently.
Ensure that the ventilator alarms are on.
Assess for signs of barotrauma altered chest expansion, crepitus,
asymmetrical chest, shift in trachea, pneumothorax is suspected

37. 6)Risk for decreased cardiac output
Mechanical ventilation can cause decreased
venous return to the heart
• Assess the heart rate, BP and level of
consciousness.
Monitor intake and output.
Notify physician immediately if signs of decreased
cardiac output.

38. 7)complication of immobility
o Prevent developing decubitus ulcers by position
changing, back massage, using alternating pressure
mattress.
Contractures can be prevented by providing range
of motion exercises and proper positioning of
extremities.

39. Weaning the
Patient from
the Ventilator

40. Respiratory weaning is the process of
withdrawing the patient from dependence on the
ventilator. It takes place in three stages. The
patient is gradually removed from the ventilator,
first, then from the endotracheal tube and finally
from oxygen.

41. Weaning can be started when vital signs are stable
and arterial blood gases are within normal limits. If
clinically stable patient can be extubated within 2-3
hours after weaning and allowed spontaneous
breathing by means of a mask with humidified
oxygen. If the patient's respiratory function is
adequate, the patient is then weaned from 1
oxygen.

42. THANKYOU