4. Ventilatory support that is given with out
establishing endotracheal intubation or
tracheostomy is called as non invasive
mechanical ventilation (NIMV )
DEFINITION
5.
6. 1) Acute respiratory failure
a) Hypercapnic acute respiratory failure:
Acute exacerbation of COPD
Post extubation
Post surgical respiratory failure
Thoracic wall deformities
Cystic fibrosis
Status asthmaticus
Acute respiratory failure in obesity hypo ventilation
syndrome
7. b) Hypoxemic acute respiratory failure:
Cardiogenic pulmonary edema
Community acquired pneumonia
Post traumatic respiratory failure
ARDS
2) Chronic respiratory failure
3) Immuno compromised patients (AIDS)
4) Do not intubate patients (terminal illness ,
malignancy)
8. A. ABSOLUTE:
Respiratory arrest
Unstable cardio respiratory status
Uncooperative patients
Unable to protect airway (impaired swallowing,
cough & impaired consciousness)
Facial ,oesophageal or gastric surgery
Craniofacial trauma or burns
Anatomic lesion of upper airway
9.
10. B. RELATIVE:
Extreme anxiety
Massive obesity
Copious secretions
Need for continous ventilatory assistance
11. SHORT TERM:
Relieve symptoms
Reduce work of breathing
Improve or stabilize gas exchange
Good patient ventilator synchrony
Optimize patient comfort
Avoid intubation
12. LONG TERM:
Improve sleep duration and quality
Maximize quality of life
Enhance functional status
Prolong survival
13. Patient is able to cooperate
Patient control airway and secretions
Have adequate cough reflex
Haemo dynamically stable
Patient is able to coordinate breathing with
ventilator
Patient can breath unaided for several minutes
14. Improvement in gas exchange , heart rate and
respiratory rate within first 2 hours.
Normal functioning of GI tract.
15. Devices that connects ventilator and tubing to
the face.
It should comfortable, offer good seal,
minimize leak.
18. Explain to the patient regarding the procedure
and what to expect.
Keep the head of the patient’s bed at 45 degree
angle .
Choose the correct interface.
Turn on the ventilator and dial in the setting.
19. Hold the mask gently over the patient’s face
until the patient become comfortable with it.
Strap the face mask and minimize the air leak
without discomfort .
Pad the ridges of facial mask with gauze
piece.
Connect humidification system.
22. Preservation of airway defense mechanism
Intermittent ventilation possible
Patient can eat ,drink and communicate
Ease of application and removal
Patient can cooperate with physiotherapy
Improved patient comfort
23. Reduced need of sedation
Avoidance of complication of endo tracheal
intubation
Ventilation outside the hospital is possible
Correction of hypoxemia without worsening of
hypercarbia.
24. Mask comfortable or claustrophobic
Time consuming
Facial pressure sores
Airway not protected
No direct access for suction, if secretions are
excess
28. 1. CHECK:
Ventilatory setting and modes
ET tube placement
Vital signs
ABG
O2 Saturation
Respiratory rate , depth , pattern
Breath sounds
LOC
Pain ,anxiety and comfort level
29. 2 . COMMUNICATION:
Assessment of the ability of the patient to
communicate
Be alert to non verbal clues
Use of signal , signs , nodding , writing and lip reading
Provide paper and pencil
Allow patient to respond and repeat explanation
Ask simple questions
30. 2 . COMMUNICATION:
Communication among health care providers,
promotes optimal outcome.
31. 3. MANAGEMENT OF AIRWAY:
Assess respiratory rate and depth
Inspect thorax
Observe for SOB
Assess patient oxygenation
Elevate head end of the bed
Suctioning ,CPT
Frequent positioning
Humidification of the airway
Proper cuff inflation of Et tube
Use of bronchodilators and mucolytics
32. 4.SUCTIONING:
Help the patient to cope
Remove airway secretions by suctioning when;
o Audible airway noise
o Coughing
o Respiratory distress
33. 4.SUCTIONING:
Suction technique:
►Sterile technique
►Suction pressure-not less than 120 H2O (for adults),
60-80 (for pediatrics)
►Use appropriate size catheter
►Pre oxygenation (100%),hyper ventilation before and
after suction
34. 4.SUCTIONING:
Suction technique:
►Don’t suction, when inserting catheter
►Suction time no longer than 15 sec
►Suction for the shortest duration possible
►Limit suctioning pressure too lowest level to
remove secretions
►Saline should not be used .
35. 5. ENSURING HUMIDIFICATION:
Temperature of humidifier kept close to body
temperature 35-37 degree celsius
Humidifier should be checked for adequate water
levels
Humidifier should not be over filled
36. 6.VENTILATOR ALARMS:
It act as an immediate warning signals to
altered ventilation.
i. High pressure alarms(rising pressure)
ii. Low pressure alarms(disconnection/leak)
37. 7.MANAGEMENT OF FLUID IMBALANCE:
Monitor daily weight
Assess edema, signs of dehydration
I/O Chart
IV fluids
CVP monitoring
Measuring cardiac output
38. 8.Prevention of infections :
Oral hygiene with chlorhexidine every 2 hrly
Suction when needed using sterile
technique
Use sterile saline for suctioning
Hand washing before and after patient
contact
39. 8.PREVENTION OF INFECTIONS :
Ensure ventilator tubing changed between
patient’s and whenever become soiled
Monitor color ,amount , consistency of
sputum.
41. 8.PREVENTION OF INFECTIONS :
VAP prevention :
Elevate the head end of bed
Sedation
Assess need of extubation
Peptic ulcer disease:
prophylaxis(eg:ranitidine,omez)
42. 8.PREVENTION OF INFECTIONS :
VAP prevention :
DVT prophylaxis :LMWH , UFH,sequential
compression
Oral care and suctioning
Check cuff pressure every shift
43. 9.MAINTAIN NUTRITION :
Assess bowel sounds
Provide NG Tube feeding
Parentral nutrition, if not tolerate orally
Avoid too much CHOH feeds as it increase
CO2 production and may cause hypercapnia
44. 10. PREVENTION OF HEMODYNAMIC
INSTABILITY :
Monitor BP every 1-2hrly
IV fluids
45. 11.MONITOR FOR COMPLICATIONS :
Rapid electrolyte changes
Severe alkalosis
Hypotension
GI problems
Respiratory distress
Barotrauma
50. 12. PROVIDE REST :
Keep calm and quite environment
Provide dim light
Side rails
Define visiting hours
Maintain warmth and adequate body
temperature
51. 13. EDUCATE THE PATIENT AND
FAMILY:
Seeing a loved one attached to ventilator is a
frightening experience.
Emphasize the positive outcomes of mechanical
ventilation ,communicate desired outcome and
patient progress.
52. 14.WEAN THE PATIENT :
Weaning methods vary according to hospital
protocols.
Best method involve team work ,consistent
evaluation of patient parameters.
53. 1.Impaired spontaneous ventilation related to
imbalance between ventilator capacity and ventilator
demand ,as manifested by ABG value.
Interventions:
Check ventilatory settings ,connections, alarms
Assess airway and lung sounds every 1-2 hrly
Check placement of ET tube and secure the tube
ROM exercise
54. 2. Ineffective airway clearance related to inability
to cough as manifested by wheezing on auscultation.
Interventions:
Assess the need for suctioning
Suction the airway
Maintain sterility during procedure
Hyper oxygenate before and after suctioning
55. 3. Impaired gas exchange related to underlying
disease process as manifested by SPO2.
Interventions :
Assess the respiratory rate and pattern
Auscultate lung sounds
Monitor ABG values and saturation
56. 4.Imbalanced nutritional status less than body
requirement related to lack of ability to eat while on
a ventilator as manifested by weight loss.
Interventions:
Check the weight
Monitor IO chart and bowel sounds
Provide adequate nutrition
Tube feeding
57. 5.Impaired oral mucous membrane related to NPO
Interventions:
Moisten the lips
Suction the oral secretions
58. 6.Risk for infection related to intubation
Interventions:
Wash hands
Use sterile technique
Provide oral care
Monitor sputum for changes in color , consistency,
amount and odor.
