it is an brief summary with diagrammatic presentation for NURSES regarding Mechanical ventilator, uses, complications, types, important terms,common modes, NIV, uses, NURING ROLES & RESPONSIBILITIES for handling INTUBATED patients...
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
Humidifiers in anaesthesia and critical careTuhin Mistry
Humidification of inhaled gases has been standard of care during mechanical ventilation in anaesthesia and intensive care. Active & Passive humidification devices have rapidly evolved. basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for anaesthesiologists and intensivists.
This slide include information regarding ventilators, modes of ventilators , its parts, weaning process, nursing care of patient in mechanical ventilation.
A breathing system is a device that conducts gases such as oxygen and anesthetic agents to the patient and conducts waste gases such as CO2 away.
Breathing systems are classified as
Open,
Semi-open,
Semi-closed
Closed.
Semi-closed systems are further divided into
Rebreathing Systems With CO2 Absorption,
Rebreathing Systems Without CO2 Absorption
Non-rebreathing Systems.
More simply, systems can be classified in two groups:
systems with CO2 washout (includes open and semi-open systems)
systems with CO2 absorption (includes closed and semi-closed systems).
It is the fastest and most commonly practiced approach and allows visual inspection of the supraglottic areas for foreign bodies (e.g., false or loose teeth, aspirated objects) and other obstructions (e.g., tumors). The most important consideration in oral intubation is appropriate head position.
Humidifiers in anaesthesia and critical careTuhin Mistry
Humidification of inhaled gases has been standard of care during mechanical ventilation in anaesthesia and intensive care. Active & Passive humidification devices have rapidly evolved. basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for anaesthesiologists and intensivists.
This slide include information regarding ventilators, modes of ventilators , its parts, weaning process, nursing care of patient in mechanical ventilation.
A breathing system is a device that conducts gases such as oxygen and anesthetic agents to the patient and conducts waste gases such as CO2 away.
Breathing systems are classified as
Open,
Semi-open,
Semi-closed
Closed.
Semi-closed systems are further divided into
Rebreathing Systems With CO2 Absorption,
Rebreathing Systems Without CO2 Absorption
Non-rebreathing Systems.
More simply, systems can be classified in two groups:
systems with CO2 washout (includes open and semi-open systems)
systems with CO2 absorption (includes closed and semi-closed systems).
It is the fastest and most commonly practiced approach and allows visual inspection of the supraglottic areas for foreign bodies (e.g., false or loose teeth, aspirated objects) and other obstructions (e.g., tumors). The most important consideration in oral intubation is appropriate head position.
The must to know facts about ventilator. Indeed a detailed information can be gathered from the presentation. This presentation includes definition, history, terminology, need of ventilation,indication, types, complications, etc.
EXTERNAL VENTRICULAR CARE FOR NURSES.pptxMURUGESHHJ
EVD---EVD CARE ESPECAILLY IN ICU SETTINGS MORE ESSENTIAL , THIS PPT EXPLAINS YOU ABOUT EVD IN BRIEF, INDICATIONS, COMPLICATIONS , , EVD CARE PROCEDURE, NURSING DIAGNOSIS & MANGEMENT ASSOCIETED WITH EVD RELATED INFECTIONS ...
HOSPTAL ACQUIRED PNEUMONIAE , PREVENTION AND MANAGEMENT PROTOCALS MURUGESH.pptxMURUGESHHJ
this is an brief explanation for one of most common infection in hospital i.e , HAI, meaning, causes, prevention & management stragies , VAP OR VAE & NVHAP bundles, especially usefull for nurses ...
IMPORTANCE OF ORAL CARE IN ICU MURUGESH HJ.pptxMURUGESHHJ
THIS PPT EXPLAINS ABOUT IMPORTANCE OF ORAL HYGIENE ESPECIALLY FOR UNCONSIOUS PATIENTS, SEVERLY ILL PATIENTS , IT EXPLAINS YOU ABOUT PROCEDURE, IMPORTANT ARTICLES , MOST BENEFICIAL FOR NURSES
HEART SOUNDS ASSESSMENT FOR NURSES MURUGESH.pptxMURUGESHHJ
IT IS AN BRIEF DESCRIPTION ABOUT SIMPLE ASSESMENT OF HEART , ANATOMY & PHYSIOLOGY OF HEART ,HEART SOUNDS, NORMAL & ABNORMAL SOUNDS..ESPECIALLY MOST USEFULL TO NURSES...
Neuroassessment important neuro reflex’s in icu for nurses +rass score+tbiMURUGESHHJ
its an small guide to assess the neuorological status with various pictures , it explains clearly about GCS, MUSCULAR POWER ASSESSMENT , PUPILLARY REACTION & IMPORTANT REFLEXES specially for nurses ....it has brief information about TBI PROTOCAL & RASS SCORE
Chest auscultation & lung sounds assessment for nursesMURUGESHHJ
its an brief explanation regarding respiratory system & most common sites to assess lung sounds &lobe associated lung infections...visuals explains briefly & clearly about abnormal lung conditions
Artereal blood gas meaning,brief guide for nurses murugeshMURUGESHHJ
ABG-It is an vital &fastest test to assess the patient haemodynamics , this ppt explains you briefly about ABG meaning, components,sampling, allens test & nurses roles....
it is an brief description and slides about the CYANOSIS,ISCHEMIA, ISCHEMIC MANAGEMENT MEANING , HEPARIN , HEPARIN USES , IV INFUSION, SIMPLE HEPARIN IV INFSUION CALUCULATION FORMULAE , ANTIDOTE AND NURSING MANAGEMENT,expalins in diagrammatic manner for nurses, ICU nursing educators,primarily its most benificial for INTENSIVE NURSES works in critical area units like ICUs , CT ICUS etc...
Diabetic ketoacidosis meaning,types &management for nurses murugeshMURUGESHHJ
its an brief information about the Diabetic ketoacidosis, causes, signs & symptoms ,hospital management protocals in simple english......provides more information with diagrammatic way ...thank you all
its an brief information for Intensive nurses about the Neurological assessment ,GCS, braian death assessment & expalins about important brain reflex's pertaining to icu setup, for making this pdf i used out hospitlas protocal, nursing journals.....
THIS IS AN BRIEF INFORMATION ABOUT AN ONE OF MY FAVOURITE SUBJECT ARDS & & ITS MANAGEMENT ,ROLES OF INTENSIVE NURSES , IT WILL EXPLAINS ABOUT CATEGORIES, PF RATIO, PRONE POSITIONING & NURSING CARE .....FOR THIS I REFFERED OLD SLIDE SHARE PPTS & IN HOSPITAL ROUTINELY PRACTICING POLICIES
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. INTRODUCTION……….
MECHANICAL VENTILATOR….
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. The
mechanical ventilator is also called a ventilator, respirator, or breathing machine. There are many
reasons why a patient may need a ventilator, but low oxygen levels or severe shortness of breath
from an infection such as pneumonia are the most common reasons….
Benefits of mechanical ventilation are improved gas exchange and decreased work of
breathing…
3. AIRWAYS…
Endotracheal Tube (ETT)….
An endotracheal tube is a “flexible plastic tube that is placed through the
mouth into the trachea (windpipe) to help a patient breathe. The
endotracheal tube is then connected to a ventilator, which delivers oxygen to
the lungs. The process of inserting the tube is called “endotracheal intubation”
4. AIRWAYS…
TRACHIOSTOMY….
Tracheostomy is an operative procedure that creates a surgical airway in the
trachea. It is most often performed in patients who have had difficulty weaning off
ventilator, followed by those who have suffered trauma or a catastrophic
insult. Infectious and neoplastic processes are less common in diseases that
a surgical airway…
The outer diameter of the tracheostomy tube should be about ⅔ to ¾ of the
tracheal diameter. As a general rule, most adult females can accommodate a tube
with an outer diameter of 10mm, whilst an outer diameter of 11mm is suitable for
most adult males.
BASED ON INCISION 2 TYPES---
1.SURGICAL TRACHIOSTOMY 2.PERCUTANEOUS TRACHIOSTOMY
5. INDICATIONS….
Why are ventilators used?
■ To deliver high concentrations of oxygen into the lungs.
■ To help get rid of carbon dioxide.
■ To decrease the amount of energy a patient uses on
breathing so their body can concentrate on fighting
infection or recovering.
■ To breathe for a person who is not breathing because of
injury to the nervous system, like the brain or spinal cord, or
who has very weak muscles.Eg; myasthenia gravis, stroke etc…
■ To breathe for a patient who is unconscious because of a
severe infection, build up of toxins, or drug overdose.
6. INDICATION FOR VENTILATION:
Poor ventilation:
CNS disease e.g. Guillain-Barré Syndrome, Myasthenia Gravis, Spinal cord
injury
***Drug over dose, Sedation
***Neuromuscular blockade
***General anesthesia
***Poor gas exchange:
***PaO2 < 50mmHg or PaCO2 > 55mmHg
***pH < 7.25
***Acute lung injury (Including ARDS, trauma)
***Apnea with respiratory arrest, including cases from intoxication
Poor circulation–Shock, Severe anaemia
***Prophylaxis (e.g. for multi trauma patients and upper GI hemorrhage)
***Raised ICP
7. COMPLICATIONS OF VENTILATOR…..
COMPLICATIONS:
*** Infection
*** Aspiration:
*** Tracheal stenosis, laryngeal edema
*** Barotrauma
*** Decreased cardiac output, especially with PEEP
*** Fluid retention
*** Inadequate nutrition
*** Ensure that Written informed consent is taken and procedure explained
to patient/relatives.
****Verbalize the rationale for the placement of NG/OGT in intubated /
ventilated patients – To prevent vomiting & aspiration.
8. VENTILATOR PARAMETERS…
Ventilator Settings/Parameters….
** Tidal Volume
** PEEP
** Mode (type of assist given by vent)
** Rate (Breaths per minute.Adjusted based on
patient’s
own respiratory rate)
** FiO2 (amount of O2 being delivered)
** PIP
** Ppeak
**PLATEU Pressure….
9. VENTILATOR PARAMETERS…
Fraction of inspired oxygen (FiO2)
***Concentration of oxygen in the inspired air
***Use the lowest FiO2 that achieves the targeted oxygenation
***Avoid prolonged FiO2 > 0.60, as this may cause oxygen toxicity
Frequency (f) or respiratory rate (RR) (10-20 breaths/min)
*** Set number of ventilator breaths per minute
*** Actual RR includes the spontaneous breaths taken by the patient
***Hypoventilation may cause respiratory acidosis; hyperventilation may
cause respiratory alkalosis
10. VENTILATOR PARAMETERS…
Inspiratory: expiratory (I:E) ratio -
Normal: longer expiratory phase than inspiratory phase (1:2, 1:3)
** Inverse ratios provide a longer inspiratory phase (1:1, 2:1, 3:1, 4:1) **Reduced
I:E allows more time for exhalation and reduces breath stacking; used for
patients who have obstructive airway disease with acute respiratory acidosis
Minute ventilation (VE) (5-10 L/minute)-
Volume of gas exchanged per minute, normally 5-10L/min
Minute ventilation caluculation formula ; VE = RR X VT
Example- RR IS 20B/MIN, TV IS 400ML, then Minute ventilation (Ve) is
Ve=20b/min x 400ml
Ve=8000ml/minute
11. VENTILATOR PARAMETERS…
Peak flow rate -
• Maximum flow delivered by the ventilator during inspiration
Peak inspiratory pressure(PIP)-
• Highest proximal airway pressure reached during inspiration
• Target PIP is < 35 cm H2O
• Low PIP may result in hypoventilation; high PIP may cause lung
damage
12. VENTILATOR PARAMETERS
Tidal volume (VT)
Normally;6-8 mL/kg of ideal bodyweight [IBW] to preventbarotrauma)
VT means- Volume of gas exchanged with each breath
• A lower VT is indicated in patients with stiff, non-compliant
lungs
• Higher VT may cause tachycardia, decreased blood pressure
and lung injury
LOW TIDAL VOLUME VENTILATION
Trigger
Breaths can be triggered by:
Timer (ventilator-initiated breaths); occur at the set
respiratory rate or frequency
Patient effort (patient-initiated breaths); occur when the
patient causes sufficient change in either the pressure or
flow in the circuit
13. VENTILATOR PARAMETERS….
Plateau pressure (Pplat)
Reflects pulmonary compliance and is measured by applying a brief inspiratory
pause after ventilation
Assess Pplat with peak inspiratory pressure (PIP):
A high PIP with normal Pplat = increased resistance to flow (i.e.,
endotracheal tube obstruction or bronchospasm)
A High PIP and high Pplat = decreased lung compliance (i.e., interstitial
pulmonary fibrosis, pneumonia, ARDS, pulmonary edema)
Positive end-expiratory pressure (PEEP) (3-10 cm H2O)
Pressure remaining in the lungs at end expiration
*** Used to keep alveoli open and “recruit” more alveoli to improve oxygenation
for patients
*** High levels may cause barotrauma, increased intracranial pressure, and
decreased cardiac output
*** For Severe ARDS requires more PEEP 8-14cm H2O
14. VENTILATOR PARAMETERS….
Pressure support (PS)(8-20 cm H2O)--
*** Provides additional pressure during inspiration to ensure a
larger Vt with minimal patient effort
***Used to help overcome the work of breathing through
ventilator tubing
Target --
Flow of air into the lung can target a predetermined flow rate
(i.e. peak inspiratory flow rate) or pressure limit
15. MODES OF VENTILATOR…
There are six conventional modes:
1. volume assist/control (VCV)
2. pressure assist/control ( PCV)
3. pressure support ventilation ( PS /CPAP)
4. volume synchronized intermittent mandatory ventilation
(SIMV)
5. pressure SIMV
6. Airway Pressure Release Ventilation (APRV)
16. MODES OF VENTILATOR…
01.Controlled Ventilation
• Vent initiates all breaths at a pre-set rate and tidal
volume
• Vent will block any spontaneous breaths
• Used mainly in the OR for paralyzed and sedated
patients.
2.Assist Control (A/C)
• Vent will allow a patient to initiate a breath and then vent
will deliver a pre-set tidal volume
• Machine set at a minimum rate so apnea will not occur if
the patient does not initiate a breath
• Disadvantages:
• Hyperventilation if patient has increased respiratory rate (can
lead to respiratory alkalosis)
• Vent dysynchrony, breath-stacking
17. MODES OF VENTILATOR….
3.Synchronized Intermittent Ventilation (SIMV)
• Similar to A/C, but patients can take own breaths with
their own TV between mechanically assisted breaths
• Can be used as a primary mode or a weaning mode
• May lead to a low respiratory rate in a patient who does
not initiate breaths if set rate is low..
4.Pressure Support Ventilation (PSV)
• Also called “spontaneous mode”
• Pt initiates breath & vent delivers a pre-set inspiratory
pressure to help overcome airway resistance and keeps
airways open
• Patient controls the rate, tidal volume, and minute ventilation
• Tidal volume is variable
• Can be used in conjunction with SIMV or CPAP settings
18. MODES OF VENTILATOR….
5.Continuous Positive Airway Pressure (PS/CPAP)
• Positive airway pressure provided during both inspiration and
expiration
• Vent provides O2 and alarms, but no respirations
• Improves gas exchange and oxygenation in patients able to
breathe on their own
• Can also be used non-invasively via a face or nasal mask for
patients with sleep apnea
6. Airway Pressure ReleaseVentilation (APRV)
• Differs from conventional vent
• Elevation of airway pressures with brief intermittent releases
of airway pressure
• Facilitates oxygenation and CO2 clearance
• May be an improved way to treat ALI/ ARDS
19. MOST COMMONLY USING MODE- PRVC
MODE……
Pressure-regulated volume control (PRVC) ventilation is a mode of
mechanical ventilation that combines volume and pressure control ventilation.
PRVC is an appropriate mode of ventilation for patients who require a specific tidal
volume (VT) with the lowest effective pressure, such as those with acute respiratory
distress syndrome (ARDS).
In the PRVC mode, the ventilator delivers a volume-controlled breath. Using the
plateau pressure from the previous delivered breath, the ventilator delivers the next
breath. This allows the lowest delivery pressure, which is the target VT. PRVC is an
adaptive control form of ventilation that allows automatic adjustment of targets
(pressure versus volume) over several breaths to maintain a selected target; in this
case, volume is targeted. In this manner, the PRVC mode may help prevent
volutrauma and barotrauma by limiting the delivery pressure to 5 cm H2O below
the set upper pressure limit alarm.
20. PRVC MODE OUTCOMES…..
EXPECTED OUTCOMES or ADVANTAGES
• Risk of barotrauma is reduced.
• Ventilator alarms when pressure limit is reached.
• Patient’s ventilation and oxygenation status are improved as evidenced by ABG
values,
decreased FIO2, decreased work of breathing, and improved vital signs.
UNEXPECTED OUTCOMES OR DISADVANTAGES
• Infection
• Hemodynamic compromise
• Complications associated with artificial airways (e.g., leaks, cuff rupture,
obstruction of endotracheal [ET] tube, pressure necrosis)
• Patient-ventilator asynchrony (e.g., auto-PEEP
, hyperventilation or
hypoventilation,
increased work of breathing, hyperoxygenation or hypo-oxygenation)
• High pressure reached before volume is delivered and set volume not delivered
to patient
21. PCV MODE….
Pressure-controlled ventilation is a modality utilized in
patients with an indwelling endotracheal tube or tracheostomy tube that affords
the practitioner the ability to ventilate a patient with a maximal peak pressure. In
contrast to volume-controlled ventilation, pressure-control involves the selection
of an inspiratory pressure instead of a tidal volume target. The setting of an
inspiratory pressure, as well as an associated positive end-expiratory pressure
(PEEP), will allow a provider to control the peak pressure, thereby protecting
from barotrauma.
ADVANTAGES….
****Most convenient for mode to use for ARDS
**PROTECTS from lung injury
DISADVANTAGES….
***Infection or VAP
***rare conditions barotrauma or volutrauma
22. ARTICLES & EQUIPMENTS PREPARATION OF
VENTILATOR……..
Articles & Equipment for
preparation of ventilator:
**Disposable ventilator tubing’s
**Disposable Heat and Moist Exchange Filter (H.M.E).
**Humidifier heater wires.
***Test Lung.
**Sterile surgical gloves
**Disposable gown.
**Servo filters OR BACTRIFILTERS
**Catheter mount
***Water for irrigation
**Under pad
**Closed sucton set or suction catheter
23. NURSES ROLE DURING INTUBATION OR
CONNECTING TO VENTILATOR…..
**Demonstrate proper connection of bacterial filter and breathing tube.
Keep an Emergency equipment on bedside for Ventilated patient:
***Ambu bag must be available & functional
***Yankeur catheter, suction catheters and functioning suction unit, airways and
masks should be available
***Keep bedside tracheostomy kit and intubation tray
****Crash trolley with defibrillator
***Demonstrate the knowledge about how to connect disposable ventilator
circuit to ventilator as per Nursing Practice Guidelines for ICU.
***Check that the ventilator is working by attaching test lung to circuit and
double checking by biomedical.
***Performs appropriate procedures for correctly identifying the patient. (by full
name and hospital number )
***Verbalize the knowledge about the things to be checked while receiving
Ventilator patients. (e.g. Ventilator settings/parameters/tubing, emergency
equipments, alarm limits)
24. NON INVASIVE VENTILATION….
Non-Invasive Ventilation (NIV)
Non-invasive ventilation (NIV) refers to the provision of ventilatory support through
the patient's upper airway using a mask or similar device.
INDICATIONS FOR NIV
***Chronic obstructive pulmonary disease (COPD): Long-term diseases like chronic
bronchitis and emphysema in which there is excessive coughing, increase in
respiratory rate and difficulty in breathing
***Cardiogenic pulmonary edema: Fluid build-up in the lungs due to cardiac
disease
***Respiratory muscle weakness
**Ventilator-associated pneumonia
***Sleep apnea (cessation of your breathing in sleep)
***COVID-19: Only those patients with the most severe symptoms of COVID-19
need noninvasive ventilation.
25. NON INVASIVE VENTILATION….TYPES
There are two types of noninvasive ventilation:
01.Positive-pressure ventilation:
It pushes the air into the lungs.
Two types of positive pressure ventilation are used in sleep apnea—Continuous
Positive Airway Pressure (CPAP) and Bi level Positive Pressure(BiPAP).
Pulmonologist will decide which one is suitable …..
02.Negative-pressure ventilation:
It sucks the air into the lungs by expanding and contracting the chest through a
device that wraps the chest.
This method of ventilation is hardly used nowadays.
26. TYPES OF NIV POSITIVE AIRWAY PRESSURE…
01. Bi-Level Airway pressure (BiPAP)
*** Delivered by mask, not through an airway
*** Similar to CPAP
, but can be set at one pressure for inhalation and another for
exhalation.
*** Used in sleep apnea, but also has been found to be useful in patients with CHF
and respiratory failure to avoid intubation….
02.Continuous positive air way pressure( CPAP)
*** delivered by mask,less expensive,in home with proper training patient can use
***mainly used for COPD, OSA Cases….
27. ADVANTAGES & COMPLICATIONS OF NIV…
Use of noninvasive ventilation offers the following
advantages:
*** Reduces the work pressure on longs
*** Eliminates the need for endotracheal intubation or a tracheotomy,
*** avoiding their complications
*** Reduces the chances of infections
*** Improves the chances of survival
*** Reduces hospital stay
Most complications are mild and happen with long-term use.
These include:
== Ulcers at the attachment of the face mask
== Eye irritation and pain
== Congestion of the nasal sinuses
Other complications include:
*** Bloating of stomach
*** Aspiration (sucking of food into the lung)
*** Hypotension (low blood pressure)
28. NURSISNG RESPONSIBILITIES…
NURSING CARE :
1. Promote respiratory function.
2. Monitor for complications
3. Prevent infections.
4. Provide adequate nutrition.
5. Monitor GI bleeding.
PROMOTE RESPIRATORY FUNCTION:
1. Auscultate lungs frequently to assess for abnormal sounds.
2. Suction as needed.
3. Turn and reposition every 2 hours.
4. Secure ETT properly.
5. Monitor ABG value and pulse oximetry.
b.Suction of an Artificial Airway:
1. To maintain a patent airway
2. To improve gas exchange.
3. To obtain tracheal aspirate specimen.
4. To prevent effect of retained secretions. ( Its important to OXYGENATE
and after suctioning)
29. NURSISNG RESPONSIBILITES
MONITOR FOR COMPLICATIONS :
1. Assess for possible early complications Rapid electrolyte changes. Severe alkalosis.
Hypotension secondary to change in Cardiac output.
2. Monitor for signs of respiratory distress: Restlessness Apprehension Irritability and
increase HR.
3. Assess for signs and symptoms of barotrauma(rupture of the lungs) Increasing
dyspnea Agitation Decrease or absent breath sounds. Tracheal deviation away from
affected side. Decreasing PaO2 level . 1. Assess for cardiovascular depression:
Hypotension Tachy. and Bradycardia Dysrhythmias
PREVENT INFECTION
1.Maintain sterile technique when suctioning.
2. Monitor color, amount and consistency of sputum.
PROVIDE ADEQUATE NUTRITION :
1. Begin tube feeding as soon as it is evident the patient will remain on the ventilator
for a long time.
2. Weigh daily. 3. Monitor I&O .
MONITOR FOR GI BLEEDING:
1. Monitor bowel sounds. 2. Monitor gastric PH and hematest gastric secretions
shift.
30. REFERANCES
***Grossbach, I., Chlan, L., & Tracy, M. F. (2011). Overview of mechanical ventilatory support and
management of patient- and ventilator-related responses. Critical Care Nurse, 31(3), 30–44.
https://doi.org/10.4037/ccn2011595 Hyzy, R. & MsSparron, J. (2020, April 5).
*** Overview of mechanical ventilation. UpToDate. https://www.uptodate.com/contents/overview-
initiating-invasive-mechanical-ventilation-in-adults-in-the-intensive-careunit Hyzy, R. (2019, May
**** Modes of mechanical ventilation. UpToDate. https://www.uptodate.com/contents/modes-
ofmechanical- ventilation
***American Thoracic Society www.thoracic.org/patients
***National Heart Lung & Blood Institutehttps://www.nhlbi.nih.gov/health/health-
**erme, C., & Chandraskekar, R.K. (2008). Managing the patient on mechanical ventilation in ICU:
mobility and walking program. Acute Care Prospectives,Vol 17(1).
*** Sadowsky, H.S. Monitoring and life support equipment. In E.A. Hillegass and H.S. Sadowsky,
Essentials of cardiopulmonary physical therapy. (pp. 509-533). 2001; Philadelphia: Saunders. •
S.P., Goval, M., & Sarani, B. (2009, Jul-Aug).
**Frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a
guide. J Intensive Care Med, 24(4):215-29. Epub 2009 Jul 17.