yosra raziani

1. Outcomes of mechanically ventilated
infants
Yosra Raziani
nursing instructor
yosra.anvar@komar.edu.iq

2. “Saving one life is as if saving whole of humanity”

3. The main indication of mechanical ventilation is in the treatment of neonates with respiratory failure .
with the increase use of Mechanical ventilation its complications have increased too.
Mechanical ventilation in infant is considered as an invasive procedure with complications such as
PIE-pneumothorax- Atelectasis and so on …
The prevalent complication was seen in the neonates was PIE and pneumothorax
complication due to mechanical ventilation in neonates is 32 percent in average.
Nurses have a responsibility to avoid these complications.

4. What is the meaning of Atelectasis?
4

5. The word atelectasis is of Greek
The collapse of the small air sacs (alveoli) in the lungs
Refers to collapse or loss of lung volume
Atelectasis is not a disease. It is the result of a disease or
abnormality in the body.
5

6. What Are the Signs of
Atelectasis?

7. The Signs of Atelectasis
1. A bluish tint to the skin and mucous membranes (cyanosis)
2. Brief pauses in breathing (apnea)
3. Decreased urine output
4. Nasal flaring
5. Rapid breathing
6. Shallow breathing
7. Shortness of breath and grunting sounds while breathing
8. Unusual movements during breathing

8. What Causes Atelectasis in
Newborns?

9. 1. Prematurity
2. Meconium aspiration
3. Breathing problems
4. Pneumonia or other lung infection
5. Lack of surfactant
6. Damage to nerve and muscles
Causes of Atelectasis in Newborns

10. pneumothorax
A collection of air in the pleural space
Occurs during the first few breatht soon after breath
A tipe of pneumothorax that occur in MV Tension

11. The Signs of pneumothorax
4- grunting
clinical signs and symptoms are unreliable and nonspecific, but may raise clinical suspicion
:
1-retractions
2-Tachypnea
3-Prominence of chest bulge on the involved side
5- cyanotic appearance
6- absent or diminished breath sounds on the affected side
7-mediastinal shift to the unaffected side

12. A significant number of pneumothorax can be predicate
But How?

13. Vigilance by expert personnel particularly
Nurses
Is effective for early detection

14. Early gestational age
RDS
High ventilator pressures
And so on
And that is decline the risk factor of pneumothorax

15. PIE
Pulmonary interstitial emphysema
Is a consequence of the overdistension of distal airways
Occurs in the smallest babies with the most immature lungs

16. Medication
Physical Therapy
Respiratory Therapy
Treatment
Treatment will be based on the causes

17. How Is Prevention?

18. • Be careful with small objects around infants.
• Work with your doctor to treat or manage any lung conditions your baby has.
• Take steps to avoid premature birth such as:
o Get regular prenatal care.
o During pregnancy, eat a well-balanced diet with plenty of fruits and vegetables.
o Get adequate activity.
Some medical conditions or treatments increase your baby’s risk of atelectasis. Steps will be taken to prevent
atelectasis such as:
• Medication to improve surfactant in premature babies
• Treating and monitoring lung infections
• Careful management of necessary oxygen or breathing therapy in infants
Prevention

19. Diagnosis

20. Diagnosis
1. Chest X Ray
2. Chest CT scan
3. Bronchoscopy
4. Blood gas analysis
5. Lab tests

21. Nursing care plans

22. Nursing Assessment
Primary pneumothorax (spontaneous) occurs most often
in adolescence. The infant or child with a pneumothorax
might have a sudden or gradual onset of symptoms.
Chest pain might be present as well as signs of respiratory
distress such as tachypnea, retractions, nasal flaring, or
grunting. Assess potential risk factors for acquiring a
pneumothorax, including chest trauma or surgery, intubation
and mechanical ventilation, or a history of chronic
lung disease such as cystic fibrosis. Inspect the child for
a pale or cyanotic appearance. Auscultate for increased
heart rate (tachycardia) and absent or diminished breath
sounds on the affected side. The x-ray reveals air within
the thoracic cavity

23. . Assess the depth of breathing frequency
choose a position that is easy to breathe
Auscultation of breath sounds
. Palpation fremitus
Monitor vital signs and cardiac rhythm.
Supervise / picture series blood gas analysis and pulse
Provide additional humidifier

24. Observation color skin, mucous membranes and nails
Assess the frequency and depth of breathing chest movement

25. Documentation Guidelines
•Physical findings: Breath sounds, vital signs, level of
consciousness, urinary output, skin temperature, amount and color
of chest tube drainage, dyspnea, cyanosis, nasal flaring, altered
chest expansion, tracheal deviation, absence of breath sounds
•Response to pain: Location, description, duration, response to
interventions
•Response to treatment: Chest tube insertion—type and amount
of drainage, presence of air leak, presence or absence of crepitus,
amount of suction, presence of clots, response to fluid
resuscitation; response to surgical management
•Complications: Infection (fever, wound drainage); inadequate gas
exchange (restlessness, dropping SaO2); tension pneumothorax

26. Nursing Management
The child with a pneumothorax requires frequent respiratory
assessments. Pulse oximetry might be used as an adjunct, but
clinical evaluation of respiratory status is most
useful. In some cases, administration of 100% oxygen hastens
the reabsorption of air, but it is generally used only for
a few hours. If a chest tube connected to a water seal or
suction is present, provide care of the drainage apparatus
as appropriate (Fig. 19.12). A pair of hemostats should be
kept at the bedside to clamp the tube should it become
dislodged from the drainage container. The dressing
around the chest tube is occlusive and is not routinely
changed. If the tube becomes dislodged from the child’s
chest, apply Vaseline gauze and an occlusive dressing,
immediately perform appropriate respiratory assessment,
and notify the physician.

27. Ventilator Management
check and control
skin
Chest
movement
ABG

28. Nursing Interventions
1.Apply a dressing over an open chest wound.
2.Administer oxygen as prescribed.
3.Position the client in high fowler’s position.
4.Prepare for chest tube placement until the lung has expanded fully.
5.Monitor chest tube drainage system.
6.Monitor for subcutaneous emphysema.