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TROUBLESHOOTING USING VENTILATOR GRAPHICS.pptx
- 1. TROUBLESHOOTING USING VENTILATOR GRAPHICS Dr.PIYUSH VILAS MALOKAR CONSULTANT PEDIATRIC INTENSIVIST
- 2. Troubleshooting Troubleshooting: identification andresolution of technical issues in the patient-ventilator system, to assist patient’s breathing. Includes – • identification of problem • understanding the cause • taking corrective steps
- 3. ALARM 1) PATIENT’S issues 2)Tubing issues 3)Ventilator issues TROUBLESHOOTING
- 4. Protecting the Patient 1.Ensure adequate ventilation and oxygenation 2. Visually assess the patient 3. Auscultation of the chest 4. Assess the monitors, SpO2, HR, chest xray.etc Disconnect the patient from the ventilator, manually ventilate Check tubings.. ET , ventilator tubings When the patient is safe, review the cause.
- 5. Do not belike this !
- 7. Identifying the Patientin Distress • Asking yes/no questions • Observing the physical signs of respiratory distress • Evaluation of ventilator settings and graphics
- 8. Patient Related Problems •Airway Problems • Pneumothorax • Bronchospasm • Secretions • Pulmonary Edema • Dynamic Hyperinflation • Abnormalities in Respiratory Drive • Change in Body Position • Pulmonary embolism
- 9. Ventilator Related Problems •Leaks • Inadequate oxygenation • Inadequate ventilatory support • Trigger sensitivity • Inadequate flow setting • Auto-PEEP • Increased ventilatory drive
- 10. Case 1 5 year/ male / K/c/o seizure disorder admitted with status epilepticus. Intubated. on PC mode of ventilation, Neurologist ask for MRI brain with contrast. post MRI pt transported back to ICU. Suddenly you heard a high peak pressure alarm. What will you do? Ask sister to silence the alarm Go yourself and silence the alarm Change peak pressure alarm setting Keep let it be ring Sedate the pt Give vecuronium
- 11. You checked theventilator waveform which showed a) Describe the abnormalities displayed in this image b) Give three possible causes for the appearance of the pattern demonstrated by the pressure time curve.
- 12. CASE 2 PT/SGA/ bornby LSCS at 31 weeks of Gestation to a primi mother with gestational diabetes (on insulin). weak cry at birth. Baby was intubated for Respiratory distress . Xray was done showed b/l opacity. 1) Identify abnormality in ventilator graph 2) What probable intervention results in change in pv loop?
- 13. CASE 3 • 8year female / 22 kgs / patient • ventilated with a pressure control mode for respiratory failure. • her arterial oxygen saturation is 97%. • Occasional high pressure alarms a) Describe the abnormalities displayed in this image and likely lung disease for which the patient is being ventilated? b) Give three possible causes for the appearance of the pattern demonstrated by the pressure time curve.
- 14. • Management: Bronchodilatortherapy, adjust ventilator settings What changes (if any) would you make to the ventilator settings?
- 15. CASE 4 12 YEARS/ 32 kgs /MALE / Had Blunt trauma abdomen due to run over of vehicle Operated from liver laceration grade 4 Peritoneal drain in situ , purulent discharge from the drain Developed respiratory complaints since 4 days Intubated .• Bilateral opacities on chest radiograph initial PaO2 / FIO2 (P/F ratio) -200 Iniatial ventilator setting -> PRVC mode/PEEP 6/RR 25/VT 260 •Ppeak 40 After 6 hrs Ventilator showed high pressure alarm And Pressure- Time scalar as below 1) Ventilator graphic suggestive of ? 2) Name the likely underlying pathology ? 3) How Do you Distinguish Between Resistance and Compliance Issue using ventilator graphics ?
- 16. Case 5 • 6yrs / male / high grade fever x 7 days . Family member on AKT. • Intubated for respiratory distress . • Air entry decreased on RT side , dull note on percussion. • Appropriate interventions done. • While monitoring a patient on a ventilator, it was noted that the inspiratory volume is 200ml and the expiratory volume is 125ml. • Having established that a very large leak is present, • The nursing staff checks the ET cuff and the vent circuit and cannot find a leak. • What are possible sources of the leak? • How you addressed the issue
- 17. CASE 6 • 7years male , dignosed as ARDS secondary to community acquired pneumonia . On PC mode – fio2 – 100%, rate – 25, PEEP – 8 , PIP -18. Despite of increasing PEEP from 6 to 8, PICU fellow said that he was not able to come down on FIO2 . • Intensivist advised him that PEEP therapy needs to be adjusted for this patient with severe hypoxemia, by looking at PV loop. • What would be a reasonable PEEP level to set for this patient, assuming all other parameters are stable?
- 18. CASE 7 A BC Above are the FV curve in 3 different neonates , presented with respiratory distress and stridor. Identify likely disease condition in A,B,C. Which of the graph more correlate with expiratory stridor , inspiratory stridor and biphasic stridor ?
- 19. Key Takeaways • Alwaysprioritize patient safety • Use systematic approach to troubleshooting • Utilize ventilator graphics for problem identification • Be familiar with specific ventilator models and their quirks • Regularly review and practice troubleshooting scenarios
- 20.
Editor's Notes
- #6 Familiar picture to everyone when we heard alarm..
- #11 Machine problems: kinked ventilator tubing / ETT Water in the ventilator tubing old waterlogged HME Patient problems biting and chewing on the tube, partial ett Blockage due to mucus plug. bronchospasm (most likely) , due drugs used for sedation. Rarely increased chest wall rigidity, eg. due to massive fentanyl bolus, or hypothermia.
- #15 in ds with low compliance – both peak pr and pplat is increased while in diseases with increased airway resistance only peak pr is increased. Likely ARDS : Consider lung-protective ventilation strategies – ventilate with low tidal volume, optimal pEEP, permissive hypercapnia , limit pplat < 30, driving pr < 15, non toxic FIO2< 0.6 Optimal PEEP –this is peep level that provides , an acceptable saturation (88- 92%),best possible lung compliance,least hemodynamic instability , able to reduce fio2 below toxic level <0.6.
- #16 Likely endotracheal tube cuff leak: Consistent with audible air leak • Check cuff pressure and reinflate: First step in addressing the issue • May need to replace ETT if persistent: Consider if leak continues after reinflation • Monitor for adequate ventilation: Ensure patient is receiving sufficient tidal volume What is likely source of leak? A. ETT cuff B. Circuit connection C. Chest tube D. Humidifier
- #17 PEEP needs to be set above the lower infection point. The goal of PEEP is to restore FRCand recruit collapsed alveoli while avoiding overdistension.
- #18 Observed in babies with intra-thoracic obstruction Limitation in both expiration more than inspiration Seen in ;Aberrant vessel compression , bun shaped FV curve. OBSERVED IN TRACHEOMALACIA , crumpled Observed in babies with extra-thoracic obstruction,Limitation in both inspiration and expiration,Seen in ;Sub-glottic stenosis,Narrow endotracheal tube, cigar shaped